title: Outpatient tonsillectomy in children: demographic and geographic variation in the United States, 2006.
abstract: OBJECTIVE
  To examine geographic and demographic variation for outpatient tonsillectomy in children nationally.
  
  
  METHODS
  The 2006 National Survey of Ambulatory Surgery was analyzed to describe outpatient tonsillectomy in children. Rates by age, sex, region, urban/rural residence, and payment source were calculated with 2006 population estimates from the Census Bureau and the National Health Interview Survey as denominators. Rates were compared with Z tests.
  
  
  RESULTS
  In 2006, approximately 583 000 (95% CI, 370 000-796 000) outpatient tonsillectomy procedures were performed in children in the United States. Rates per 10 000 children were lower in children 13 to 17 years old (33.8 per 10 000) than in both children 7 to 12 years old (91.3; P < .05) and children 0 to 6 years old (102.9; P < .001). Compared with the South, tonsillectomy rates were lower in the West (29 per 10 000 versus 125 per 10 000; P < .01) and not significantly different in other regions. Compared with large central metropolitan areas, tonsillectomy rates were higher in small/medium metropolitan areas (118 per 10 000 versus 42 per 10 000; P < .05), and not significantly different in large fringe or non-metropolitan areas. Tonsillectomy rates were similar for children insured by Medicaid compared with those insured by private sources. Compared with older children (13-17 years), children in the younger age groups (0-6 years, 7-12 years) underwent tonsillectomy more commonly for airway obstruction (69.5% and 59.2% versus 34.3%, P < .05 for both). Compared with older children, younger children (0-6 years) underwent tonsillectomy less commonly for infection (40.4% versus 61.0% [7-12 years] and 72.2% [13-17 years], P < .001 for both).
  
  
  CONCLUSIONS
  Use of tonsillectomy in the ambulatory setting varies across age groups, geographic regions, levels of urbanization, and indication. Further research is warranted to examine these differences.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. erudnic2@jhmi.edu
authors.forename: Emily F
authors.initials: EF
authors.lastname: Boss
authors.forename: Jill A
authors.initials: JA
authors.lastname: Marsteller
authors.forename: Alan E
authors.initials: AE
authors.lastname: Simon
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000556:Ambulatory Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D003710:Demography; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D015994:Incidence; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D010045:Outpatients / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011787:Quality of Health Care; D012189:Retrospective Studies; D012424:Rural Population; D017678:Sex Distribution; D014068:Tonsillectomy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States; D014505:Urban Population