title: Factors contributing to cost in partial versus total tonsillectomy.
abstract: OBJECTIVE
  To examine differences between total tonsillectomy and partial intracapsular tonsillectomy techniques that may lead to differences in overall cost and resource utilization between these procedures. Preoperative, perioperative, and postoperative management and outcome factors were examined.
  
  
  METHODS
  Retrospective review at two university-based tertiary care hospitals from January 2007 to June 2010.
  
  
  METHODS
  Pediatric patients with obstructive symptoms were divided into those undergoing total tonsillectomy and those undergoing partial intracapsular tonsillectomy. The records of 289 patients who underwent total tonsillectomy and 289 patients who underwent partial intracapsular tonsillectomy were reviewed.
  
  
  RESULTS
  The average age of patients undergoing total and partial tonsillectomies was 5.0 years for both groups. Significant differences for patients undergoing total versus partial tonsillectomies were as follows: operative time (32.4 vs. 26.4 minutes, P < .0001), postanesthesia care unit (PACU) time (174 vs. 91.6 minutes, P < .0001), percent admitted postoperatively (21.5% vs. 1.7%, P < .0001), number requiring pediatric intensive care unit stay (3.5% vs. 0.3%, P < .05), number of readmissions after discharge (3.5% vs. 0.3%, P < .05), and number of postoperative emergency room visits separate from those requiring readmission (4.8% vs. 0%, P < .05). Factors that were not found to be significantly different included number of patients with postoperative hemorrhage and number requiring second operations for tonsillar regrowth.
  
  
  CONCLUSIONS
  Previous studies have shown equivalent effectiveness between these two procedures; our study suggests decreased cost and resource utilization with partial tonsillectomy through reduced operative and PACU times and number of postoperative admissions and emergency department visits. As in all retrospective reviews, the findings are potentially confounded by unmeasured variables, including patient and demographic factors.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, New York, U.S.A.; Department of Otolaryngology-Head and Neck Surgery, Columbia University Medical Center, New York, New York, U.S.A.
authors.forename: Emily Z
authors.initials: EZ
authors.lastname: Stucken
authors.forename: Eli
authors.initials: E
authors.lastname: Grunstein
authors.forename: Joseph
authors.initials: J
authors.lastname: Haddad
authors.forename: Vikash K
authors.initials: VK
authors.lastname: Modi
authors.forename: Erik H
authors.initials: EH
authors.lastname: Waldman
authors.forename: Robert F
authors.initials: RF
authors.lastname: Ward
authors.forename: Michael G
authors.initials: MG
authors.lastname: Stewart
authors.forename: Max M
authors.initials: MM
authors.lastname: April
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019990:Perioperative Care; D012189:Retrospective Studies; D014068:Tonsillectomy / Q000191:economics* / Q000379:methods*
keywords: Total tonsillectomy; complete tonsillectomy; cost analysis; obstructive sleep apnea; partial intracapsular tonsillectomy; sleep disordered breathing