title: Variation in inpatient tonsillectomy costs within and between US hospitals attributable to postoperative complications.
abstract: BACKGROUND
  Tonsillectomy is the second most common inpatient procedure in US children. However, the factors that influence tonsillectomy-related costs are unknown.
  
  
  OBJECTIVE
  The objective of the study was to describe variation in US inpatient tonsillectomy costs and examine whether postoperative complications contribute to these disparities in costs.
  
  
  METHODS
  This is a retrospective cohort study of the 2009 Nationwide Inpatient Sample. Hierarchical, mixed-effects linear regression modeling was used to analyze the association between postoperative complications and cost, controlling for clinically relevant characteristics such as age, number of chronic comorbidity indicators, and hospital mean complication rates. We also estimated the variance in cost attributable to the treating hospital using the intraclass correlation coefficient.
  
  
  METHODS
  The study cohort comprised 12,512 adult and pediatric patients undergoing tonsillectomy or adenotonsillectomy in the inpatient setting.
  
  
  METHODS
  Cost, posttonsillectomy hemorrhage, and mechanical ventilator use at the individual encounter and at hospital level were evaluated.
  
  
  RESULTS
  The aggregate cost of tonsillectomies in the cohort was $94.2 million. The median cost per encounter across all hospitals was $4393 (interquartile range, $3279-$6981), whereas the mean cost was $7525 (95% confidence interval, $6453-$8597). Mechanical ventilation was associated with an adjusted increase of $30,081 per encounter (95% confidence interval, $18,199-$41,964). The intraclass correlation coefficient declined from 0.117 to 0.070 after adjusting for mean hospital mechanical ventilation rate, which accounted for 40.2% of the interhospital variation in cost.
  
  
  CONCLUSIONS
  Use of mechanical ventilation significantly increases the cost of inpatient tonsillectomy care. Further research should examine risk factors contributing to higher rates of mechanical ventilation after tonsillectomy, which in turn can guide systemic quality improvement interventions to reduce costs.
authors: *Robert Wood Johnson Foundation †Department of Otolaryngology-Head and Neck Surgery, University of Michigan ‡VA Center for Clinical Management Research, Ann Arbor VA Healthcare System Departments of §Pediatrics and Communicable Diseases ∥Surgery, Section of Plastic Surgery ¶Internal Medicine #Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, MI.
authors: Gordon H
authors: GH
authors: Sun
authors: Katherine A
authors: KA
authors: Auger
authors: Oluseyi
authors: O
authors: Aliu
authors: Stephen W
authors: SW
authors: Patrick
authors: Sonya
authors: S
authors: DeMonner
authors: Matthew M
authors: MM
authors: Davis
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003365:Costs and Cost Analysis; D005260:Female; D006302:Health Services Research; D006801:Humans; D007223:Infant; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics*; D019106:Postoperative Hemorrhage / Q000191:economics / Q000209:etiology; D012121:Respiration, Artificial / Q000191:economics; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D014068:Tonsillectomy / Q000009:adverse effects* / Q000191:economics*; D014481:United States; D055815:Young Adult