title: Resource analysis of tonsillectomy in children.
abstract: OBJECTIVE
  To analyze variables that affect time and cost parameters of pediatric adenotonsillectomy.
  
  
  METHODS
  Longitudinal 7-month retrospective review of sequential tonsil and adenoid surgery at a university pediatric tertiary care hospital.
  
  
  METHODS
  All children aged 2 to 12 years who underwent adenotonsillectomy from May 2008 to October 2008 had charts and billing records analyzed for variations in charges and times of adenotonsillectomy according to patient age, body mass index for age (BMIFA), American Society of Anesthesiologists (ASA) status, surgical indication, technology used, and teaching status of case. A total of 214 children had records reviewed.
  
  
  RESULTS
  Statistically significant variations were observed for all measured parameters except for indications for surgery. Children 3 years and younger had shorter procedures (P = .005) and total operating room times (P = .037). Charges for supplies were lower for ASA 1 patients than for ASA 2 patients (P = .010). Obese children with elevated BMIFA required longer procedures (P = .039) and more expensive surgery (P = .003). Procedure times were shorter for Coblation (ArthroCare, Austin, TX) compared with electrocautery (P = .27) and for microdebrider compared with electrocautery (P < .001). Charges for Coblation were substantially higher (P < .001). Teaching cases took longer (P < .001).
  
  
  CONCLUSIONS
  Charges and times for adenotonsillectomy surgery varied by patient age, BMIFA, ASA status, tonsillectomy technique, and teaching case status. Clinically salient differences were noted for ASA status, BMIFA, and surgical technique. This method of cost analysis provides useful information for resource management in tonsillectomy.
authors.affiliation: Department of Otolaryngology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, U.S.A.; Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A; Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Udayan K
authors.initials: UK
authors.lastname: Shah
authors.forename: Zachary
authors.initials: Z
authors.lastname: Theroux
authors.forename: Gopi B
authors.initials: GB
authors.lastname: Shah
authors.forename: William J
authors.initials: WJ
authors.lastname: Parkes
authors.forename: Christine
authors.initials: C
authors.lastname: Schuck
mesh_terms: D000233:Adenoidectomy / Q000191:economics / Q000379:methods*; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D005260:Female; D017722:Hospital Charges; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D009765:Obesity / Q000150:complications; D061646:Operative Time; D011183:Postoperative Complications; D012189:Retrospective Studies; D014068:Tonsillectomy / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome
keywords: Cost containment; medical economics; sleep apnea; tonsillitis