title: Surgeon dependent variation in adenotonsillectomy costs in children.
abstract: OBJECTIVE
  To (1) identify the major expenses for same-day adenotonsillectomy (T&A) and the costs for postoperative complication encounters in a children's hospital and (2) compare differences for variations in costs by surgeon.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  Tertiary children's hospital.
  
  
  METHODS
  A standardized activity-based hospital accounting system was used to determine total hospital costs per encounter (not including professional fees for surgeons or anesthetists) for T&A cases at a tertiary children's hospital from 2007 to 2012. Hospital costs were subdivided into categories, including operating room (OR), OR supplies, postanesthesia care unit (PACU), same-day services (SDS), anesthesia, pharmacy, and other. Costs for postoperative complication encounters were included to identify a mean total cost per case per surgeon.
  
  
  RESULTS
  The study cohort included 4824 T&As performed by 14 different surgeons. The mean cost per T&A was $1506 (95% confidence interval, $1492-$1519, with a range of $1156-$1828 for the lowest and highest cost per case per surgeon; P < .01). Including the cost for postoperative complications, the mean cost increased to $1599 ($1570-$1629). The largest cost categories included OR (31.9%), SDS (28.1%), and OR supplies (15.6%).
  
  
  CONCLUSIONS
  A large portion of T&A expenses are due to OR and supply costs. Significant differences in costs between surgeons for outpatient T&A were identified. Studies to understand the reasons for this variation and the impact on outcomes are needed. If this variation does not affect patient outcomes, then reducing this variation may improve health care value by limiting waste.
authors: Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA.
authors: Jeremy D
authors: JD
authors: Meier
authors: Melanie
authors: M
authors: Duval
authors: Jacob
authors: J
authors: Wilkes
authors: Seth
authors: S
authors: Andrews
authors: E Kent
authors: EK
authors: Korgenski
authors: Albert H
authors: AH
authors: Park
authors: Rajendu
authors: R
authors: Srivastava
mesh_terms: D000233:Adenoidectomy / Q000191:economics*; D002648:Child; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000191:economics; D010818:Practice Patterns, Physicians' / Q000191:economics*; D014068:Tonsillectomy / Q000191:economics*; D014589:Utah
keywords: surgeon variation; tonsillectomy costs