title: Variation in pediatric outpatient adenotonsillectomy costs in a multihospital network.
abstract: OBJECTIVE
  Identify hospital costs for same-day pediatric adenotonsillectomy (T&A) surgery, and evaluate surgeon, hospital, and patient factors influencing variation in costs, and compare relationship of costs to complications for T&A.
  
  
  METHODS
  Observational retrospective cohort study.
  
  
  METHODS
  A multihospital network's standardized activity-based accounting system was used to determine hospital costs per T&A from 1998 to 2012. Children 1 to 18 years old who underwent same-day T&A surgery were included. Subjects with additional procedures were excluded. Mixed effects analyses were performed to identify variation in mean costs due to surgeon, hospital, and patient factors. Surgeons' mean cost/case was related to subsequent complications, defined as any unplanned visit within 21 days in the healthcare system.
  
  
  RESULTS
  The study cohort included 26,626 T&As performed by 66 surgeons at 18 hospitals. Mean cost per T&A was $1,355 ± $505. Mixed effects analysis using patient factors as fixed effects and surgeon and hospital as a random effect identified significant variation in mean costs per surgeon, with 95% of surgeons having a mean cost/case between 67% and 150% of the overall mean (range, $874-$2,232/case). Similar variability was found among hospitals, with 95% of the facilities having mean costs between 64% to 156% of the mean (range, $1,029-$2,385/case). Severity of illness and several other patient factors exhibited small but statistically significant associations with cost. Surgeons' mean cost/case was moderately associated with an increased complication rate.
  
  
  CONCLUSIONS
  Significant variation in same-day pediatric T&A surgery costs exists among different surgeons and hospitals within a multihospital network. Reducing variation in costs while maintaining outcomes may improve healthcare value and eliminate waste.
  
  
  METHODS
  4.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery , Intermountain Healthcare, Salt Lake City, Utah, U.S.A.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Meier
authors.forename: Yingying
authors.initials: Y
authors.lastname: Zhang
authors.forename: Tom H
authors.initials: TH
authors.lastname: Greene
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Curtis
authors.forename: Rajendu
authors.initials: R
authors.lastname: Srivastava
mesh_terms: D000233:Adenoidectomy / Q000191:economics*; D000293:Adolescent; D000556:Ambulatory Surgical Procedures / Q000191:economics*; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000191:economics*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D014068:Tonsillectomy / Q000191:economics*
keywords: Pediatric tonsillectomy costs; complications; variation