Causes and costs for ED visits after pediatric adenotonsillectomy.
OBJECTIVE
(1) Review the reasons, timing, and costs for children presenting to the emergency department (ED) after adenotonsillectomy (T&A).


METHODS
Case series with chart review.


METHODS
Tertiary care children's hospital.


METHODS
A standardized activity-based hospital accounting system was used to identify 437 children from an academic pediatric otolaryngology practice presenting to the ED after T&A from 2009 to 2012. The reason for presentation, timing after surgery, and facility costs were recorded.


RESULTS
The study cohort represented 13.3% of the 3198 patients who underwent T&A during that time period. Overall, 133 (4.2%) presented for dehydration, 106 (3.3%) presented for post-tonsillectomy hemorrhage, 65 (2.0%) for poorly controlled pain, 42 (1.3%) for fever, 29 (1.0%) for vomiting/nausea/GI discomfort, 22 (0.7%) for respiratory complications, and 12 (0.4%) for miscellaneous reasons related to the operation; 28 (0.8%) were unrelated to the T&A and excluded. Mean postoperative day at the time of ED presentation was 4.4 (95% CI, 4.1-4.7). The mean cost per patient presenting to the ED was $1420 (95% CI, $1104-$1737), the most costly subgroups being those presenting with respiratory complications ($2855; 95% CI, $1434-$4277), hemorrhage ($1502; 95% CI, $1216-$1787), and dehydration ($1372; 95% CI, $995-$1750). The least costly subgroup was acute postoperative pain ($781; 95% CI, $282-$1200).


CONCLUSIONS
A significant portion of children present to the ED after T&A for poorly controlled pain, dehydration, or fever. The costs from these visits are significant. Accounting for these costs in the global care for pediatric T&A could assist in calculating appropriate reimbursement for bundled payments in this climate of health care reform.
University of Utah School of Medicine, Salt Lake City, Utah, USA.
Jonathan L
JL
Curtis
Division of Otolaryngology, University of Utah School of Medicine, Salt Lake City, Utah, USA.
D Brandon
DB
Harvey
University of Utah School of Medicine, Salt Lake City, Utah, USA.
Scott
S
Willie
University of Utah School of Medicine, Salt Lake City, Utah, USA.
Evan
E
Narasimhan
Primary Children's Hospital, Intermountain Healthcare Inc, Salt Lake City, Utah, USA.
Seth
S
Andrews
Intermountain Healthcare, Surgical Services Clinical Program, Salt Lake City, Utah, USA.
Jake
J
Henrichsen
Division of Otolaryngology, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Nicholas C
NC
Van Buren
Primary Children's Hospital, Intermountain Healthcare Inc, Salt Lake City, Utah, USA Division of Pediatric Inpatient Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA Institute for Health Care Delivery Research, Intermountain Healthcare Inc, Salt Lake City, Utah, USA.
Rajendu
R
Srivastava
Division of Otolaryngology, University of Utah School of Medicine, Salt Lake City, Utah, USA jeremy.meier@imail.org.
Jeremy D
JD
Meier
D000233:Adenoidectomy / Q000009:adverse effects / Q000191:economics; D003365:Costs and Cost Analysis; D004636:Emergency Service, Hospital / Q000191:economics*; D006801:Humans; D010149:Postoperative Pain / Q000453:epidemiology; D011183:Postoperative Complications / Q000191:economics* / Q000453:epidemiology; D011184:Postoperative Period; D014068:Tonsillectomy / Q000009:adverse effects / Q000191:economics
emergency department; pediatric adenotonsillectomy