title: Causes, costs, and risk factors for unplanned return visits after adenotonsillectomy in children.
abstract: OBJECTIVE
  To review the causes, costs, and risk factors for unplanned return visits and readmissions after pediatric adenotonsillectomy (T&A).
  
  
  METHODS
  Review of administrative database of outpatient adenotonsillectomy performed at any facility within a vertically integrated health care system in the Intermountain West on children age 1-18 years old between 1998 and 2012. Data reviewed included demographic variables, diagnosis associated with return visit and costs associated with return visits.
  
  
  RESULTS
  Data from 39,906 children aged 1-18 years old were reviewed. A total of 2499 (6.3%) children had unplanned return visits. The most common reasons for return visits were bleeding (2.3%), dehydration, (2.3%) and throat pain (1.2%). After multivariate analysis, the main risk factors for any type of return visits were Medicaid insurance (OR=1.64 95% CI 1.47-1.84), Hispanic race (OR=1.36 95% CI 1.13-1.64), and increased severity of illness (SOI) (OR=11.29 95% CI 2.69-47.4 for SOI=3). The only factor associated with increased odds of requiring an inpatient admission on return visit was length of time spent in PACU (p<0.001). A linear relationship was also observed between the child's age and the risk of post-tonsillectomy hemorrhage.
  
  
  CONCLUSIONS
  Children with increased severity of illness, those insured with Medicaid, and children of Hispanic ethnicity should be targeted with increased education and interventions in order to reduce unplanned visits after T&A. Further studies on post-tonsillectomy complications should include evaluating the effect of surgical technique and post-operative pain management on all complications and not solely post-tonsillectomy hemorrhage.
authors.affiliation: Department of Otolaryngology, McGill University, Montreal, Canada. Electronic address: melanie.duval@mcgill.ca.
authors.forename: Melanie
authors.initials: M
authors.lastname: Duval
authors.affiliation: Intermountain Healthcare, Pediatric Clinical Program, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: Jacob
authors.initials: J
authors.lastname: Wilkes
authors.affiliation: Intermountain Healthcare, Pediatric Clinical Program, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: Kent
authors.initials: K
authors.lastname: Korgenski
authors.affiliation: Intermountain Healthcare, Murray, UT, USA; Division of Pediatric Inpatient Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: Rajendu
authors.initials: R
authors.lastname: Srivastava
authors.affiliation: Division of Otolaryngology, University of Utah, UT, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Meier
mesh_terms: D000233:Adenoidectomy / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*; D000293:Adolescent; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008484:Medicaid; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D014068:Tonsillectomy / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States
keywords: Adenotonsillectomy; Cost; Post-operative complications; Post-tonsillectomy hemorrhage; Tonsillectomy