title: Pediatric Posttonsillectomy Hemorrhage: Demographic and Geographic Variation in Health Care Costs in the United States.
abstract: To examine variations in management of pediatric posttonsillectomy hemorrhage and associated costs from a national third-party payer perspective.
  
  
  
  The MarketScan database was analyzed for claims made for 30 days following tonsillectomy/adenotonsillectomy between 2008 and 2012 for privately insured children aged 1 to 17 years. Costs for management of postoperative hemorrhage by age, sex, and region were calculated in addition to total costs incurred for 30 days postoperatively.
  
  
  
  MarketScan database.
  
  
  
  Database study.
  
  
  
  A total of 305,860 children were included. Overall, 0.3% had a postoperative bleed that required treatment but not surgical intervention or admission for hospitalization; 0.2% had one that required hospitalization; and 0.8% had one that required surgical intervention. The mean 30-day costs were $7660 for postoperative bleed that required surgery or hospitalization, $4580 for outpatient treatment, and $370 for no postoperative bleed. Children between 11 and 17 years old were most likely to have interventions for postoperative bleeding but had the lowest mean costs for them ($7320 for hospital based, $3860 for outpatient). There were regional differences in costs for in-patient management of bleeds, with highest costs in the West, with a mean of $8850, versus the South, with a mean of $7160.
  
  
  
  There are geographic and demographic variations in managing pediatric posttonsillectomy hemorrhage and in the costs associated with management on a national level.
authors.affiliation: Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Harounian
authors.affiliation: Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Schaefer
authors.affiliation: Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA.
authors.forename: Jane
authors.initials: J
authors.lastname: Schubart
authors.affiliation: Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA mcarr@hmc.psu.edu.
authors.forename: Michele M
authors.initials: MM
authors.lastname: Carr
mesh_terms: D000233:Adenoidectomy; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D008297:Male; D019106:Postoperative Hemorrhage / Q000191:economics* / Q000628:therapy*; D014068:Tonsillectomy; D014481:United States
keywords: adenotonsillectomy; health care cost; pediatric surgery; tonsillectomy