title: Pediatric adenotonsillectomy and postoperative hemorrhage: Demographic and geographic variation in the US.
abstract: OBJECTIVE
  To examine demographic and regional variations in pediatric tonsillectomy, with or without adenoidectomy, and post-tonsillectomy hemorrhage on a national level.
  
  
  METHODS
  The MarketScan(®) database was analyzed for claims made between 2008-2012 for the 30 days following tonsillectomy/adenotonsillectomy in privately insured children 1-17 years of age.
  
  
  RESULTS
  We analyzed 305,860 patients with 98.6% of these tonsillectomies occurring in an ambulatory setting. Children between 3-6 years old comprised our largest group of tonsillectomies (45.1%). More tonsillectomies were done in the South (42.1%) than any other region in our sample. Patients between 11 and17 years old had the highest percentage of bleeding (4.8%). Patients between 1 and 3 years old had the lowest values. Of the 8,518 children who presented with post-operative hemorrhage, 71.7% had only one hemorrhagic event, 28.3% had at least a second one, 6.0% had at least 3 events, and 1.3% had at least 4 events. Post-operative dehydration had a similar pattern. The South had the lowest percentage of post-tonsillectomy bleeds (2.5%) and overall ER visits (7.1%), both of which were most common in the Midwest. Gender had no significant association with incidence of tonsillectomy procedures or post-op complications.
  
  
  CONCLUSIONS
  There are geographic and demographic variations in adenotonsillectomy and in post-operative complications for children nationally.
authors.affiliation: Department of Surgery, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA. Electronic address: jharounian@hmc.psu.edu.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Harounian
authors.affiliation: Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA. Electronic address: eschaefe@phs.psu.edu.
authors.forename: Eric
authors.initials: E
authors.lastname: Schaefer
authors.affiliation: Department of Surgery, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA; Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA. Electronic address: jschubart@hmc.psu.edu.
authors.forename: Jane
authors.initials: J
authors.lastname: Schubart
authors.affiliation: Department of Surgery, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA 17033-0850, USA. Electronic address: mcarr@psu.edu.
authors.forename: Michele M
authors.initials: MM
authors.lastname: Carr
mesh_terms: D000233:Adenoidectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D003681:Dehydration / Q000209:etiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019106:Postoperative Hemorrhage / Q000209:etiology*; D011184:Postoperative Period; D012008:Recurrence; D014068:Tonsillectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D014481:United States
keywords: adenotonsillectomy; epidemiology database; hemorrhage; pediatric surgery; tonsillectomy