Acute care revisits after adenotonsillectomy in a pediatric Medicaid population in Ohio.
BACKGROUND
Guidelines for inpatient admission after pediatric tonsillectomy have been proposed to improve the safety of this procedure. This study examined the association between performing adenotonsillectomy in an inpatient setting and acute care revisits within 30 days among children enrolled in a Medicaid Accountable Care Organization in Ohio.


METHODS
The Accountable Care Organization's claims database was queried for adenotonsillectomies performed in children ages 0-18 years in 2008-2014. Procedures associated with an inpatient facility stay were classified as inpatient adenotonsillectomies. The primary outcome was emergency department visit or inpatient re-admission within 30 days. Secondary outcomes were revisits within 7 days and >7 days post-discharge. Logistic regression was used to test for association between inpatient procedure and need for revisits.


RESULTS
Adenotonsillectomies in 8835 girls and 7773 boys (age 6.8 ± 3.8 years) were analyzed, of which 842 (5%) were inpatient procedures. Revisits were required in 2511 (15%) cases and were primarily visits to the emergency department. In multivariable analysis, inpatient and outpatient procedures had comparable need for 30-day revisits (OR = 0.85; 95% CI: 0.69, 1.05; p = 0.124). In sub-analyses, inpatient adenotonsillectomy was associated with lower odds of early (≤7 days post-discharge; OR = 0.76; 95% CI: 0.58, 0.99; p = 0.045) but not later (≥8 days) revisits.


CONCLUSIONS
In a pediatric Medicaid population, inpatient adenotonsillectomy was not associated with greater odds of acute care revisits, compared to outpatient procedures. Appropriate risk stratification of children undergoing adenotonsillectomy can reduce the need for early acute care revisits by scheduling high-risk patients for prolonged observation.
Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA. Electronic address: Dmitry.Tumin@nationwidechildrens.org.
Dmitry
D
Tumin
Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
Hina
H
Walia
Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
Vidya T
VT
Raman
Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Department of Anesthesiology & Pain Medicine, The Ohio State University, Columbus, OH, USA.
Joseph D
JD
Tobias
D000233:Adenoidectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D000293:Adolescent; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D009820:Ohio; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D014068:Tonsillectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D014481:United States
Inpatient; Readmission; Surgery; Tonsillectomy