Hospital Type Affects Cost, Outcome of Tonsillectomies in Kids

Tonsillectomies performed in kids at children’s teaching hospitals (CTHs) have a significantly higher cost, are more likely to involve complications, and result in more comorbidities than when performed at other types of hospitals.

This is the finding of a cross-sectional study published in Otolaryngology Head and Neck Surgery that looked at whether hospital type was associated with differences in total cost and outcomes for inpatient tonsillectomy.

Using data from the Kids’ Inpatient Database for 2006, 2009, and 2012, investigators gathered data on an estimated 40,591 inpatient tonsillectomies performed during those years on children younger than 18 years of age.

When performed at a CTH, the total cost of the tonsillectomy was $9423.34 compared with $6250.78 and $5905.10 at a non-children’s teaching hospital (NCTH) or nonteaching hospital (NTH), respectively. Length of stay was also significantly higher at a CTH compared with an NCTH or NTH (2.8 versus 2.11 and 2.08 days, respectively).

Children undergoing a tonsillectomy at a CTH were at higher odds of having a complication and were significantly more likely to have comorbidities when compared with children undergoing the procedure at an NCTH.

Lead author of the study, Nikhila Raol, MD, a fellow in the Center for Surgery and Public Health at Brigham and Women’s Hospital in Boston, said that she and her colleagues did not know the reason for the differences among hospital types but suggested that it may be due to sicker children being admitted to children’s hospitals or, in part, may be due to patient or facility factors.

“We need to find out what it is about each different hospital type that makes them cost different amounts for the same procedure,” she said. “We as surgeons need to improve adherence to current guidelines regarding admission after tonsillectomy and work to refine these guidelines to identify children who would benefit from more tertiary care.”