Pediatric ENT Readmissions Rare, but Vary with Procedure Type

What are the frequency and nature of readmissions to freestanding pediatric hospitals after otolaryngologic procedures?

Background: More than 1.3 million pediatric otolaryngology procedures occur each year, including tonsillectomy and tympanostomy tube placement. The high volume of pediatric otolaryngology procedures performed annually means that even a small percentage of readmissions can exact a large cost on the healthcare system. Readmission rates may vary after different types of cases.

Study design: Retrospective analysis of 30-day inpatient readmissions in 424,593 children younger than 18 years old who underwent a total of 493,507 otolaryngology procedures between Jan. 1, 2009, and Dec. 31, 2011.

Setting: Pediatric Health Information Systems database, a national administrative database that includes 44 freestanding pediatric hospitals.

Synopsis: Operative procedures were categorized into eight mutually exclusive groups: tonsillectomy, adenoidectomy, or both (TA); bilateral myringotomy with tube placement (BMT); facial plastics, including cleft surgery (FP); head and neck (HN); laryngeal and airway (LARYNX); rhinologic (SINUS); otologic, excluding BMT (OTO); and general, excluding TA procedures (GEN). TA and BMT groups accounted for 63.6% of surgeries, with a readmission rate of 1.9%. LARYNX had the highest readmission rate, while OTO and BMT had the lowest. The most frequently occurring ICD-9 readmission code was 99811 (postoperative hemorrhage complicating a procedure); of these, almost all occurred after TA. Pulmonary infections and other respiratory problems were the second and third most common readmission reasons. HN and SINUS had the largest number of primary readmitting diagnoses attributed to other reasons. LARYNX had the highest percentage of pulmonary infection and other respiratory disease readmissions. All procedures had a peak incidence of daily readmissions within the first five days after surgery. LARYNX and HN tended to have higher readmission rates throughout the 30 days. Limitations included a lack of deep understanding for individual readmissions, a potential lack of representation of the broader healthcare community, lack of clarity on the Medicare/Medicaid 30-day window relevance, and a potential lack of readmission data from other medical centers.

Bottom line: Readmissions after pediatric otolaryngologic surgery are relatively uncommon. These readmission rates vary directly with the type of procedure performed, as well as patient level factors, including age, ethnicity, and the presence of other medical comorbidities.

Citation: Murray R, Logvinenko T, Roberson D. Frequency and cause of readmissions following pediatric otolaryngologic surgery; Laryngoscope. 2016;126:199-204.