Preoperative Predictors and Costs of 30‐Day Readmission Following Inpatient Pediatric Tonsillectomy in the United States

Khoury, Habib; Azar, Shaghauyegh S.; Boutros, Hannah; Shapiro, Nina L.

doi:10.1177/0194599820980709

Cited by 12 publications

(11 citation statements)

References 17 publications

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“…Readmissions are an important metric for quality and safety and are used to benchmark care. The readmission rate in this sample was 5.2%, similar to previous reports 23,24 . Our readmission analysis was limited to multiple logistic regression of variables such as age, sex, and common diagnosis associated with tonsillectomy.…”

Section: Discussionsupporting

confidence: 85%

“…The readmission rate in this sample was 5.2%, similar to previous reports. 23,24 Our readmission analysis was limited to multiple logistic regression of variables such as age, sex, and common diagnosis associated with tonsillectomy. We also included the APR-DRG level of severity, which subsequently was the only measure associated with readmissions.…”

Section: Discussionmentioning

confidence: 99%

“…3,[14][15][16][17][18] The Healthcare Cost and Utilization Project (HCUP), developed by the US Agency for Healthcare Research and Quality, produces a suite of databases that can be used to estimate nationally representative statistics of ambulatory procedures, hospitalizations, and readmissions. [19][20][21] These databases have been used in previous tonsillectomyrelated research 1,9,[22][23][24] and are well suited to provide the informative base rates (demographics, associated conditions, outcomes, and cost) needed to create targeted Q&I initiatives.…”

mentioning

confidence: 99%

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Estimations of Inpatient and Ambulatory Pediatric Tonsillectomy in the United States: A Cross‐sectional Analysis

Johnson

Zhang

Chorney

et al. 2023

Otolaryngol.--head neck surg.

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Objective. To estimate the incidence of inpatient and ambulatory pediatric tonsillectomies in the United States in 2019.Study Design. Cross-sectional analysis.Setting. Healthcare Cost and Utilization Project databases.Methods. We determined national incidences of hospitalbased ambulatory procedures, inpatient admissions, and readmissions among pediatric tonsillectomy patients, ages 0 to 20 years, using the Kids Inpatient Database, Nationwide Ambulatory Surgery Sample, and Nationwide Readmission Database. We described the demographics, commonly associated conditions, complications, and predictors of readmission.Results. An estimated 559,900 ambulatory and 7100 inpatient tonsillectomies were performed in 2019. Among inpatients, the majority were male (59%) and the largest ethnic group was white (37%). Adenotonsillar hypertrophy (ATH), 79%, and obstructive sleep apnea (OSA), 74%, were the most frequent diagnosis and Medicaid (61%) was the most frequent primary payer. The majority of ambulatory tonsillectomy patients were female (52%) and white (65%); ATH, OSA, and Medicaid accounted for 62%, 29%, and 45% of cases, respectively, (all p < .001 when compared to inpatient cases). Common inpatient complications were bleeding (2%), pain/nausea/ vomiting (5.6%), and postprocedural respiratory failure (1.7%). On the other hand, ambulatory complications occurred in less than 1% of patients. The readmission rate was 5.2%, with pain/nausea/vomiting and bleeding accounting for 35% and 23% of overall readmissions. All Patient Refined Diagnosis Related Groups severity of illness subclass predicted readmission (odds ratio = 2.18, 95% confidence interval = 1.73-2.73, p < .001). Conclusion.A total of 567,000 pediatric ambulatory and inpatient tonsillectomies were performed in 2019; the majority were performed in ambulatory settings. The index admission severity of illness was associated with readmission risk.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Estimations of Inpatient and Ambulatory Pediatric Tonsillectomy in the United States: A Cross‐sectional Analysis

Johnson

Zhang

Chorney

et al. 2023

Otolaryngol.--head neck surg.

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“…37,38 Older children and adolescents who tend to maintain hydration status well enough to prevent gross signs of dehydration may have relative dehydration, hence more secondary bleeding than younger children who present earlier with dehydration. [39][40][41] Conversely, the tonsil bleed rate may be associated with the larger feeding vessels and surface area in adolescents, making hemostasis less likely if bleeding oc-curs. Regardless, this and other data show that increasing age has been associated with more revisits for tonsil bleeding; therefore, any evaluation of tonsillectomy bleeding rates should consider patient age.…”

Section: Discussionmentioning

confidence: 99%

“…A relatively dry oropharynx (from inadequate hydration) can compound the propensity for bleeding . Older children and adolescents who tend to maintain hydration status well enough to prevent gross signs of dehydration may have relative dehydration, hence more secondary bleeding than younger children who present earlier with dehydration . Conversely, the tonsil bleed rate may be associated with the larger feeding vessels and surface area in adolescents, making hemostasis less likely if bleeding occurs.…”

Section: Discussionmentioning

confidence: 99%

Estimated Probability Distribution of Bleeding After Pediatric Tonsillectomy

Johnson

Beams

Zaniletti

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceThe American Academy of Otolaryngology–Head and Neck Surgery Foundation has recommended yearly surgeon self-monitoring of posttonsillectomy bleeding rates. However, the predicted distribution of rates to guide this monitoring remain unexplored.ObjectiveTo use a national cohort of children to estimate the probability of bleeding after pediatric tonsillectomy to guide surgeons in self-monitoring of this event.Design, Settings, and ParticipantsThis retrospective cohort study used data from the Pediatric Health Information System for all pediatric (&lt;18 years old) patients who underwent tonsillectomy with or without adenoidectomy in a children’s hospital in the US from January 1, 2016, through August 31, 2021, and were discharged home. Predicted probabilities of return visits for bleeding within 30 days were calculated to estimate quantiles for bleeding rates. A secondary analysis included logistic regression of bleeding risk by demographic characteristics and associated conditions. Data analyses were conducted from August 7, 2022 to January 28, 2023.Main Outcomes and MeasuresRevisits to the emergency department or hospital (inpatient/observation) for bleeding (primary/secondary diagnosis) within 30 days after index discharge after tonsillectomy.ResultsOf the 96 415 children (mean [SD] age, 5.3 [3.9] years; 41 284 [42.8%] female; 46 954 [48.7%] non-Hispanic White individuals) who had undergone tonsillectomy, 2100 (2.18%) returned to the emergency department or hospital with postoperative bleeding. The predicted 5th, 50th, and 95th quantiles for bleeding were 1.17%, 1.97%, and 4.75%, respectively. Variables associated with bleeding after tonsillectomy were Hispanic ethnicity (OR, 1.19; 99% CI, 1.01-1.40), very high residential Opportunity Index (OR, 1.28; 99% CI, 1.05-1.56), gastrointestinal disease (OR, 1.33; 99% CI, 1.01-1.77), obstructive sleep apnea (OR, 0.85; 99% CI, 0.75-0.96), obesity (OR,1.24; 99% CI, 1.04-1.48), and being more than 12 years old (OR, 2.48; 99% CI, 2.12-2.91). The adjusted 99th percentile for bleeding after tonsillectomy was approximately 6.39%.Conclusions and RelevanceThis retrospective national cohort study predicted 50th and 95th percentiles for posttonsillectomy bleeding of 1.97% and 4.75%. This probability model may be a useful tool for future quality initiatives and surgeons who are self-monitoring bleeding rates after pediatric tonsillectomy.

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Associations Between Social Vulnerability Indicators and Pediatric Tonsillectomy Outcomes

Nieri,

Davies,

Luttrell

et al. 2023

The Laryngoscope

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ObjectiveTo investigate the impact of neighborhood‐level social vulnerability on pediatric tonsillectomy outcomes.MethodsThis single‐center retrospective cohort study included tonsillectomies performed on children aged 1 to 18 between August 2019 and August 2020. Geographic information systems were used to geocode addresses, and spatial overlays were used to assign census‐tract level social vulnerability index (SVI) scores to each patient. For categorical variables, two‐sided Pearson chi‐square tests were used, whereas for continuous variables, paired t‐tests, means, and standard deviations were calculated. SVI and its four subthemes were investigated using binomial logistic regressions to determine their impact on post‐T&A complications and readmissions.ResultsThe study included 397 patients, with 52 having complications (13.1%) and 33 (8.3%) requiring readmissions due to their complications. Controlling for age, gender, race, insurance status, surgical indication, comorbidities, obesity, and obstructive sleep apnea, postoperative complications were associated with high overall SVI (odds ratio [OR] 5.086, 95% confidence interval [CI] 1.128–22.938), high socioeconomic vulnerability (SVI theme 1, OR 6.003, 95% CI 1.270–28.385), and high house composition vulnerability (SVI theme 2, OR 6.340, 95% CI 1.275–31.525). Readmissions were also associated with high overall SVI (10.149, 95% CI 1.293–79.647) and high housing/transportation vulnerability (SVI theme 4, OR 5.657, 95% CI 1.089–29.396).ConclusionSocial vulnerability at the neighborhood level is linked to poorer surgical outcomes in otherwise healthy children, suggesting a target for community‐based interventions. Because of the increased risk, it may have implications for preoperative decision‐making, treatment plans, and clinic follow‐ups.Level of evidenceIII. Laryngoscope, 2023

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Preoperative Predictors and Costs of 30‐Day Readmission Following Inpatient Pediatric Tonsillectomy in the United States

Cited by 12 publications

References 17 publications

Estimations of Inpatient and Ambulatory Pediatric Tonsillectomy in the United States: A Cross‐sectional Analysis

Estimations of Inpatient and Ambulatory Pediatric Tonsillectomy in the United States: A Cross‐sectional Analysis

Estimated Probability Distribution of Bleeding After Pediatric Tonsillectomy

Associations Between Social Vulnerability Indicators and Pediatric Tonsillectomy Outcomes

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