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Published on: December 6, 2016
Adenotonsillectomy in children with obstructive sleep apnea syndrome reduces health care utilization
Ariel Tarasiuk1, Tzahit Simon, Asher Tal
1Sleep-Wake Disorders Unit, Soroka University Medical Center, and Department of Physiology, Beer-Sheva, Israel. arieltarasiuk@yahoo.com
Insights
Adenotonsillectomy (T&A) significantly reduces healthcare utilization in children with obstructive sleep apnea syndrome (OSAS). Untreated children with OSAS continue to consume high healthcare resources, indicating T&A
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Health Services Research
Background:
- Obstructive sleep apnea syndrome (OSAS) in children is associated with significant healthcare utilization.
- The impact of adenotonsillectomy (T&A) on long-term healthcare resource consumption in pediatric OSAS requires further investigation.
Purpose of the Study:
- To evaluate healthcare utilization in children with OSAS one year after undergoing T&A.
- To compare healthcare resource use between children with OSAS who had T&A, those with OSAS who did not have surgery, and a control group.
Main Methods:
- A prospective, case-controlled study involving three groups of children: OSAS with T&A (n=130), OSAS without T&A (n=90), and matched controls (n=520).
- OSAS diagnosis was confirmed by polysomnography.
- Healthcare utilization was analyzed for one year before and one year after T&A, including emergency department visits, hospitalizations, consultations, and medication costs.
Main Results:
- Children with OSAS who underwent T&A experienced a one-third reduction in total annual healthcare costs.
- T&A was associated with significant decreases in new admissions (60%), emergency visits (39%), consultations (47%), and drug costs (22%).
- Untreated children with OSAS and the control group showed no significant changes in healthcare utilization.
Conclusions:
- T&A is an effective intervention for reducing healthcare utilization in children diagnosed with OSAS.
- Children with moderate to severe OSAS who do not receive surgical treatment continue to incur high healthcare costs.
- Upper respiratory tract infections are a primary driver of morbidity in children with OSAS.
Objective:
To investigate health care utilization of children with obstructive sleep apnea syndrome (OSAS) 1 year after adenotonsillectomy (T&A).
Methods:
A longitudinal, case-controlled, prospective study was conducted at Clalit Health Care Services (CHS), a health maintenance organization in the southern region of Israel. We defined 3 groups of children: 1) children who had OSAS and were treated with T&A (n = 130); 2) children who had OSAS and did not undergo surgery (n = 90); and 3) control subjects who were matched by age, sex, and area of residency (n = 520) and randomly selected from the CHS database. OSAS was verified with polysomnography studies in all patients. Indices of health care utilization were analyzed 1 year before and 1 year after T&A. Medical records in the emergency department and during hospitalization were reviewed for diagnosis before the polysomnography diagnosis.
Results:
Mean age of all children with OSAS was 5.6 +/- 3.6 years. Total annual health care costs were reduced by one third in children who underwent T&A, whereas there was no change in the control and untreated OSAS groups. T&A was associated with a 60% reduction in the number of new admissions, 39% reduction in emergency department visits, 47% reduction in the number of consultations, and 22% reduction in costs for prescribed drugs. In group 2, the total costs were similar in years 1 and 2.
Conclusions:
T&A significantly reduces health care utilization in children with OSAS. Untreated children with moderate and severe OSAS will continue to consume high levels of health care resources. Increased morbidity among children with OSAS is mainly related to upper respiratory tract infections.
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