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Patterns of Hospital Use and Regionalization of Inpatient Pediatric Adenotonsillectomy
Sophie Shay1, Nina L Shapiro1, Neil Bhattacharyya2
1Department of Head and Neck Surgery, David Geffen School of Medicine, University of California-Los Angeles.
Insights
Pediatric adenotonsillectomy care is increasingly centralized in academic hospitals. This trend is accompanied by a rise in Medicaid patients undergoing these procedures in teaching hospitals.
Area of Science:
- Health Services Research
- Pediatric Otolaryngology
- Health Economics
Background:
- Pediatric adenotonsillectomy is a common surgical procedure in the US.
- Previous research has focused on surgical techniques rather than care distribution patterns.
- Understanding shifts in care delivery is crucial for financial and educational planning.
Purpose of the Study:
- To investigate the regionalization of inpatient pediatric adenotonsillectomy over a decade.
- To analyze changes in care distribution based on hospital teaching status and primary payer.
Main Methods:
- Secondary analysis of Nationwide Inpatient Sample data for pediatric adenotonsillectomy admissions in 2000, 2005, and 2010.
- Comparison of percentage distributions of procedures by hospital teaching status and primary payer over time.
- Multivariate logistic regression to identify temporal changes, controlling for hospital characteristics.
Main Results:
- A significant increase in the proportion of pediatric adenotonsillectomies performed in academic hospitals (60.1% to 78.6%).
- A notable shift in primary payers for inpatient tonsillectomies in teaching hospitals, with Medicaid increasing (38.4% to 50.5%) and private insurance decreasing (57.7% to 43.9%).
Conclusions:
- Inpatient pediatric adenotonsillectomy care is becoming more regionalized to academic/teaching hospitals.
- The proportion of Medicaid patients undergoing these procedures in teaching hospitals has significantly increased.
- These shifts have substantial implications for healthcare reimbursement and the overall distribution of pediatric surgical care.
Importance:
Pediatric adenotonsillectomy is one of the most frequently performed procedures in the United States. Whereas several studies have focused on tonsillectomy techniques and outcomes, little is known about the overall changes in the distribution of care. Variations in care patterns between academic and nonacademic settings may have important financial and educational effects.
Objective:
To determine whether regionalization of inpatient pediatric adenotonsillectomy has occurred over the past decade with respect to hospital teaching status and primary expected payer.
Design, Setting, And Participants:
Secondary analysis of all inpatient admissions following pediatric adenotonsillectomy (age <18 years) in the Nationwide Inpatient Sample during the calendar years 2000, 2005, and 2010.
Exposure:
Inpatient pediatric tonsillectomy.
Main Outcomes And Measures:
The percentage distributions of pediatric adenotonsillectomies with respect to hospital teaching status and primary payer were compared according to calendar year to determine temporal changes. Multivariate analysis was conducted with logistic regression to determine year-to-year changes in the proportion of pediatric adenotonsillectomy admissions, controlling for hospital teaching status and expected source of payment.
Results:
The estimated numbers of inpatient hospital pediatric adenotonsillectomy stays in the United States in 2000, 2005, and 2010 were 12 879 (SE, 1695), 17 245 (SE, 2276), and 13 732 (SE, 2082), respectively. There was a significant increase in the proportion of children admitted to academic hospitals from 60.1% to 69.8% to 78.6%, respectively (P = .045). With respect to teaching hospitals, the primary expected payer distribution shifted significantly, with an increase in Medicaid recipients from 38.4% to 38.9% to 50.5%, and a decline in private insurance from 57.7% to 51.5% to 43.9% (P = .02).
Conclusions And Relevance:
Inpatient pediatric adenotonsillectomies are increasingly being regionalized to academic/teaching hospitals. Concurrently, the proportion of patients using Medicaid as the primary payer has increased for inpatient tonsillectomies in teaching hospitals. Such regionalization has important implications for health care reimbursement and distribution of care.
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