Insurance Coverage and Acute Care Revisits After Pediatric Ambulatory Tonsillectomy

Area of Science:

• Pediatric surgery
• Health services research
• Health insurance

Background:

• Tonsillectomy is a common pediatric procedure.
• Understanding factors influencing post-operative care, such as health insurance, is crucial for patient outcomes.
• Previous studies have not fully explored the impact of insurance transitions on pediatric surgical revisits.

Purpose of the Study:

• To examine the association between health insurance coverage patterns and 30-day all-cause acute care revisits following ambulatory tonsillectomy in children.
• To identify specific insurance transitions that may be associated with increased risk of readmission.

Main Methods:

• Retrospective cohort study at a pediatric hospital.
• Insurance patterns were categorized: continuous private, continuous Medicaid, Medicaid-to-private, and private-to-Medicaid.
• Multivariable analysis was used to assess the association between insurance changes and 30-day revisits, controlling for comorbidities and healthcare utilization.

Main Results:

• 13% of analyzed children (n=148) experienced 30-day revisits.
• The private-to-Medicaid insurance change group had a significantly higher revisit rate (19%) compared to continuous private coverage (10%).
• Children in the private-to-Medicaid group were more likely to be overweight, have sleep-disordered breathing symptoms, and have higher prior healthcare utilization.

Conclusions:

• Transitioning from private to Medicaid insurance is associated with a higher risk of 30-day acute care revisits after pediatric tonsillectomy.
• This increased risk is explained by higher comorbidity burden and greater past healthcare utilization in this group.
• Healthcare systems should consider insurance transitions as a potential risk factor for post-operative adverse events in pediatric surgery.