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Published on: December 6, 2016
Admission Criteria for Children With Obstructive Sleep Apnea After Adenotonsillectomy: Considerations for Cost
David F Smith1,2, Charlene P Spiceland3, Stacey L Ishman1,2,4
1Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
Current guidelines for pediatric obstructive sleep apnea (OSA) patients undergoing adenotonsillectomy do not balance safety and cost for postoperative respiratory complications (PRCs). A refined model identified 95% of high-risk children with PRCs at a moderate cost.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Health Economics
Background:
- Postoperative respiratory complications (PRCs) are frequent in children with obstructive sleep apnea (OSA) after adenotonsillectomy.
- Existing admission guidelines for these patients do not adequately balance patient safety with healthcare costs.
Purpose of the Study:
- To analyze current postoperative admission guidelines for children with OSA undergoing adenotonsillectomy.
- To determine which guidelines best balance patient safety and cost-effectiveness in identifying children at risk for PRCs.
Main Methods:
- Retrospective study of 630 children (≤12 years) with OSA undergoing adenotonsillectomy.
- Collected demographics, medical history, and hospital course data.
- Utilized advanced Excel modeling and logistic regression to assess guideline performance and costs.
Main Results:
- 116 children experienced PRCs; they were younger, more often male, and had higher apnea-hypopnea index (AHI) values.
- Current guidelines identified 82-99% of children with PRCs but incurred significant costs ($535,962-$1,053,694).
- A refined predictive model identified 95% of children with PRCs at a moderate cost.
Conclusions:
- Existing guidelines for pediatric OSA patients after adenotonsillectomy are insufficient in balancing safety and cost.
- A refined model shows promise in identifying high-risk children for PRCs more cost-effectively.
Study Objectives:
Postoperative respiratory complications (PRCs) are common among children with obstructive sleep apnea (OSA) after adenotonsillectomy. We analyzed postoperative admission guidelines to determine which optimally balanced patient safety and cost.
Methods:
Retrospective study of children aged 12 years or younger undergoing adenotonsillectomy for OSA after polysomnography at a tertiary academic care center over 2 years. Demographics, medical History, and hospital course were collected. Advanced Excel modeling was used to assess the number of children with PRCs identified with guideline admission criteria and to validate the significance of these findings in our patient population with logistic regression.
Results:
Six hundred thirty children were included; 116 had documented PRCs. Children with PRCs were younger (P = .024) and more frequently male (P = .012). There were no significant differences in race (P = .411) or obesity (P = .265). More children with PRCs had an apnea-hypopnea index (AHI) > 24 events/h (P < .001). Following guidelines from the American Academy of Pediatrics, American Academy of Otolaryngology - Head and Neck Surgery, and Nationwide Children's Hospital, 82%, 87%, and 99% of children with PRCs would be identified, costing $535,962, $647,165, and $1,053,694 for admission, respectively. Using a non-validated, forced model to refine predictors described in published guidelines, our model would have identified 95% of children with one or more PRCs, with a moderate cost.
Conclusions:
Current admission guidelines attempt to identify children with OSA at high risk for PRCs after adenotonsillectomy; however, none consider the economic cost to the health care system. We present a comparison of the number of patients identified with PRCs after adenotonsillectomy and the cost of expected admissions using currently published guidelines.
Commentary:
A commentary on this article appears in this issue on page 1371.
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