National trends in pediatric concurrent inferior turbinate reduction with tonsillectomy and adenoidectomy

To examine the national trends in tonsillectomy and adenoidectomy (TA) with concurrent inferior turbinate reduction (ITR) over a 10-year period.

Retrospective analysis of a one percent random sample from the Merative MarketScan Commercial Claims and Encounters (CCAE) database from 2015 through 2024. Pediatric patients (<18 years) with an outpatient claim for TA or TA with concurrent ITR were included. The primary outcome included the annual rate of concurrent ITR. Secondary outcomes included the annual rates of concurrent ITR stratified by patient age group, associated preoperative nasal diagnoses, turbinate procedure type, postoperative bleeding complications and readmission rates.

Of 11,174 TA procedures, 586 (5.2%) included a concurrent ITR. The annual rate of these paired procedures remained stable across the study period, with a transient increase during the COVID-19 pandemic (range 4.5-8.3%, Cochran-Armitage p = 0.43). Concurrent ITR increased significantly with patient age (X² = 123.8, p < 0.0001), with adolescents (13-17 years) at four times the rate of young children (0-3 years) (10.7% vs 2.6%). Submucous resection was performed in 304 of 586 cases (52%). Concurrent ITR was not independently associated with increased risk of postoperative hemorrhage (OR 1.29, 95% CI 0.67-2.27, p = 0.41) or 30-day readmission (OR 0.64, 95% CI 0.16-1.74, p = 0.46).

Concurrent ITR is performed in approximately 1 in 20 pediatric TAs at a stable overall rate over the past decade. Utilization is higher in older patients, submucous resection is most performed, postoperative bleeding complications and 30-day readmissions are rare.