Postoperative Interventions and Cost Associated With Disposition After Tonsil and Adenoidectomy

Area of Science:

• Pediatric Surgery
• Healthcare Resource Management
• Patient Outcomes

Background:

• Tonsillectomy and adenoidectomy (T/A) are common pediatric procedures.
• Postoperative disposition following T/A, particularly decisions regarding inpatient unit versus pediatric intensive care unit (PICU) admission, impacts resource utilization and costs.

Purpose of the Study:

• To evaluate postoperative disposition and resource use in pediatric patients undergoing T/A.
• To compare outcomes and costs between inpatient unit and PICU admissions after T/A.

Main Methods:

• Retrospective cohort study of over 388,000 patients aged 18 or younger undergoing T/A procedures.
• Analysis of data from the Pediatric Health Information System database (2016-2023).
• Categorization of patients by postoperative disposition: ambulatory, inpatient unit, inpatient unit with PICU transfer, or PICU.

Main Results:

• A small percentage of patients in both the inpatient unit (2%) and PICU (16%) received urgent interventions.
• Emergent interventions or outcomes occurred in 2% of patients in both inpatient and PICU settings.
• Daily hospital costs were significantly higher in the PICU ($1774 more per day for patients without interventions).

Conclusions:

• A minority of pediatric patients admitted to the PICU after T/A procedures require urgent or emergent interventions.
• Deimplementing routine PICU admissions for T/A patients could lead to substantial cost savings (estimated $2.6 million) and optimize PICU resource allocation.
• Transitioning T/A patients to the inpatient unit when appropriate can improve efficiency and reduce healthcare expenditures.