Postoperative Interventions and Cost Associated With Disposition After Tonsil and Adenoidectomy

To evaluate postoperative disposition and resource use among patients admitted to the inpatient unit or pediatric intensive care unit (PICU) following tonsillectomy, adenoidectomy, and tonsillectomy/adenoidectomy (T/A).

This retrospective cohort study featured patients aged 18 years or less after T/A procedures in 38 children's hospitals in the Pediatric Health Information System database (2016-2023). Patients were categorized by postoperative disposition: ambulatory, inpatient unit, inpatient unit with subsequent PICU transfer, or PICU; inpatient admissions were analyzed. Primary outcomes were the frequency of urgent interventions (racemic epinephrine administration and noninvasive ventilation) and emergent interventions or outcomes (invasive mechanical ventilation, cardiopulmonary resuscitation, hemorrhage, blood transfusion, or return to operating room). The secondary outcome was median daily hospital cost.

A total of 388 071 T/A procedures were identified, including 316 323 ambulatory and 71 748 inpatient. Among the patients in the inpatient unit and PICU, 2% and 16% received an urgent intervention, and, in both locations, 2% received an emergent intervention or outcome. For patients without interventions, the median daily cost difference between PICU and inpatient unit admissions was $1774. Based on the difference between PICU and inpatient costs for patients with no interventions, we estimate that $2.6 million could be saved if 50% of these patients in the PICU were admitted to the inpatient unit.

A minority of PICU admissions following T/A procedures require urgent or emergent interventions. This suggests that deimplementation of routine T/A PICU admissions may facilitate transitioning patients to the inpatient unit, reducing costs and optimizing PICU use.