Otoplasty Utilization and Cost Trends in Tertiary Care Children's Hospitals

This study examines temporal trends in otoplasty volume and inflation-adjusted cost, and characterizes variation by patient age, sex, anesthesia type, insurance, and geographic region using a national pediatric hospital database.

Retrospective cohort analysis of the Pediatric Health Information System (PHIS) database. Patients undergoing otoplasty (CPT 69300) from 2000 to 2025 were identified. Patients with congenital ear malformations other than a prominent ear (ICD-10 Q17.5) were excluded. Annual procedure volume and inflation-adjusted estimated costs were modeled with ordinary least-squares regression. Differences in cost across anesthesia type, insurance category, and census region were assessed with Kruskal-Wallis and Wilcoxon pairwise tests.

A total of 3428 patients underwent otoplasty (51.7% male). Annual volume increased significantly (β=3.7 procedures/year, R2=0.57, P<0.001). Inflation-adjusted median cost rose by $161/year (R2=0.67, P<0.001). Median age at surgery was 8.0 years (IQR: 6-12). General anesthesia was associated with higher costs than local anesthesia ($6930 versus $5355; P<0.001). Costs were highest in the West ($7136) and lowest in the South ($4793; P<0.001). Medicaid/CHIP patients incurred higher median costs than privately insured patients ($7188 versus $6496; P=0.010).

Otoplasty utilization and real costs have increased significantly at U.S. children's hospitals over the past 2 decades. Meaningful variation exists by anesthesia type, payer, and geography. These findings highlight opportunities to standardize care delivery and address cost disparities in pediatric otoplasty.