Tonsillectomy and adenoidectomy in-hospital charges, 1991

Trends in tonsillectomy and adenoidectomy (T&A) procedure rates show a steady national decline since 1970. MetLife hospital T&A claims experience is analyzed for group policyholders and dependents during 1991. The total claims charges increased over the years while the number of in-hospital procedures decreased. The average cost to MetLife for a T&A in 1991 was $3,440, $2,910 in 1990 and $2,580 in 1989 among 625, 1,193 and 1,683 patients, respectively. The 1991 charges were the highest in the Pacific area and the lowest in the East North Central geographic area. Among states with ten or more T&As, Illinois led with charges 37 percent above the average. The lowest claims charges were reported in Maryland, 30 percent below the U.S. total. Average U.S. physician fees were $1,230 and comprised 36 percent of the total charges. This proportion varied from half of the total T&A charges in New York to one-quarter in South Carolina. Ancillary fees accounted for 77 percent of the hospital charges and ranged from just over half in California to 90 percent in South Carolina. Length of stay increased from 1.1 days in both 1989 and 1990 to 1.2 days in 1991. As increasing numbers of surgeons and patients are aware of and comfortable with the concept of outpatient surgeries and as more insurance plans include incentives for ambulatory surgeries, it seems clear that fewer uncomplicated T&As will be performed on an inpatient basis.