Author(s)
Vraj P. Shah, BS
Amar D. Desai, MPH
Sean Z. Haimowitz, BS
Aman M. Patel, BS
Prayag Patel, MD
Christina H. Fang, MD
Jean Anderson Eloy, MD
Christen Caloway, MD
Affiliation(s)
Rutgers New Jersey Medical School;
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to understand the impact of insurance type on the management of pediatric patients undergoing tonsillectomy in the context of a database study.
Objectives: To investigate the associations between insurance type and the management of inpatient pediatric patients undergoing tonsillectomy.
Study Design: Retrospective database study.
Methods: The 2016 Kid's Inpatient Database was used to identify pediatric patients undergoing tonsillectomy (ICD-10: 0CTPXZZ). Complications were identified via ICD-10 codes. Univariate and multivariate analyses were performed to determine statistical associations. Results: Of the 5,600 patients in our cohort, 2008 had private insurance, 3295 had Medicaid, and 297 were remaining payers (Medicare, self-pay, "other"). Patients with private insurance were older than Medicaid patients (6.09 vs. 5.63 years, p=0.001), but similar in age to remaining payers (6.09 vs. 6.13 years, p=0.902). Medicaid patients were more likely to be obese than those with private insurance or remaining payers (15.8% vs. 6.2% vs. 6.4% respectively, p<0.001). Multivariate analysis indicated that patients with private insurance had lower total charges than remaining payers (mean $32,149.38 vs. $39,279.41, p=0.041) and similar charges to Medicaid patients ($32,149.38 vs. $34,661.66, p=0.454). Patients with private insurance had shorter length of stay (LOS) than Medicaid patients (2.23 vs. 2.53 days, p=0.010) and remaining payers (2.23 vs. 2.63 days, p=0.015). Patients with Medicaid and private insurance had similar risks for respiratory complications (p=0.244); however, remaining payers had an elevated risk for developing respiratory complications compared to those with private insurance (OR 1.593, 95% CI 1.022-2.484, p=0.040).
Conclusions: Our study suggests that the management of pediatric tonsillectomy patients varies by insurance type, as highlighted by differences in charges, length of stay, and respiratory complication risk.