Author(s)
Flora Yan, BA
Terral A. Patel, BS
Clarice S. Clemmens, MD
Phayvanh P. Pecha, MD
Affiliation(s)
Otolaryngology, Med. Univ. of South Carolina, Charleston, SC.;
Abstract:
Introduction: Adenoidectomy is a common pediatric surgical procedure, however regional variations in expenditures and frequency of surgery have not been well described. Therefore, we aim to investigate cost and proportion of adenoidectomy by geographic region.
Methods: A cross-sectional analysis of children 2-18 years that underwent adenoidectomy with minor procedures excluding tonsillectomy from the Kids' Inpatient Database (KID) database. Rates of adenoidectomy were observed during the years 1997, 2000, 2003, 2006, 2009 or 2012. Hospital costs were derived from cost-to-charge ratios and converted using the US dollars Hospital Consumer Price Indices for available years 2006, 2009 and 2012. Descriptive statistics and Kruskall-Wallis test were used for statistical analysis.
Results: A total of 4,481 children were included. Of the total adenoidectomies, 1686 (37.6%) were performed in the South, followed by 1,349 (30.1%) in the Northeast, 742 (16.6%) in the Midwest, and 704 (15.7%) in the West. Over the 15-year period, there was a 25.3% proportional decline in the Northeast. However, the proportion of adenoidectomy performed in the Midwest, West and South all increased by 8.3%,7.9% and 9.1% respectively. From 1997 to 2012, the number of adenoidectomy performed as a primary surgery decreased by 43%. A subanalysis of 1,820 children demonstrated that costs varied across geographic region, with the highest median costs in the West ($12,129, IQR $7,382 - $22,696), followed by the Midwest ($9,878, IQR $6,039 - $16,595), South ($9,510, IQR $6,234 - $18,064), and Northeast ($9,270, IQR $5,914-$14,596) (p =0.001).
Conclusion: The results demonstrate geographic variation for costs in adenoidectomy, with the highest cost in the Western region. The greatest proportion of adenoidectomies was performed in the South with rising rates in the Midwest and West. Further characterization of these cost differences is needed to decrease regional differences and unwarranted variation.