Author(s)
Theresa Schneider, DO
Prasad Thottam, DO
Coray Preece, DO
Colin Bohr, DO
Michael Haupert, DO
Affiliation(s)
Henry Ford Health - Warren
Abstract:
Introduction: Currently powered intracapsular tonsillectomy and adenoidectomy (PITA) and extracapsular tonsillectomy and adenoidectomy (T&A) are performed for pediatric patients with obstructive sleep apnea (OSA). Although the effectiveness of both procedures has been established in the treatment of pediatric OSA, a safety and cost comparison between the two procedures is not well established.
Objective: The primary objective of this study is to compare the safety and cost of PITA versus T&A.
Methods: Retrospective chart review was performed by electronic medical record review. All patients underwent either PITA or T&A for treatment of OSA at a tertiary pediatric care center or outpatient surgical center. Patients from three different surgeons were included in the study. Patients between the ages of 6 months to 18 years were considered. The type of surgery and any complications that occurred were collected. The complications considered were postoperative pain, bleeding, fever or infection. Emergency Department (ED) visits, phone calls to the office, clinic visits, or admission to the hospital after discharge were also documented. A cost analysis was performed based on an average cost of admission to the hospital, ED visits, clinic visits, and office staff time. A cost analysis was also performed on equipment needed to perform a PITA versus the cost to perform a T&A.
Results: There were 1984 patients included in this study. There were 183 patients who underwent PITA, while 1801 patients underwent T&A. Five of the PITA patients experienced a complication, versus 194 patients from the T&A group, a statistically significant difference at p = 0.001. Statistical analysis was performed on rates of complications and overall costs for patients in the PITA group versus the T&A group.
Conclusions: Both PITA and T&A are established successful treatments for pediatric OSA. This study documented the complications that occurred after either procedure. PITA found significantly lower complication rate overall, as well as decreased costs associated with these complications.