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Walsan R, Mitchell RJ, Braithwaite J, Westbrook J, Hibbert P, Mumford V, Harrison R. Is there an association between out-of-pocket hospital costs, quality and care outcomes? A systematic review of contemporary evidence. BMC Health Serv Res 2023; 23:984. [PMID: 37705006 PMCID: PMC10500869 DOI: 10.1186/s12913-023-09941-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 08/21/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Out of pocket (OOP) costs vary substantially by health condition, procedure, provider, and service location. Evidence of whether this variation is associated with indicators of healthcare quality and/or health outcomes is lacking. METHODS The current review aimed to explore whether higher OOP costs translate into better healthcare quality and outcomes for patients in inpatient settings. The review also aimed to identify the population and contextual-level determinants of inpatient out-of-pocket costs. A systematic electronic search of five databases: Scopus, Medline, Psych Info, CINAHL and Embase was conducted between January 2000 to October 2022. Study procedures and reporting complied with PRISMA guidelines. The protocol is available at PROSPERO (CRD42022320763). FINDINGS A total of nine studies were included in the final review. A variety of quality and health outcomes were examined in the included studies across a range of patient groups and specialities. The scant evidence available and substantial heterogeneity created challenges in establishing the nature of association between OOP costs and healthcare quality and outcomes. Nonetheless, the most consistent finding was no significant association between OOP cost and inpatient quality of care and outcomes. INTERPRETATION The review findings overall suggest no beneficial effect of higher OOP costs on inpatient quality of care and health outcomes. Further work is needed to elucidate the determinants of OOP hospital costs. FUNDING This study was funded by Medibank Better Health Foundation.
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Affiliation(s)
- Ramya Walsan
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia.
| | - Rebecca J Mitchell
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Peter Hibbert
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Virginia Mumford
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Reema Harrison
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
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Noorbakhsh KA, Liu H, Kurs-Lasky M, Smith KJ, Hoberman A, Shaikh N. Cost-effectiveness of management strategies in recurrent acute otitis media. J Pediatr 2022; 256:11-17.e2. [PMID: 36470464 DOI: 10.1016/j.jpeds.2022.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/21/2022] [Accepted: 11/30/2022] [Indexed: 12/08/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of tympanostomy tube placementvs nonsurgical medical management, with the option of tympanostomy tube placement in the event of treatment failure, in children with recurrent acute otitis media (AOM). STUDY DESIGN A Markov decision model compared management strategies in children ages 6-35 months, using patient-level data from a recently completed, multicenter, randomized clinical trial of tympanostomy tube placement vs medical management. The model ran over a 2-year time horizon using a societal perspective. Probabilities, including risk of AOM symptoms, were derived from prospectively collected patient diaries. Costs and quality-of-life measures were derived from the literature. We performed one-way and probabilistic sensitivity analyses, and secondary analyses in predetermined low- and high-risk subgroups. The primary outcome was incremental cost per quality-adjusted life-year gained. RESULTS Tympanostomy tubes cost $989 more per child than medical management. Children managed with tympanostomy tubes gained 0.69 more quality-adjusted life-days than children managed medically, corresponding to $520 855 per quality-adjusted life-year gained. Results were sensitive to the costs of oral antibiotics, missed work, special childcare, the societal cost of antibiotic resistance, and the quality of life associated with AOM. In probabilistic sensitivity analyses, medical management was favored in 66% of model iterations at a willingness-to-pay threshold of $100 000/quality-adjusted life-year. Medical management was preferred in secondary analyses of low- and high-risk subgroups. CONCLUSIONS For young children with recurrent AOM, the additional cost associated with tympanostomy tube placement outweighs the small improvement in quality of life. Medical management for these children is an economically reasonable strategy. TRIAL REGISTRATION ClinicalTrials.gov number, NCT02567825.
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Affiliation(s)
| | - Hui Liu
- Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Marcia Kurs-Lasky
- Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Kenneth J Smith
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Alejandro Hoberman
- Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Nader Shaikh
- Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA
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Jacobs K, Roman E, Lambert J, Moke L, Scheys L, Kesteloot K, Roodhooft F, Cardoen B. Variability drivers of treatment costs in hospitals: A systematic review. Health Policy 2021; 126:75-86. [PMID: 34969532 DOI: 10.1016/j.healthpol.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 12/08/2021] [Accepted: 12/14/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Studies on variability drivers of treatment costs in hospitals can provide the necessary information for policymakers and healthcare providers seeking to redesign reimbursement schemes and improve the outcomes-over-cost ratio, respectively. This systematic literature review, focusing on the hospital perspective, provides an overview of studies focusing on variability in treatment cost, an outline of their study characteristics and cost drivers, and suggestions on future research methodology. METHODS We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane Handbook for Systematic Reviews of Interventions. We searched PubMED/MEDLINE, Web of Science, EMBASE, Scopus, CINAHL, Science direct, OvidSP and Cochrane library. Two investigators extracted and appraised data for citation until October 2020. RESULTS 90 eligible articles were included. Patient, treatment and disease characteristics and, to a lesser extent, outcome and institutional characteristics were identified as significant variables explaining cost variability. In one-third of the studies, the costing method was classified as unclear due to the limited explanation provided by the authors. CONCLUSION Various patient, treatment and disease characteristics were identified to explain hospital cost variability. The limited transparency on how hospital costs are defined is a remarkable observation for studies wherein cost variability is the main focus. Recommendations relating to variables, costs, and statistical methods to consider when designing and conducting cost variability studies were provided.
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Affiliation(s)
- Karel Jacobs
- KU Leuven, Faculty of Medicine, LIGB (Leuven Institute for Health Policy), Leuven, Belgium; KU Leuven, Faculty of Medicine, IORT (Institute for Orthopaedic Research and Training), Leuven, Belgium; Vlerick Business School, Ghent, Belgium.
| | - Erin Roman
- Vlerick Business School, Ghent, Belgium; KU Leuven, Faculty of Economics and Business, Leuven, Belgium
| | - Jo Lambert
- Ghent University Hospital, department of Dermatology, Ghent, Belgium
| | - Lieven Moke
- KU Leuven, Faculty of Medicine, IORT (Institute for Orthopaedic Research and Training), Leuven, Belgium
| | - Lennart Scheys
- KU Leuven, Faculty of Medicine, IORT (Institute for Orthopaedic Research and Training), Leuven, Belgium
| | - Katrien Kesteloot
- KU Leuven, Faculty of Medicine, LIGB (Leuven Institute for Health Policy), Leuven, Belgium
| | - Filip Roodhooft
- Vlerick Business School, Ghent, Belgium; KU Leuven, Faculty of Economics and Business, Leuven, Belgium
| | - Brecht Cardoen
- Vlerick Business School, Ghent, Belgium; KU Leuven, Faculty of Economics and Business, Leuven, Belgium
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Tran AHL, Horne RSC, Rimmer J, Nixon GM. Adenotonsillectomy for paediatric sleep disordered breathing in Australia and New Zealand. Sleep Med 2020; 78:101-107. [PMID: 33421669 DOI: 10.1016/j.sleep.2020.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/09/2020] [Accepted: 12/09/2020] [Indexed: 11/30/2022]
Abstract
AIMS To review the contributions of Australian and New Zealand research on adenotonsillectomy for the treatment of symptoms of obstructed breathing during sleep (sleep disordered breathing, SDB) in children. METHODS A search of the scientific literature was conducted using the MEDLINE (Ovid), PubMed and Scopus databases in August 2020. The following search string was used: (tonsillectomy OR adenoidectomy OR adenotonsillectomy) AND (paediatric OR child) AND (Australia OR New Zealand). A focused internet search was additionally conducted on Google to identify grey literature. RESULTS Researchers from Australia and New Zealand have made important contributions to the understanding and improvement of adenotonsillectomy (AT), including its epidemiology, cost, surgical techniques and peri-operative safety. Rates of AT have fluctuated over the years, becoming the most common paediatric surgery today, with SDB becoming the most common indication. Research in Australia and New Zealand has also focussed on the impact of AT on quality of life, and behaviour, neurocognition and cardiovascular sequelae. CONCLUSIONS Australian and New Zealand researchers have played a significant role in understanding the epidemiology and improving the safety of AT. There are promising directions in research still to come, including better understanding of the reasons for geographical variation in surgery rates, developing more efficient pre-operative risk assessment tools and alternative treatment options for mild OSA.
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Affiliation(s)
- Aimy H L Tran
- Department of Paediatrics, Monash University and The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
| | - Rosemary S C Horne
- Department of Paediatrics, Monash University and The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
| | - Joanne Rimmer
- Department of Otolaryngology, Head and Neck Surgery, Monash Health, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia
| | - Gillian M Nixon
- Department of Paediatrics, Monash University and The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia; Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Australia.
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Mahant S, Richardson T, Keren R, Srivastava R, Meier J. Variation in tonsillectomy cost and revisit rates: analysis of administrative and billing data from US children's hospitals. BMJ Qual Saf 2020; 30:bmjqs-2019-010730. [PMID: 32606211 DOI: 10.1136/bmjqs-2019-010730] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 04/28/2020] [Accepted: 05/25/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Tonsillectomy is one of the most common and cumulatively expensive surgical procedures in children. We determined if substantial variation in resource use, as measured by standardised costs, exists across hospitals for performing tonsillectomy and if higher resource use is associated with better quality of care, as measured by revisits to hospital. METHODS We conducted a retrospective analysis of children undergoing routine outpatient tonsillectomy between 2011 to 2017 across US children's hospitals using an administrative and billing data source. The primary outcome measures were the hospital tonsillectomy standardised cost and the 30-day revisit rate to hospital. We analysed the interhospital variation in standardised cost by determining the number of outlier hospitals in standardised cost and the intraclass correlation coefficient. RESULTS 131 814 children (median age 6 years, IQR: 4,9; female sex 52.5%) underwent tonsillectomy for airway obstruction (62.9%) and infection (23.9%) across 28 hospitals. The median adjusted hospital standardised cost for tonsillectomy was $2392 (IQR: $1827, $2793; range: $1166 to $4222). There was substantial interhospital variation in costs as 11 (40%) hospitals were cost outliers, and the intraclass correlation coefficient was 0.62, suggesting that 62% of the variation in cost was attributable to variation between hospitals. The median hospital revisit rate was 9.5% (IQR: 7.8, 12.1) and higher hospital costs did not correlate with lower revisit rates (rs =0.03, 95% CI -0.36 to 0.41; p=0.87). CONCLUSIONS There is substantial variation in hospital resource use and standardised costs for routine outpatient tonsillectomy across US children's hospitals. Higher resource use is not associated with lower revisit rates. Further study is needed to understand the practices of lower resource use hospitals who deliver high quality of care.
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Affiliation(s)
- Sanjay Mahant
- Department of Pediatrics and Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Troy Richardson
- Research and Statistics, Children's Hospital Association, Lexena, Kansas, USA
| | - Ron Keren
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Rajendu Srivastava
- Department of Pediatrics, Primary Children's Hospital, Salt Lake City, Utah, USA
- Healthcare Delivery Institute, Intermountain Health Inc, Salt Lake City, Utah, United States
| | - Jeremy Meier
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, United States
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Thomas AJ, McCoul ED, Meier JD, Newberry CI, Smith TL, Alt JA. Cost and operative time estimation itemized by component procedures of endoscopic sinus surgery. Int Forum Allergy Rhinol 2020; 10:755-761. [PMID: 32216166 DOI: 10.1002/alr.22554] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 01/13/2020] [Accepted: 02/21/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Endoscopic sinus surgery (ESS) is a variable combination of individual procedures. Cost estimates for ESS as a single entity have wide variation, likely influenced by variation in procedures performed. We sought to identify operative time, supply costs, and total procedure cost specific to the component procedure combinations comprising ESS. METHODS Bilateral ESS cases at 13 Intermountain Healthcare facilities (2008 to 2016) were identified from a database with corresponding cost and time data. Procedure details were obtained by chart review. Least-squares (LS) means of cost (in 2016 US dollars) and time for specific procedures were obtained by multivariable gamma regression models. RESULTS Among 1477 bilateral ESS cases with 19 different procedure combinations, operative time ranged from 59.5 (95% confidence interval [CI], 48.6-73.0) minutes for total ethmoid to 147.1 (95% CI, 126.4-171.2) minutes for full ESS with maxillary and sphenoid tissue removal. Sphenoidotomy had lowest total and supply costs (in US dollars) of $2112 (95% CI, $1672-$2667) and $636 (95% CI, $389-$1040), respectively. Total cost was highest for full ESS with maxillary tissue removal at $4640 (95% CI, $4115-$5232). Supply cost was highest for full ESS with maxillary and sphenoid tissue removal at $2191 (95% CI, $1649-$2909). CONCLUSION Operative time and costs for ESS vary depending on the procedures performed, demonstrating the importance of procedure specificity in assessment of ESS time, cost, and, ultimately, value. These procedure-specific estimates of cost enable nonbinary valuation of ESS, appropriate for the multitude of procedure options intended to optimize individual outcomes.
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Affiliation(s)
- Andrew J Thomas
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.,Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, LA
| | - Edward D McCoul
- Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, LA
| | - Jeremy D Meier
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Christopher I Newberry
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Timothy L Smith
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - Jeremiah A Alt
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
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Xiao H, Huang J, Liu W, Dai Z, Peng S, Peng Z, Liang R, Ma R, Wen Y, Li J, Wen W. The cost-effectiveness analysis of drug therapy versus surgery for symptomatic adenoid hypertrophy by a Markov model. Qual Life Res 2019; 29:629-638. [PMID: 31782019 PMCID: PMC7028839 DOI: 10.1007/s11136-019-02374-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2019] [Indexed: 12/26/2022]
Abstract
Purpose Adenoid hypertrophy (AH) is common among young children. Adenoid-based surgery and drug therapy could be applied for symptomatic AH patients, yet the treatment decision is difficult to make due to the diverse cost and efficacy between these two treatments. Methods A Markov simulation model was designed to estimate the cost-effectiveness (CE) of the adenoid-based surgery and the drug therapy for symptomatic AH patients. Transition probabilities, costs and utilities were extracted from early researches and expert opinions. Simulations using two set of parameter inputs for China and the USA were performed. Primary outcome was cost per QALY gained over a 6-year period. Deterministic and probabilistic sensitivity analyses were also conducted. Results The utility for the surgery group and the drug group were 4.10 quality-adjusted life years (QALYs) and 3.58 QALYs, respectively. The cost of the surgery group was more than that of the drug group using model parameters specific to China ($1069.0 vs. $753.7) but was less for the USA ($1994.4 vs. $3977.7). Surgery was dominant over drug therapy when US specific parameters were used. Surgery group had an ICER of $604.0 per QALY when parameters specific to China was used. Conclusion Surgery is cost-effective in the simulations for both China and the USA at WTP thresholds of $9633.1 and $62,517.5, respectively. Electronic supplementary material The online version of this article (10.1007/s11136-019-02374-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Han Xiao
- Division of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jinqiang Huang
- Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Weifeng Liu
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zihao Dai
- Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Sui Peng
- Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhenwei Peng
- Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ruiming Liang
- Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Renqiang Ma
- Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yihui Wen
- Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jian Li
- Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Weiping Wen
- Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Lawlor CM, Riley CA, Carter JM, Rodriguez KH. Association Between Age and Weight as Risk Factors for Complication After Tonsillectomy in Healthy Children. JAMA Otolaryngol Head Neck Surg 2019; 144:399-405. [PMID: 29543971 DOI: 10.1001/jamaoto.2017.3431] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance The 1996 Tonsillectomy and Adenoidectomy Inpatient Guidelines of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) Pediatric Otolaryngology Committee recommended that children younger than 3 years be admitted following tonsillectomy. Recommendations for hospital observation were not included as a key action statement in the 2011 AAO-HNS Clinical Practice Guidelines for Tonsillectomy in Children. Objective To examine the association between posttonsillectomy complication rate and the age and weight of the child at the time of surgery. Design, Setting, and Participants This was a multicenter case series study with medical record review of 2139 consecutive children ages 3 to 6 years who underwent tonsillectomy at 1 tertiary care academic center and 5 acute care centers in New Orleans, Louisiana, between 2005 and 2015. Children with moderate to severe developmental delay, bleeding disorders, and other major medical comorbidities were excluded. Main Outcomes and Measures Complications examined included respiratory distress, dehydration requiring intravenous fluids, and bleeding. Results Of the 2139 patients, 1817 met inclusion criteria. A total of 1011 (55.6%) were male. The mean (SD) age at the time of the procedure was 46 (14) months (range, 12-72 months). The mean weight at the time of the procedure was 17 (5) kg (range, 9-43 kg). A total of 95 patients (5.2%) had a postoperative complication. Of the 455 children younger than 3 years in the study, 32 (7.0%) had complications compared with 63 (4.6%) of the 1362 patients 3 years or older. The odds of having a complication in children younger than 3 years was 1.5 times greater than it was in children 3 years or older (odds ratio [OR], 1.56; 95% CI, 1.00-2.42). When examining total complications, children younger than 3 years were more likely to experience a complication within the first 24 hours after surgery than children 3 years or older (25% vs 9.5%; OR, 3.17; 95% CI, 1.00-10.11). The children admitted to the hospital had a greater risk of complication than those treated as an outpatient, independent of age (6.9% vs 93.0%; OR, 3.49; 95% CI, 2.0.18-6.05). No association between weight and complications was found on logistic regression (area under the curve = 0.5268; P = .66). Conclusions and Relevance Healthy children younger than 3 years may be at an increased risk for complication following tonsillectomy. Those children may also be at increased risk for complications within the first 24 hours after surgery compared with children 3 years or older. Our data suggest that complications are independent of weight in these patients. In our cohort, those patients selected for overnight observation were associated with an increased number of adverse events following tonsillectomy, suggesting that clinician judgment is crucial in determining which patients are safe for outpatient tonsillectomy.
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Affiliation(s)
- Claire M Lawlor
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Charles A Riley
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - John M Carter
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana.,Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana.,University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, Louisiana
| | - Kimsey H Rodriguez
- Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana.,Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana.,University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, Louisiana
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Casazza GC, Thomas AJ, Dewey J, Gurgel RK, Shelton C, Meier JD. Variations in Stapes Surgery Cost within a Multihospital Network. Otolaryngol Head Neck Surg 2019; 161:835-841. [DOI: 10.1177/0194599819855055] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
ObjectiveTo identify costs and operative times for stapedotomy and evaluate factors influencing cost variation.Study DesignCase series with cost analysis.SettingMultihospital network.Subjects and MethodsA multihospital network’s standardized activity-based accounting system was used to determine costs and operative times of all patients undergoing stapedotomy from 2013 to 2017. Subjects with additional procedures were excluded. Correlations between variable factors and cost were calculated by Spearman correlation coefficients. Audiometric and cost data were compared with a Mann-Whitney U test.ResultsThe study cohort included 176 stapedotomies performed by 23 surgeons at 10 hospitals. Mean ± SD patient age was 44.3 ± 17.4 years. Mean cut-to-close time was 61.1 ± 23.55 minutes. Mean total encounter cost was $3542.14 ± $1258.78 (US dollars). Significant factors correlating with increased total encounter cost were surgical supply cost ( r = 0.74, P < .0001) and cut-to-close time ( r = 0.66, P < .0001). Laser utilization ($563.37 ± $407.41) was the highest-cost surgical supply, with the carbon dioxide laser being significantly more costly than the potassium titanyl phosphate (KTP; $852.60 vs $230.55, P < .001). Additionally, the carbon dioxide laser was associated with a significantly higher mean total encounter cost than the KTP laser ($4645.43 vs $2903.00, P < .001) and cases where no laser was used ($4645.43 vs $2932.47, P < .001). There was no difference in mean total encounter cost between the KTP laser and cases of no laser use ($2903.00 vs $2932.47, P = .75).ConclusionsSignificant cost variation exists in stapes surgery. Surgical supply cost, specifically laser use, may be associated with significantly increased costs. Reducing variation in costs while maintaining outcomes may improve health care value.
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Affiliation(s)
- Geoffrey C. Casazza
- Division of Otolaryngology–Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Andrew J. Thomas
- Department of Otolaryngology–Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, USA
| | - Jesse Dewey
- College of Osteopathic Medicine, Rocky Vista University, Ivins, Utah, USA
| | - Richard K. Gurgel
- Division of Otolaryngology–Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Clough Shelton
- Division of Otolaryngology–Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Jeremy D. Meier
- Division of Otolaryngology–Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
- Primary Children’s Hospital, Salt Lake City, Utah, USA
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Lin C, Thung AK, Jatana KR, Cooper JN, Barron LC, Elmaraghy CA. Impact of coblation versus electrocautery on acute post-operative outcomes in pediatric tonsillectomy. Laryngoscope Investig Otolaryngol 2018; 4:154-159. [PMID: 30828633 PMCID: PMC6383316 DOI: 10.1002/lio2.212] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 07/14/2018] [Accepted: 08/22/2018] [Indexed: 12/27/2022] Open
Abstract
Objective Based on previous studies in the pediatric population, it remains unclear whether there is a difference in postoperative pain between two widely used tonsillectomy techniques: coblation and bovie electrocautery. This large prospective study investigates whether postoperative pain scores differ between these two surgical techniques for tonsillectomy. Methods Prospective, non‐randomized study of children aged 2–8 enrolled in a randomized controlled trial of single‐dose intravenous acetaminophen for pain associated with adenotonsillectomy. Included procedures occurred between October 2012 and June 2015 at a tertiary referral center. Only patients whose operations exclusively used coblation or electrocautery and who required postoperative admission for extended observation were included. Follow‐up period was the length of inpatient stay. Patients and nurses who recorded the pain scores were blinded to the tonsillectomy technique. Results A total of 183 patients were included: 117 coblation cases and 66 electrocautery cases. Pain scores in the surgical recovery unit and pain scores after admission to the floor unit were not significantly different between coblation and electrocautery, either before or after adjustment for patient age, body mass index, intravenous acetaminophen use, and surgeon. There was also no difference in length of stay, readmission rate, or post‐tonsillectomy hemorrhage. Conclusions Coblation and electrocautery tonsillectomy are associated with similar post‐operative pain scores in the recovery and inpatient units in the pediatric population. As coblation is costlier, the results of this study may affect which tool is used by otolaryngologists from a cost–benefit perspective. Level of evidence III
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Affiliation(s)
- Chen Lin
- Department of Otolaryngology-Head and Neck Surgery Nationwide Children's Hospital and The Ohio State University Wexner Medical Center Columbus Ohio
| | - Arlyne K Thung
- Department of Anesthesiology and Pain Medicine Nationwide Children's Hospital Columbus Ohio
| | - Kris R Jatana
- Department of Otolaryngology-Head and Neck Surgery Nationwide Children's Hospital and The Ohio State University Wexner Medical Center Columbus Ohio
| | - Jennifer N Cooper
- Center for Surgical Outcomes Research The Research Institute at Nationwide Children's Hospital Columbus Ohio
| | | | - Charles A Elmaraghy
- Department of Otolaryngology-Head and Neck Surgery Nationwide Children's Hospital and The Ohio State University Wexner Medical Center Columbus Ohio
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Thomas AJ, Smith KA, Newberry CI, Cardon B, Davis B, Ou Z, Presson AP, Meier JD, Alt JA. Operative time and cost variability for functional endoscopic sinus surgery. Int Forum Allergy Rhinol 2018; 9:23-29. [PMID: 30118175 DOI: 10.1002/alr.22198] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 07/19/2018] [Accepted: 07/22/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Understanding the variation in costs of endoscopic sinus surgery (ESS) is critical to defining value. Current published costs of ESS have not identified potential sources of variation. Our objective was to analyze ESS costs to identify sources of variance that could guide value-improving decisions. METHODS ESS cases (n = 1739) performed between 2008 and 2016 were identified from a database of 22 rural to tertiary facilities. Cost and time data were extracted from the database. Medical records were reviewed to confirm procedures. Three bilateral groupings were examined (n = 895 cases from 13 facilities): (1) full ESS (all sinuses); (2) intermediate ESS (total ethmoid, maxillary); and (3) anterior ESS (anterior ethmoid, maxillary). Cost and operative time were analyzed using multivariable gamma regression. RESULTS Median costs for full, intermediate, and anterior ESS were $4281, $3716, and $2549 U.S. dollars (p < 0.001). Median durations were 87, 60, and 58 minutes (p < 0.001). Among patients with no additional procedures, those with full ESS had operative duration, total cost, and supply costs that were 1.37 (95% confidence interval [CI], 1.17 to 1.61), 1.52 (95% CI, 1.32 to 1.75), and 2.40 (95% CI, 1.76 to 3.25) times greater than anterior ESS, respectively (all p < 0.001). Intermediate ESS duration at community urban facilities was 1.87 (95% CI, 1.74 to 2.02) times that of community rural facilities (p < 0.001). CONCLUSION Duration of surgery, extent of surgery, and location of surgery are sources of significant variation in the cost of ESS. These findings will assist healthcare policy makers, hospitals, and surgeons in optimizing the value of ESS.
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Affiliation(s)
- Andrew J Thomas
- Division of Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Kristine A Smith
- Division of Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Christopher I Newberry
- Division of Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Brandon Cardon
- Division of Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Brock Davis
- Division of Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Zhining Ou
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Angela P Presson
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Jeremy D Meier
- Division of Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Jeremiah A Alt
- Division of Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
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13
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Faramarzi M, Safari S, Roosta S. Comparing Cold/Liquid Diet vs Regular Diet on Posttonsillectomy Pain and Bleeding. Otolaryngol Head Neck Surg 2018; 159:755-760. [PMID: 30012046 DOI: 10.1177/0194599818788555] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Tonsillectomy is a common operation; however, there are controversial opinions regarding the posttonsillectomy diet. The aim of this study was to compare the effects of cold/liquid diet vs regular diet on posttonsillectomy pain and bleeding. Study Design Prospective randomized controlled trial. Setting Tertiary referral center. Subjects and Methods In total, 194 children who underwent tonsillectomy (with or without adenoidectomy) were randomly allocated into 2 groups. A total of 100 patients were allocated in the cold/liquid diet, and 94 patients were allocated in the regular diet group. Pain score was recorded for the first 7 days, and rate of hemorrhage was recorded for 10 days after surgery. Results The participants' age range was 3 to 17 years. The mean pain score level in the regular diet group after breakfast, lunch, and dinner was not statistically significant in comparison with the cold/liquid diet group. One patient in the regular diet group was admitted to the hospital due to secondary bleeding, but it stopped without any intervention. Conclusion Most otolaryngologists believe in dietary restrictions following tonsillectomy. However, there is much controversy regarding posttonsillectomy dietary advice in the literature. In addition, only a few randomized clinical trials have focused on this subject. We found that there was no difference between regular diet and cold/liquid diet in terms of posttonsillectomy pain and bleeding. Hence, we do not recommend a limited posttonsillectomy diet.
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Affiliation(s)
- Mohammad Faramarzi
- 1 Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sima Safari
- 2 Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sareh Roosta
- 1 Otolaryngology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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14
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Quinn NA, Olson JA, Meier JD, Baskin H, Schunk JE, Thorell EA, Hodo LN. Pediatric lateral neck infections - Computed tomography vs ultrasound on initial evaluation. Int J Pediatr Otorhinolaryngol 2018; 109:149-153. [PMID: 29728170 DOI: 10.1016/j.ijporl.2018.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 04/02/2018] [Accepted: 04/02/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Review the evaluation of children with a deep lateral neck infection and define the impact of initial imaging modality on outcomes and costs. METHOD Case series, pediatric patients <18 years of age admitted to a tertiary care hospital with lateral neck infection between 01/01/14-05/31/16 as identified by ICD-9 and ICD-10 codes: 289.3 (lymphadenitis, unspecified), 682.1 (cellulitis and abscess of neck), 683 (acute lymphadenitis), I88.9 (nonspecific lymphadenitis, unspecified), L02.11 (cutaneous abscess of neck), L03.221 (cellulitis of neck), and L03.222 (acute lymphangitis of neck). Patients were divided into two groups based on initial imaging modality: primary ultrasound or primary computed tomography. Differences in length of stay, type and total number of imaging studies obtained, number of procedures, hospital readmission, and hospital cost were compared between cohorts. RESULTS There were 40 (31%) primary ultrasound and 88 (69%) primary computed tomography patients (128 total). Median length of stay was 46 (IQR: 25,90) hours (1.9 days) for primary ultrasound and 63 (IQR: 39,88) hours (2.6 days) for primary computed tomography patients (p = 0.33). Drainage was performed in 48% of both groups. Additional imaging occurred in 17 (43%) primary ultrasound and 18 (20%) primary computed tomography patients (p = 0.02). Readmission occurred in 8 patients (6.3%). Retropharyngeal infection was encountered in 13 patients (10%); this was only discovered in patients who had a computed tomography performed. Median cost per primary ultrasound patients was $5363 (IQR: 3011, 7920) and $5992 (IQR: 3450, 8060) for primary computed tomography patients. CONCLUSIONS The primary imaging modality (ultrasound or computed tomography) used to work-up children with a lateral neck infection did not impact length of stay or hospital cost. However, a significant subset had a coexisting retropharyngeal infection that was only identified on computed tomography. Future studies are needed to identify appropriate criteria for imaging in the work-up of lateral neck infections.
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Affiliation(s)
- Nicholas A Quinn
- Department of Surgery, Division of Otolaryngology, 50 N Medical Drive, University of Utah, Salt Lake City UT 84132, USA; Primary Children's Hospital, Salt Lake City, UT 84113, USA.
| | - Jared A Olson
- Department of Pharmacy, Primary Children's Hospital, 100 Mario Capecchi Drive, Salt Lake City, UT 84113, USA; Department of Pediatrics, Division of Infectious Diseases, University of Utah, Salt Lake City, UT 84132, USA
| | - Jeremy D Meier
- Department of Surgery, Division of Otolaryngology, 50 N Medical Drive, University of Utah, Salt Lake City UT 84132, USA; Primary Children's Hospital, Salt Lake City, UT 84113, USA
| | - Hank Baskin
- Intermountain Pediatric Imaging, Intermountain Healthcare, 100 Mario Capecchi Drive, Salt Lake City, UT 84113, USA; Department of Radiology, 50 N. Medical Drive, University of Utah, Salt Lake City, UT 84132, USA
| | - Jeff E Schunk
- Primary Children's Hospital, Salt Lake City, UT 84113, USA; Department of Pediatrics, Division of Emergency Medicine, 50 N Medical Drive, University of Utah, Salt Lake City, UT 84132, USA
| | - Emily A Thorell
- Department of Pediatrics, Division of Infectious Diseases, 50 N Medical Drive, University of Utah, Salt Lake City, UT 84132, USA; Primary Children's Hospital, Salt Lake City, UT 84113, USA
| | - Laura N Hodo
- Department of Pediatrics, Division of Inpatient Medicine, 50 N Medical Drive, University of Utah, Salt Lake City, UT 84132, USA; Primary Children's Hospital, Salt Lake City, UT 84113, USA
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Padia R, Hall D, Sjogren P, Narayanan P, Meier JD. Sequelae of Tympanostomy Tubes in a Multihospital Health System. Otolaryngol Head Neck Surg 2018; 158:930-933. [DOI: 10.1177/0194599817752633] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Reema Padia
- Division of Otolaryngology–Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Daniel Hall
- Intermountain Healthcare, Surgical Services Clinical Program, Murray, Utah, USA
| | - Phayvanh Sjogren
- Division of Otolaryngology–Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Prem Narayanan
- Intermountain Healthcare, Surgical Services Clinical Program, Murray, Utah, USA
| | - Jeremy D. Meier
- Division of Otolaryngology–Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Postoperative care after tonsillectomy: what's the evidence? Curr Opin Otolaryngol Head Neck Surg 2017; 25:498-505. [DOI: 10.1097/moo.0000000000000420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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17
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Sjogren PP, Thomas AJ, Hunter BN, Butterfield J, Gale C, Meier JD. Comparison of pediatric adenoidectomy techniques. Laryngoscope 2017; 128:745-749. [DOI: 10.1002/lary.26904] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 07/30/2017] [Accepted: 08/10/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Phayvanh P. Sjogren
- Division of Otolaryngology-Head and Neck Surgery; University of Utah School of Medicine; Salt Lake City Utah U.S.A
| | - Andrew J. Thomas
- Division of Otolaryngology-Head and Neck Surgery; University of Utah School of Medicine; Salt Lake City Utah U.S.A
| | - Benjamin N. Hunter
- Division of Otolaryngology-Head and Neck Surgery; University of Utah School of Medicine; Salt Lake City Utah U.S.A
| | - James Butterfield
- Division of Otolaryngology-Head and Neck Surgery; University of Utah School of Medicine; Salt Lake City Utah U.S.A
| | - Craig Gale
- Division of Otolaryngology-Head and Neck Surgery; University of Utah School of Medicine; Salt Lake City Utah U.S.A
| | - Jeremy D. Meier
- Division of Otolaryngology-Head and Neck Surgery; University of Utah School of Medicine; Salt Lake City Utah U.S.A
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The Effect of Severity of Illness on Spine Surgery Costs Across New York State Hospitals: An Analysis of 69,831 Cases. Clin Spine Surg 2017; 30:407-412. [PMID: 28926344 DOI: 10.1097/bsd.0000000000000587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN Observational database review. OBJECTIVE To determine the effect of patient severity of illness (SOI) on the cost of spine surgery among New York state hospitals. SUMMARY OF BACKGROUND DATA National health care spending has risen at an unsustainable rate with musculoskeletal care, and spine surgery in particular, accounting for a significant portion of this expenditure. In an effort towards cost-containment, health care payers are exploring novel payment models some of which reward cost savings but penalize excessive spending. To mitigate risk to health care institutions, accurate cost forecasting is essential. No studies have evaluated the effect of SOI on costs within spine surgery. MATERIALS AND METHODS The New York State Hospital Inpatient Cost Transparency Database was reviewed to determine the costs of 69,831 hospital discharges between 2009 and 2011 comprising the 3 most commonly performed spine surgeries in the state. These costs were then analyzed in the context of the specific all patient refined diagnosis-related group (DRG) SOI modifier to determine this index's effect on overall costs. RESULTS Overall, hospital-reported cost increases with the patient's SOI class and patients with worse baseline health incur greater hospital costs (P<0.001). Moreover, these costs are increasingly variable for each worsening SOI class (P<0.001). This trend of increasing costs is persistent for all 3 DRGs across all 3 years studied (2009-2011), within each of the 7 New York state regions, and occurs irrespective of the hospital's teaching status or size. CONCLUSIONS Using the 3M all patient refined-DRG SOI index as a measure of patient's health status, a significant increase in cost for spine surgery for patients with higher SOI index was found. This study confirms the greater cost and variability of spine surgery for sicker patients and illustrates the inherent unpredictability in cost forecasting and budgeting for these same patients.
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Simon KL, Frelich MJ, Gould JC. Picking apart surgical pick lists - Reducing variation to decrease surgical costs. Am J Surg 2017; 215:19-22. [PMID: 28676153 DOI: 10.1016/j.amjsurg.2017.06.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 06/08/2017] [Accepted: 06/13/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Average costs associated with common procedures can vary by surgeon without a corresponding variation in outcome or case complexity. METHODS De-identified cost and equipment utilization data were collected from our hospital for elective laparoscopic cholecystectomy performed by 17 different surgeons over a 6-month period. A group of surgeons used this data to design a standardized equipment pick list that became optional (not mandated) for laparoscopic cholecystectomy. Cost and consumable surgical supply utilization data were collected for six months prior to and following the creation of the standardized pick-list. RESULTS 280 elective laparoscopic cholecystectomies were performed during the study interval. In the 6 months after standardized pick list creation, the cost of disposable supplies utilized per case decreased by 32%. CONCLUSIONS Surgical cost savings can be achieved with standardized procedure pick lists and attention to the cost of consumable surgical supplies.
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Affiliation(s)
- Kathleen L Simon
- Medical College of Wisconsin, Department of Surgery, Division of General Surgery, Milwaukee, WI, USA
| | - Matthew J Frelich
- Medical College of Wisconsin, Department of Surgery, Division of General Surgery, Milwaukee, WI, USA
| | - Jon C Gould
- Medical College of Wisconsin, Department of Surgery, Division of General Surgery, Milwaukee, WI, USA.
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20
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Developing a standardized healthcare cost data warehouse. BMC Health Serv Res 2017; 17:396. [PMID: 28606088 PMCID: PMC5469019 DOI: 10.1186/s12913-017-2327-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 05/22/2017] [Indexed: 01/17/2023] Open
Abstract
Background Research addressing value in healthcare requires a measure of cost. While there are many sources and types of cost data, each has strengths and weaknesses. Many researchers appear to create study-specific cost datasets, but the explanations of their costing methodologies are not always clear, causing their results to be difficult to interpret. Our solution, described in this paper, was to use widely accepted costing methodologies to create a service-level, standardized healthcare cost data warehouse from an institutional perspective that includes all professional and hospital-billed services for our patients. Methods The warehouse is based on a National Institutes of Research–funded research infrastructure containing the linked health records and medical care administrative data of two healthcare providers and their affiliated hospitals. Since all patients are identified in the data warehouse, their costs can be linked to other systems and databases, such as electronic health records, tumor registries, and disease or treatment registries. Results We describe the two institutions’ administrative source data; the reference files, which include Medicare fee schedules and cost reports; the process of creating standardized costs; and the warehouse structure. The costing algorithm can create inflation-adjusted standardized costs at the service line level for defined study cohorts on request. Conclusion The resulting standardized costs contained in the data warehouse can be used to create detailed, bottom-up analyses of professional and facility costs of procedures, medical conditions, and patient care cycles without revealing business-sensitive information. After its creation, a standardized cost data warehouse is relatively easy to maintain and can be expanded to include data from other providers. Individual investigators who may not have sufficient knowledge about administrative data do not have to try to create their own standardized costs on a project-by-project basis because our data warehouse generates standardized costs for defined cohorts upon request. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2327-8) contains supplementary material, which is available to authorized users.
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21
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Gudnadottir G, Tennvall GR, Stalfors J, Hellgren J. Indirect costs related to caregivers' absence from work after paediatric tonsil surgery. Eur Arch Otorhinolaryngol 2017; 274:2629-2636. [PMID: 28289832 DOI: 10.1007/s0045-017-4526-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/03/2017] [Indexed: 05/23/2023]
Abstract
Tonsillotomy has gradually replaced tonsillectomy as the surgical method of choice in children with upper airway obstruction during sleep, because of less postoperative pain and a shorter recovery time. The aim of this study was to examine the costs related to caregivers' absenteeism from work after tonsillectomy (TE) and tonsillotomy (TT). All tonsillectomies and tonsillotomies in Sweden due to upper airway obstruction during 1 year, reported to the National Tonsil Surgery Register in children aged 1-11 were included, n = 4534. The number of days the child needed analgesics after surgery was used as a proxy to estimate the number of work days lost for the caregiver. Data from the Social Insurance Agency (Försäkringskassan) regarding the days the parents received temporary parental benefits in the month following surgery were also analysed. The indirect costs due to the caregivers' absenteeism after tonsillectomy vs tonsillotomy were calculated, using the human capital method. The patient-reported use of postoperative analgesic use was 77% (n = 3510). Data from the Social Insurance Agency were gathered for all 4534 children. The mean duration of analgesic treatment was 4.6 days (indirect cost of EUR 747). The mean number of days with parental benefits was 2.9 (EUR 667). The indirect cost of tonsillectomy was 61% higher than that of tonsillotomy (EUR 1010 vs EUR 629). The results show that the choice of surgical method affects the indirect costs, favouring the use of tonsillotomy over tonsillectomy for the treatment of children with SDB, due to less postoperative pain.
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Affiliation(s)
- Gunnhildur Gudnadottir
- Department of Otorhinolaryngology, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gröna stråket 9, 413 46, Gothenburg, Sweden.
| | | | - J Stalfors
- Department of Otorhinolaryngology, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gröna stråket 9, 413 46, Gothenburg, Sweden
| | - J Hellgren
- Department of Otorhinolaryngology, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gröna stråket 9, 413 46, Gothenburg, Sweden
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22
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Gudnadottir G, Tennvall GR, Stalfors J, Hellgren J. Indirect costs related to caregivers' absence from work after paediatric tonsil surgery. Eur Arch Otorhinolaryngol 2017; 274:2629-2636. [PMID: 28289832 PMCID: PMC5419997 DOI: 10.1007/s00405-017-4526-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/03/2017] [Indexed: 12/19/2022]
Abstract
Tonsillotomy has gradually replaced tonsillectomy as the surgical method of choice in children with upper airway obstruction during sleep, because of less postoperative pain and a shorter recovery time. The aim of this study was to examine the costs related to caregivers' absenteeism from work after tonsillectomy (TE) and tonsillotomy (TT). All tonsillectomies and tonsillotomies in Sweden due to upper airway obstruction during 1 year, reported to the National Tonsil Surgery Register in children aged 1-11 were included, n = 4534. The number of days the child needed analgesics after surgery was used as a proxy to estimate the number of work days lost for the caregiver. Data from the Social Insurance Agency (Försäkringskassan) regarding the days the parents received temporary parental benefits in the month following surgery were also analysed. The indirect costs due to the caregivers' absenteeism after tonsillectomy vs tonsillotomy were calculated, using the human capital method. The patient-reported use of postoperative analgesic use was 77% (n = 3510). Data from the Social Insurance Agency were gathered for all 4534 children. The mean duration of analgesic treatment was 4.6 days (indirect cost of EUR 747). The mean number of days with parental benefits was 2.9 (EUR 667). The indirect cost of tonsillectomy was 61% higher than that of tonsillotomy (EUR 1010 vs EUR 629). The results show that the choice of surgical method affects the indirect costs, favouring the use of tonsillotomy over tonsillectomy for the treatment of children with SDB, due to less postoperative pain.
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Affiliation(s)
- Gunnhildur Gudnadottir
- Department of Otorhinolaryngology, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gröna stråket 9, 413 46, Gothenburg, Sweden.
| | | | - J Stalfors
- Department of Otorhinolaryngology, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gröna stråket 9, 413 46, Gothenburg, Sweden
| | - J Hellgren
- Department of Otorhinolaryngology, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gröna stråket 9, 413 46, Gothenburg, Sweden
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Sowder JC, Gale CM, Henrichsen JL, Veale K, Liljestrand KB, Ostlund BC, Sherwood A, Smith A, Olsen GH, Ott M, Meier JD. Primary Caregiver Perception of Pain Control following Pediatric Adenotonsillectomy. Otolaryngol Head Neck Surg 2016; 155:869-875. [DOI: 10.1177/0194599816661715] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 07/08/2016] [Indexed: 11/16/2022]
Abstract
Objectives To (1) review pain medications prescribed following pediatric adenotonsillectomy (T&A), (2) identify pain medications reported to be helpful, and (3) compare parent-reported outcomes among various combinations of pain medications. Study Design Case series with planned data collection. Setting Multihospital network. Subjects and Methods The primary caregivers of children aged 1 to 18 years who underwent isolated T&A from June to December 2014 were contacted 14 to 21 days after surgery. Data collected included pain medications prescribed, medications most helpful in controlling pain, and duration that pain medication was required. Parents rated their children’s pain on postoperative days 2, 3, 7, and 14 and reported the time to resumption of normal diet/activity, as well as any hospital return visits. Results The study cohort included 672 subjects of 1444 potential participants (46% response rate). The mean age of the patients was 7.9 ± 3.6 years. Narcotics were prescribed in 71.9%, and 70.4% were told to use ibuprofen. Children who took ibuprofen alone were significantly younger ( P < .001). Pain was significantly less on postoperative days 2 and 3 in the ibuprofen-only group as compared with the groups taking narcotics only ( P < .001) and ibuprofen with narcotics ( P = .002). Those taking ibuprofen alone returned to normal activity ( P < .001) and diet ( P = .026) sooner than those taking ibuprofen with narcotics. No difference was seen in pain control on subgroup analysis comparing oxycodone and hydrocodone. Conclusions For pediatric T&A, significant variation exists in the management of postoperative pain. Parents of children given ibuprofen reported less pain than those given narcotics with and without ibuprofen. Further studies are needed to identify the optimal pain regimen for children after T&A.
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Affiliation(s)
- Justin C. Sowder
- Division of Otolaryngology–Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Craig M. Gale
- Surgical Services Clinical Program, Intermountain Medical Center, Intermountain Healthcare, Murray, Utah, USA
| | - Jacob L. Henrichsen
- Surgical Services Clinical Program, Intermountain Medical Center, Intermountain Healthcare, Murray, Utah, USA
| | - Kristy Veale
- Surgical Services Clinical Program, Intermountain Medical Center, Intermountain Healthcare, Murray, Utah, USA
| | - Katie B. Liljestrand
- Surgical Services Clinical Program, Intermountain Medical Center, Intermountain Healthcare, Murray, Utah, USA
| | - Barbara C. Ostlund
- Surgical Services Clinical Program, Intermountain Medical Center, Intermountain Healthcare, Murray, Utah, USA
| | - Aaron Sherwood
- Surgical Services Clinical Program, Intermountain Medical Center, Intermountain Healthcare, Murray, Utah, USA
| | - Austin Smith
- Surgical Services Clinical Program, Intermountain Medical Center, Intermountain Healthcare, Murray, Utah, USA
| | - Griffin H. Olsen
- Surgical Services Clinical Program, Intermountain Medical Center, Intermountain Healthcare, Murray, Utah, USA
| | - Mark Ott
- Surgical Services Clinical Program, Intermountain Medical Center, Intermountain Healthcare, Murray, Utah, USA
| | - Jeremy D. Meier
- Division of Otolaryngology–Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Thomas A, Alt J, Gale C, Vijayakumar S, Padia R, Peters M, Champagne T, Meier JD. Surgeon and hospital cost variability for septoplasty and inferior turbinate reduction. Int Forum Allergy Rhinol 2016; 6:1069-1074. [PMID: 27438782 DOI: 10.1002/alr.21775] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 02/15/2016] [Accepted: 02/19/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Septoplasty and turbinate reduction (STR) is a common procedure for which cost reduction efforts may improve value. The purpose of this study was to identify sources of variation in medical facility and surgeon costs associated with STR, and whether these costs correlated with short-term complications. METHODS An observational cohort study was performed in a multifacility network using a standardized cost-accounting system to determine costs associated with adult STR from January 1, 2008 to July 31, 2015. A total of 4007 cases, performed at 21 facilities, by 72 different surgeons were included in the study. Total costs, variable costs, operating room (OR) time, and 30-day complications (eg, epistaxis) were compared among surgeons, facilities, and specialties. RESULTS Total procedure cost: (mean ± standard deviation [SD]) $2503 ± $790 (range, $852 to $10,559). Mean total variable cost: $1147 ± $423 (range, $400 to $5,081). Intersurgeon and interfacility variability was significant for total cost (p < 0.0001) and OR time (p < 0.0001). Intersurgeon OR supply cost variability was also significant (p < 0.0001). Otolaryngologists had less total cost (p < 0.0001), OR time/cost (p < 0.0001), and complications (p = 0.0164), but greater supply cost (p < 0.0001), than other specialties. CONCLUSION There is wide variation in cost associated with STR. Significant variance in OR time and supply cost between surgeons suggests these are potential areas for cost reduction. Although no increased 30-day complications were seen with faster and less costly surgeries, further research is needed to evaluate how time and cost relate to quality of care.
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Affiliation(s)
- Andrew Thomas
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Jeremiah Alt
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Craig Gale
- Intermountain Healthcare, Surgical Services Clinical Program, Intermountain Medical Center, Murray, UT
| | - Sathya Vijayakumar
- Intermountain Healthcare, Surgical Services Clinical Program, Intermountain Medical Center, Murray, UT
| | - Reema Padia
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Matthew Peters
- Intermountain Healthcare, Surgical Services Clinical Program, Intermountain Medical Center, Murray, UT
| | - Trevor Champagne
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Jeremy D Meier
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT.
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Harounian JA, Schaefer E, Schubart J, Carr MM. Pediatric Posttonsillectomy Hemorrhage: Demographic and Geographic Variation in Health Care Costs in the United States. Otolaryngol Head Neck Surg 2016; 155:289-94. [PMID: 27048667 DOI: 10.1177/0194599816641627] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 03/08/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine variations in management of pediatric posttonsillectomy hemorrhage and associated costs from a national third-party payer perspective. STUDY DESIGN The MarketScan database was analyzed for claims made for 30 days following tonsillectomy/adenotonsillectomy between 2008 and 2012 for privately insured children aged 1 to 17 years. Costs for management of postoperative hemorrhage by age, sex, and region were calculated in addition to total costs incurred for 30 days postoperatively. SETTING MarketScan database. SUBJECTS AND METHODS Database study. RESULTS A total of 305,860 children were included. Overall, 0.3% had a postoperative bleed that required treatment but not surgical intervention or admission for hospitalization; 0.2% had one that required hospitalization; and 0.8% had one that required surgical intervention. The mean 30-day costs were $7660 for postoperative bleed that required surgery or hospitalization, $4580 for outpatient treatment, and $370 for no postoperative bleed. Children between 11 and 17 years old were most likely to have interventions for postoperative bleeding but had the lowest mean costs for them ($7320 for hospital based, $3860 for outpatient). There were regional differences in costs for in-patient management of bleeds, with highest costs in the West, with a mean of $8850, versus the South, with a mean of $7160. CONCLUSIONS There are geographic and demographic variations in managing pediatric posttonsillectomy hemorrhage and in the costs associated with management on a national level.
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Affiliation(s)
- Jonathan A Harounian
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Eric Schaefer
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Jane Schubart
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Michele M Carr
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
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Padia R, Thomas A, Alt J, Gale C, Meier JD. Hospital cost of pediatric patients with complicated acute sinusitis. Int J Pediatr Otorhinolaryngol 2016; 80:17-20. [PMID: 26746605 DOI: 10.1016/j.ijporl.2015.11.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/15/2015] [Accepted: 11/18/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Review costs for pediatric patients with complicated acute sinusitis. METHODS A retrospective case series of patients in a pediatric hospital was created to determine hospital costs using a standardized activity-based accounting system for inpatient treatment between November 2010 and December 2014. Children less than 18 years of age who were admitted for complicated acute sinusitis were included in the study. Demographics, length of stay, type of complication and cost of care were determined for these patients. RESULTS The study included 64 patients with a mean age of 10 years. Orbital cellulitis (orbital/preseptal/postseptal cellulitis) accounted for 32.8% of patients, intracranial complications (epidural/subdural abscess, cavernous sinus thrombosis) for 29.7%, orbital abscesses (subperiosteal/intraorbital abscesses) for 25.0%, potts puffy tumor for 7.8%, and other (including facial abscess and dacryocystitis) for 4.7%. The average length of stay was 5.7 days. The mean cost per patient was $20,748. Inpatient floor costs (31%) and operating room costs (18%) were the two greatest expenditures. The major drivers in variation of cost between types of complications included pediatric intensive care unit stays and pharmacy costs. CONCLUSION Although complicated acute sinusitis in the pediatric population is rare, this study demonstrates a significant financial impact on the health care system. Identifying ways to reduce unnecessary costs for these visits would improve the value of care for these patients.
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Affiliation(s)
- Reema Padia
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Andrew Thomas
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Jeremiah Alt
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Craig Gale
- Intermountain Healthcare, Surgical Services Clinical Program, Murray, UT, United States
| | - Jeremy D Meier
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States.
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Raol N, Zogg CK, Boss EF, Weissman JS. Inpatient Pediatric Tonsillectomy: Does Hospital Type Affect Cost and Outcomes of Care? Otolaryngol Head Neck Surg 2015; 154:486-93. [PMID: 26701174 DOI: 10.1177/0194599815621739] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 11/19/2015] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To ascertain whether hospital type is associated with differences in total cost and outcomes for inpatient tonsillectomy. STUDY DESIGN Cross-sectional analysis of the 2006, 2009, and 2012 Kids' Inpatient Database (KID). SUBJECTS AND METHODS Children ≤18 years of age undergoing tonsillectomy with/without adenoidectomy were included. Risk-adjusted generalized linear models assessed for differences in hospital cost and length of stay (LOS) among children managed by (1) non-children's teaching hospitals (NCTHs), (2) children's teaching hospitals (CTHs), and (3) nonteaching hospitals (NTHs). Risk-adjusted logistic regression compared the odds of major perioperative complications (hemorrhage, respiratory failure, death). Models accounted for clustering of patients within hospitals, were weighted to provide national estimates, and controlled for comorbidities. RESULTS The 25,685 tonsillectomies recorded in the KID yielded a national estimate of 40,591 inpatient tonsillectomies performed in 2006, 2009, and 2012. The CTHs had significantly higher risk-adjusted total cost and LOS per tonsillectomy compared with NCTHs and NTHs ($9423.34/2.8 days, $6250.78/2.11 days, and $5905.10/2.08 days, respectively; P < .001). The CTHs had higher odds of complications compared with NCTHs (odds ratio [OR], 1.48; 95% CI, 1.15-1.91; P = .002) but not when compared with NTHs (OR, 1.19; 95% CI, 0.89-1.59; P = .23). The CTHs were significantly more likely to care for patients with comorbidities (P < .001). CONCLUSION Significant differences in costs, outcomes, and patient factors exist for inpatient tonsillectomy based on hospital type. Although reasons for these differences are not discernable using isolated claims data, findings provide a foundation to further evaluate patient, institutional, and system-level factors that may reduce cost of care and improve value for inpatient tonsillectomy.
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Affiliation(s)
- Nikhila Raol
- Center for Surgery and Public Health, Harvard Medical School and Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, Massachusetts, USA Massachusetts Eye and Ear Infirmary, Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Cheryl K Zogg
- Center for Surgery and Public Health, Harvard Medical School and Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Emily F Boss
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Joel S Weissman
- Center for Surgery and Public Health, Harvard Medical School and Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, Massachusetts, USA
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Sjogren PP, Gale C, Henrichsen J, Olsen G, Ott MJ, Peters M, Srivastava R, Meier JD. Variation in costs among surgeons and hospitals in Pediatric tympanostomy tube placement. Laryngoscope 2015; 126:1935-9. [DOI: 10.1002/lary.25775] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 09/02/2015] [Accepted: 10/12/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Phayvanh P. Sjogren
- Division of Otolaryngology-Head and Neck Surgery; Intermountain Healthcare Inc; Salt Lake City Utah U.S.A
| | - Craig Gale
- Intermountain Healthcare, Surgical Services Clinical Program, Intermountain Medical Center; Murray Utah U.S.A
| | - Jacob Henrichsen
- Intermountain Healthcare, Surgical Services Clinical Program, Intermountain Medical Center; Murray Utah U.S.A
| | - Griffin Olsen
- Intermountain Healthcare, Surgical Services Clinical Program, Intermountain Medical Center; Murray Utah U.S.A
| | - Mark J. Ott
- Intermountain Healthcare, Surgical Services Clinical Program, Intermountain Medical Center; Murray Utah U.S.A
| | - Matthew Peters
- Intermountain Healthcare, Surgical Services Clinical Program, Intermountain Medical Center; Murray Utah U.S.A
| | - Rajendu Srivastava
- Division of Pediatric Inpatient Medicine; Department of Pediatrics; University of Utah School of Medicine, Intermountain Healthcare Inc; Salt Lake City Utah U.S.A
- Primary Children's Hospital; Intermountain Healthcare Inc; Salt Lake City Utah U.S.A
- Institute for Health Care Delivery Research, Intermountain Healthcare Inc; Salt Lake City Utah U.S.A
| | - Jeremy D. Meier
- Division of Otolaryngology-Head and Neck Surgery; Intermountain Healthcare Inc; Salt Lake City Utah U.S.A
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Ejaz A, Kim Y, Spolverato G, Taylor R, Hundt J, Pawlik TM. Understanding drivers of hospital charge variation for episodes of care among patients undergoing hepatopancreatobiliary surgery. HPB (Oxford) 2015; 17:955-63. [PMID: 26256003 PMCID: PMC4605332 DOI: 10.1111/hpb.12452] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 05/06/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Understanding factors associated with variation in hospital charges may help identify means to increase savings. The aim of the present study was to define potential variation in hospital charges associated with hepatopancreatobiliary(HPB) surgery. METHODS Patients who underwent an HPB procedure between 2009-2013 were identified. Total hospital charges were tabulated for room and board, surgical/anaesthesia services, medications, laboratory/radiology services and other miscellaneous charges. RESULTS Approximately 2545 patients underwent either a pancreas (66.8%) or liver/biliary (33.2%) resection. The mean total charges for all patients were $42,357 ± 33,745 (pancreas: $46,352 ± 34,932 versus the liver: $34,303 ± 29,639; P < 0.001). Morbidity (pancreas, range: 7-18%; liver, range: 9-18%) and observed:expected (O:E) length of stay (LOS)(pancreas, range: 0.67-1.64; liver, range: 1.06-3.35) varied among providers (both P < 0.001). While a peri-operative complication resulted in increased total hospital charges (complication: $66,401 ± 55,124 versus no complication: $39,668 ± 29,250; P < 0.001), total charges remained variable even among patients who did not experience a complication (P < 0.001). Surgeons within the lowest quartile of O:E LOS had lower total charges ($33 879 ± $27 398) versus surgeons in the highest quartile ($49,498 ± 40 971) (P < 0.001). Surgeons with the highest O:E LOS had higher across-the-board charges (operating room, highest quartile: $10,514 ± $4496 versus lowest quartile: $7842 ± $3706; medication, highest quartile: $1796 ± $3799 versus lowest quartile: $925 ± $2211; radiology, highest quartile: $2494 ± $4683 versus lowest quartile: $1424 ± $3247; P = 0.001; laboratory, highest quartile: $4236 ± $5991 versus lowest quartile: $3028 ± $3804; all P < 0.001). CONCLUSIONS After accounting for in-hospital complications, the total mean hospital charges for HPB surgery remained variable by case type and provider. While the variation in charges was associated with LOS, provider-level differences in across-the-board charges were also noted.
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Affiliation(s)
- Aslam Ejaz
- Department of Surgery, University of Illinois Hospital and Health Sciences SystemChicago, IL, USA
| | - Yuhree Kim
- Department of Surgery, The Johns Hopkins HospitalBaltimore, MD, USA
| | - Gaya Spolverato
- Department of Surgery, The Johns Hopkins HospitalBaltimore, MD, USA
| | - Ryan Taylor
- Department of Surgery, The Johns Hopkins HospitalBaltimore, MD, USA
| | - John Hundt
- Department of Surgery, The Johns Hopkins HospitalBaltimore, MD, USA
| | - Timothy M Pawlik
- Department of Surgery, The Johns Hopkins HospitalBaltimore, MD, USA
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Curtis JL, Harvey DB, Willie S, Narasimhan E, Andrews S, Henrichsen J, Van Buren NC, Srivastava R, Meier JD. Causes and Costs for ED Visits after Pediatric Adenotonsillectomy. Otolaryngol Head Neck Surg 2015; 152:691-6. [DOI: 10.1177/0194599815572123] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 01/20/2015] [Indexed: 11/16/2022]
Abstract
Objective (1) Review the reasons, timing, and costs for children presenting to the emergency department (ED) after adenotonsillectomy (T&A). Study Design Case series with chart review. Setting Tertiary care children’s hospital. Subjects and Methods A standardized activity-based hospital accounting system was used to identify 437 children from an academic pediatric otolaryngology practice presenting to the ED after T&A from 2009 to 2012. The reason for presentation, timing after surgery, and facility costs were recorded. Results The study cohort represented 13.3% of the 3198 patients who underwent T&A during that time period. Overall, 133 (4.2%) presented for dehydration, 106 (3.3%) presented for post-tonsillectomy hemorrhage, 65 (2.0%) for poorly controlled pain, 42 (1.3%) for fever, 29 (1.0%) for vomiting/nausea/GI discomfort, 22 (0.7%) for respiratory complications, and 12 (0.4%) for miscellaneous reasons related to the operation; 28 (0.8%) were unrelated to the T&A and excluded. Mean postoperative day at the time of ED presentation was 4.4 (95% CI, 4.1-4.7). The mean cost per patient presenting to the ED was $1420 (95% CI, $1104-$1737), the most costly subgroups being those presenting with respiratory complications ($2855; 95% CI, $1434-$4277), hemorrhage ($1502; 95% CI, $1216-$1787), and dehydration ($1372; 95% CI, $995-$1750). The least costly subgroup was acute postoperative pain ($781; 95% CI, $282-$1200). Conclusion A significant portion of children present to the ED after T&A for poorly controlled pain, dehydration, or fever. The costs from these visits are significant. Accounting for these costs in the global care for pediatric T&A could assist in calculating appropriate reimbursement for bundled payments in this climate of health care reform.
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Affiliation(s)
| | - D. Brandon Harvey
- Division of Otolaryngology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Scott Willie
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Evan Narasimhan
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Seth Andrews
- Primary Children’s Hospital, Intermountain Healthcare Inc, Salt Lake City, Utah, USA
| | - Jake Henrichsen
- Intermountain Healthcare, Surgical Services Clinical Program, Salt Lake City, Utah, USA
| | - Nicholas C. Van Buren
- Division of Otolaryngology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Rajendu Srivastava
- Primary Children’s Hospital, Intermountain Healthcare Inc, Salt Lake City, Utah, USA
- Division of Pediatric Inpatient Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Institute for Health Care Delivery Research, Intermountain Healthcare Inc, Salt Lake City, Utah, USA
| | - Jeremy D. Meier
- Division of Otolaryngology, University of Utah School of Medicine, Salt Lake City, Utah, USA
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