*Robert Wood Johnson Foundation †Department of Otolaryngology-Head and Neck Surgery, University of Michigan ‡VA Center for Clinical Management Research, Ann Arbor VA Healthcare System Departments of §Pediatrics and Communicable Diseases ∥Surgery, Section of Plastic Surgery ¶Internal Medicine #Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, MI.
Med Care. 2013 Dec;51(12):1048-54. doi: 10.1097/MLR.0b013e3182a50325.
Tonsillectomy is the second most common inpatient procedure in US children. However, the factors that influence tonsillectomy-related costs are unknown.
The objective of the study was to describe variation in US inpatient tonsillectomy costs and examine whether postoperative complications contribute to these disparities in costs.
This is a retrospective cohort study of the 2009 Nationwide Inpatient Sample. Hierarchical, mixed-effects linear regression modeling was used to analyze the association between postoperative complications and cost, controlling for clinically relevant characteristics such as age, number of chronic comorbidity indicators, and hospital mean complication rates. We also estimated the variance in cost attributable to the treating hospital using the intraclass correlation coefficient.
The study cohort comprised 12,512 adult and pediatric patients undergoing tonsillectomy or adenotonsillectomy in the inpatient setting.
Cost, posttonsillectomy hemorrhage, and mechanical ventilator use at the individual encounter and at hospital level were evaluated.
The aggregate cost of tonsillectomies in the cohort was $94.2 million. The median cost per encounter across all hospitals was $4393 (interquartile range, $3279-$6981), whereas the mean cost was $7525 (95% confidence interval, $6453-$8597). Mechanical ventilation was associated with an adjusted increase of $30,081 per encounter (95% confidence interval, $18,199-$41,964). The intraclass correlation coefficient declined from 0.117 to 0.070 after adjusting for mean hospital mechanical ventilation rate, which accounted for 40.2% of the interhospital variation in cost.
Use of mechanical ventilation significantly increases the cost of inpatient tonsillectomy care. Further research should examine risk factors contributing to higher rates of mechanical ventilation after tonsillectomy, which in turn can guide systemic quality improvement interventions to reduce costs.
扁桃体切除术是美国儿童中第二常见的住院手术。然而，影响扁桃体切除术相关成本的因素尚不清楚。
本研究旨在描述美国住院扁桃体切除术费用的变化，并探讨术后并发症是否导致这些费用差异。
这是一项对 2009 年全国住院患者样本的回顾性队列研究。采用分层混合效应线性回归模型分析术后并发症与成本之间的关联，控制年龄、慢性合并症指标数量和医院平均并发症率等临床相关特征。我们还使用组内相关系数估计了治疗医院成本差异的方差。
研究队列包括 12512 名在住院环境下接受扁桃体切除术或腺样体扁桃体切除术的成人和儿科患者。
个体就诊和医院水平的扁桃体切除术后出血和机械通气使用的成本。
队列中扁桃体切除术的总费用为 9420 万美元。所有医院的每次就诊中位数费用为 4393 美元（四分位距，3279 美元-6981 美元），平均费用为 7525 美元（95%置信区间，6453 美元-8597 美元）。机械通气与每次就诊调整后增加 30081 美元（95%置信区间，18199 美元-41964 美元）相关。调整平均医院机械通气率后，组内相关系数从 0.117 下降至 0.070，占医院间成本差异的 40.2%。
使用机械通气显著增加了住院扁桃体切除术护理的成本。进一步的研究应探讨导致扁桃体切除术后机械通气率升高的风险因素，这反过来可以指导系统质量改进干预措施，以降低成本。
