Curtis Jonathan L, Harvey D Brandon, Willie Scott, Narasimhan Evan, Andrews Seth, Henrichsen Jake, Van Buren Nicholas C, Srivastava Rajendu, Meier Jeremy D
University of Utah School of Medicine, Salt Lake City, Utah, USA.
Division of Otolaryngology, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Otolaryngol Head Neck Surg. 2015 Apr;152(4):691-6. doi: 10.1177/0194599815572123. Epub 2015 Mar 2.
(1) Review the reasons, timing, and costs for children presenting to the emergency department (ED) after adenotonsillectomy (T&A).
Case series with chart review.
Tertiary care children's hospital.
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.
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).
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.
（1）回顾扁桃体腺样体切除术（T&A）后儿童前往急诊科（ED）就诊的原因、时间及费用。
病历回顾的病例系列研究。
三级医疗儿童医院。
采用标准化的基于活动的医院会计系统，从2009年至2012年期间在一家学术性儿科耳鼻喉科诊所接受T&A手术并前往ED就诊的患者中识别出437名儿童。记录就诊原因、术后时间及医院费用。
该研究队列占同期接受T&A手术的3198名患者的13.3%。总体而言，133例（4.2%）因脱水就诊，106例（3.3%）因扁桃体切除术后出血就诊，65例（2.0%）因疼痛控制不佳就诊，42例（1.3%）因发热就诊，29例（1.0%）因呕吐/恶心/胃肠道不适就诊，22例（0.7%）因呼吸道并发症就诊，12例（0.4%）因与手术相关的其他原因就诊；28例（0.8%）与T&A无关，予以排除。前往ED就诊时的平均术后天数为4.4天（95%置信区间，4.1 - 4.7天）。每名前往ED就诊患者的平均费用为1420美元（95%置信区间，1104 - 1737美元），费用最高的亚组为出现呼吸道并发症的患者（2855美元；95%置信区间，1434 - 4277美元）、出血患者（1502美元；95%置信区间，1216 - 1787美元）及脱水患者（1372美元；95%置信区间，995 - 1750美元）。费用最低的亚组为术后急性疼痛患者（781美元；95%置信区间，282 - 1200美元）。
很大一部分儿童在T&A术后因疼痛控制不佳、脱水或发热前往ED就诊。这些就诊产生的费用很高。在儿科T&A整体护理中考虑这些费用，有助于在当前医疗改革环境下计算捆绑支付的适当报销金额。
