Causes and Costs for ED Visits after Pediatric Adenotonsillectomy

Abstract

Objectives: (1) Review the reasons, timing, management, and costs for children presenting to the emergency department (ED) after tonsillectomy or adenotonsillectomy (T&A). Methods: A standardized activity-based hospital accounting system was used to create an observational cohort of children from an academic pediatric otolaryngology practice who presented to the ED after T&A from 2011 to 2012. The reason for presentation, number of days after surgery, and facility costs for each visit were recorded. Results: The study cohort included 176 patients. Five of the patients had visits unrelated to the operation. Of the remaining patients, 21% presented for post-tonsillectomy hemorrhage, 54% for dehydration, 13% for poorly controlled pain, and 12% for other miscellaneous reasons. The mean postoperative day at the time of ED presentation was 3.7 ± 3.4 days. The mean hospital facility cost when the patient was discharged from the ED was $153 per visit. This increased to $1,634 per encounter when the patient was admitted or observed overnight, and the cost per return to the OR for bleeding was $1,392 per episode. Conclusions: A relatively significant portion of children present to the ED after T&A for dehydration, poorly controlled pain, or hemorrhage. The costs from these visits are not insignificant. Developing strategies to reduce these visits may improve outcomes and reduce costs.