Preoperative Predictors and Costs of 30-Day Readmission Following Inpatient Pediatric Tonsillectomy in the United States.

Abstract

To understand national trends in 30-day postoperative readmission following inpatient pediatric tonsillectomy and adenoidectomy. Retrospective cohort study. Nationwide Readmissions Database. We used the Nationwide Readmissions Database to identify and analyze 30-day readmissions following inpatient tonsillectomy from 2010 to 2015. Using the <i>International Classification of Disease</i> codes, we identified 66,652 patients and analyzed the incidence, causes, risk factors, and costs of 30-day readmission. Of 66,652 patients who underwent inpatient tonsillectomy, 2660 (4.0%) experienced a readmission. Readmitted patients were more commonly aged <2 years (23.4 vs 10.6%, <i>P</i> = .01) and had a greater burden of comorbidities, including preoperative anemia (3.9 vs 1.3%, <i>P</i> < .001), coagulopathy (3.5 vs 1.4%, <i>P</i> < .001), and neurologic disorders (19.1 vs 6.6%, <i>P</i> < .001). Readmitted patients experienced higher rates of postoperative complications (17.4 vs 9.0%, <i>P</i> < .001) and had a longer length of stay (4.5 vs 2.2 days, <i>P</i> < .001). Index cost of hospitalization was higher among readmitted patients ($14,129 vs $7307, <i>P</i> < .001), and each readmission cost an additional $7576. Postoperative hemorrhage (21.3%) and dehydration (17.7%) were the 2 most common causes for readmission. Independent predictors of readmission included age <3 years, multiple comorbidities, and postoperative neurologic complications. The incidences of tonsillectomies and readmissions declined during the study period, most notably between 2010 and 2012. Readmission after inpatient tonsillectomy and adenoidectomy places a substantial financial burden on the health care system. Targeted strategies to improve preoperative assessment and optimize postoperative care may prevent readmission, reduce unnecessary health care expenditures, and improve patient outcomes.