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Variation in tonsillectomy cost and revisit rates: analysis of administrative and billing data from US children’s hospitals
  1. Sanjay Mahant1,2,
  2. Troy Richardson3,
  3. Ron Keren4,
  4. Rajendu Srivastava5,6,
  5. Jeremy Meier7
  6. for the Pediatric Research in Inpatient Setting (PRIS) Network
  1. 1 Department of Pediatrics and Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  2. 2 Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
  3. 3 Research and Statistics, Children's Hospital Association, Lexena, Kansas, USA
  4. 4 Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  5. 5 Department of Pediatrics, Primary Children's Hospital, Salt Lake City, Utah, USA
  6. 6 Healthcare Delivery Institute, Intermountain Health Inc, Salt Lake City, Utah, USA
  7. 7 Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
  1. Correspondence to Dr Sanjay Mahant, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, M5G 0A4, Canada; sanjay.mahant{at}


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.

  • hospital medicine
  • paediatrics
  • health services research
  • surgery

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors All authors have made substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data; drafting the work or revising it critically for important intellectual content; provided final approval of the version published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.