Surgeon Dependent Variation in Perioperative Costs for Tonsillectomy and Adenoidectomy in Children

Abstract

Objectives:

1) Identify the major expenses for routine tonsillectomy and adenoidectomy (T&A) at a children’s hospital. 2) Identify sources for the greatest inter-surgeon cost variation.

Methods:

A standardized activity based hospital accounting system was used to determine total facility costs per encounter (not including physician costs) for T&A cases at a tertiary children’s hospital from 2008-2011. Facility costs were subdivided into categories including operating room (OR), same day services (SDS), room and care (R&C), OR supplies, recovery room, pharmacy, anesthesia, and imaging. Average costs/case were determined for each surgeon who performed >50 cases. Stepwise regression analysis was performed to determine cost categories that provided the most significant inter-surgeon variation.

Results:

The study cohort included 3,454 T&A’s by 14 different surgeons (we excluded 8 surgeons who combined performed only 102 T&A’s). The mean cost per T&A encounter was $1,620. The largest cost categories included OR ($479/case, 28% of total costs), SDS ($332, 19% of total costs), and R&C ($260, 16% of total costs). The average cost by surgeon per case varied from $1,163 to $2,059/case (P<0.05). The most significant categories with inter-surgeon mean costs/case variation included OR ($358-$643/case), R&C ($26-$508/case), and OR supplies ($25-$491/case).

Conclusions:

A majority of T&A expenses are accounted by OR, SDS, and R&C costs. Significant inter-surgeon differences in costs for T&A were identified. Differences in OR, R&C, and OR supplies accounted for the greatest inter-surgeon variation. Studies identifying the reasons for inter-surgeon cost variations for T&A and their association to patient outcomes are warranted.