Patterns of Hospital Use and Regionalization of Inpatient Pediatric Adenotonsillectomy

IMPORTANCE Pediatric adenotonsillectomy is one of the most frequently performed procedures in the United States. Whereas several studies have focused on tonsillectomy techniques and outcomes, little is known about the overall changes in the distribution of care. Variations in care patterns between academic and nonacademic settings may have important financial and educational effects. OBJECTIVE To determine whether regionalization of inpatient pediatric adenotonsillectomy has occurred over the past decade with respect to hospital teaching status and primary expected payer. DESIGN, SETTING, AND PARTICIPANTS Secondary analysis of all inpatient admissions following pediatric adenotonsillectomy (age < 18 years) in the Nationwide Inpatient Sample during the calendar years 2000, 2005, and 2010. EXPOSURE Inpatient pediatric tonsillectomy. MAIN OUTCOMES AND MEASURES The percentage distributions of pediatric adenotonsillectomies with respect to hospital teaching status and primary payer were compared according to calendar year to determine temporal changes. Multivariate analysis was conducted with logistic regression to determine year-to-year changes in the proportion of pediatric adenotonsillectomy admissions, controlling for hospital teaching status and expected source of payment. RESULTS The estimated numbers of inpatient hospital pediatric adenotonsillectomy stays in the United States in 2000, 2005, and 2010 were 12 879 (SE, 1695), 17 245 (SE, 2276), and 13 732 (SE, 2082), respectively. There was a significant increase in the proportion of children admitted to academic hospitals from 60.1% to 69.8% to 78.6%, respectively (P = .045). With respect to teaching hospitals, the primary expected payer distribution shifted significantly, with an increase in Medicaid recipients from 38.4% to 38.9% to 50.5%, and a decline in private insurance from 57.7% to 51.5% to 43.9%(P = .02). CONCLUSIONS AND RELEVANCE Inpatient pediatric adenotonsillectomies are increasingly being regionalized to academic/teaching hospitals. Concurrently, the proportion of patients using Medicaid as the primary payer has increased for inpatient tonsillectomies in teaching hospitals. Such regionalization has important implications for health care reimbursement and distribution of care.