Associations between socioeconomic status and race with complications after tonsillectomy in children

Abstract

Objective: To determine if disparities exist for revisits and complications after pediatric tonsillectomy.

Study design: Cross-sectional analysis of multistate databases.

Setting: Ambulatory surgery.

Methods: Cases of pediatric tonsillectomy with or without adenoidectomy were extracted from state ambulatory surgery databases and linked to state emergency department databases and inpatient databases for California, Iowa, Florida, and New York for 2010 and 2011. Revisit rates and diagnoses within 14 days were analyzed for potential associations of these complications with sex, race, and median household income quartile.

Results: There were 79,520 cases of pediatric tonsillectomy that were extracted (50.3% male; mean age, 7.5 years). Overall, 6419 patients (8.1%) incurred a revisit after the procedure. Revisit rates for posttonsillectomy bleeding, acute pain, and fever/dehydration were 2.1%, 1.5%, and 2.2%, respectively. On multivariate analysis, increasing household income quartile was significantly associated with a decreasing rate of all complications: revisits (odds ratio [OR], 0.87; 95% confidence interval [CI], 0.84-0.89), posttonsillectomy bleeding (OR, 0.91; 95% CI, 0.86-0.96), acute pain (OR, 0.79; 95% CI, 0.74-0.84), and fever/dehydration (OR, 0.93; 95% CI, 0.89-0.98). Female sex was associated with a decreased rate of posttonsillectomy hemorrhaging (OR, 0.81; 95% CI, 0.73-0.91). Black and Hispanic children had an increased risk for a revisit after tonsillectomy (OR, 1.11; 95% CI, 1.01-1.22; and OR, 1.17; 95% CI, 1.09-1.26, respectively) and increased odds for acute pain at the revisit (OR, 1.36; 95% CI, 1.10-1.67; and OR, 1.34; 95% CI, 1.14-1.57, respectively) relative to white children. Race was not associated with the rate of hemorrhage posttonsillectomy.

Conclusion: Significant disparities, particularly with respect to household income, exist in the incidence of revisits and complications after pediatric tonsillectomy. The disparate burden of increased revisits and acute pain diagnoses after tonsillectomy deserve further attention.

Keywords: bleeding; children; complications; disparities; household income; race; readmission; revisits; tonsillectomy.