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Jason L. Acevedo, MD; Lina Lander, ScD; Udayan K. Shah, MD; Rahul K. Shah, MD

Arch Otolaryngol Head Neck Surg. 2009;135(1):28-32.

Objective  To determine national variations in resource utilization in the treatment of pediatric mastoiditis.

Design  Retrospective review.

Setting  National pediatric inpatient database.

Patients  The Kids' Inpatient Database for 2003 was used to extract data for admissions for mastoiditis.

Results  A total of 1049 patients (57% were male, and the mean age was 6.3 years) were identified. Median total charges for an admission were $9600; total charges were less than $28 604 in 90% of admissions. The mean length of stay (LOS) was 4.3 days (range, 0-87 days). A total of 792 procedures were performed; 50.0% of patients underwent tympanostomy tube placement and/or myringocentesis, and 21.6% underwent mastoidectomy. The LOS for nonsurgical patients was 3.7 days. The LOS for children undergoing tube placement was 4.6 days, with mean total charges of $15 713; for mastoidectomy, the LOS was 5.5 days, with mean total charges of $23 185. The primary payer was private insurance in 51.5% and Medicaid in 39.4%. Predictors of increased charges were treatment at teaching hospitals (P = .005), treatment at children's hospitals (P < .001), LOS (P < .001), the number of procedures (P < .001), and hospital region (P = .003). Wide geographic variation was noted with respect to the mean total charges per admission, which ranged from $5016 to $35 898.

Conclusions  In 2003, the median charge for a pediatric mastoiditis admission was $9600; 50% of patients underwent tympanostomy tube placement, and about 21.6% underwent a mastoidectomy. There was wide variation in total charges for admissions. Resource utilization was higher in teaching hospitals and in children’s' hospitals.

Author Affiliations: Department of Otolaryngology–Head and Neck Surgery, National Capitol Consortium, Washington, DC (Dr Acevedo); Environmental Health, Harvard School of Public Health, Boston, Massachusetts (Dr Lander); Division of Otolaryngology, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, Delaware (Dr U. K. Shah); Departments of Pediatrics and Otolaryngology–Head and Neck Surgery, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania (Dr U. K. Shah); and Division of Otolaryngology, Children's National Medical Center, The George Washington University Medical Center, Washington, DC (Dr R. K. Shah). Dr Lander is now with the Department of Epidemiology, University of Nebraska Medical Center, Omaha.

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