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Objective: To provide information on the prevalence of common complications of adult tonsillectomy and associated health care utilization and expenditures., Study Design: Retrospective analysis of a large insurance database., Setting: Data from the MarketScan Commercial Claims and Encounters Database., Subjects and Methods: Treated prevalence rates for post-tonsillectomy complications were calculated for 36,210 patients with employer-sponsored insurance who had an outpatient tonsillectomy between 2002 and 2007. The relationships with various patient characteristics were examined using multivariate logistic regression. Postoperative emergency department (ED) visits and hospitalizations and total per capita health care expenditures were analyzed., Results: This analysis suggests that of adult patients who undergo a tonsillectomy, 20% will have a complication, 10% will visit an ED, and approximately 1.5% will be admitted to a hospital within 14 days of the tonsillectomy. Six percent were treated for postoperative hemorrhage, 2% for dehydration, and 11% for ENT pain within 14 days of surgery. Patients with comorbidities, prior peritonsillar abscess, or an increased number of antibiotic prescriptions in the past year were significantly more likely to develop complications. Three out of 4 patients with postoperative hemorrhage went to the ED (4.63% of all patients), and 50% had a procedural intervention (3.09% overall). The average cost associated with a tonsillectomy was $3832 if no complication. If there was a complication within 14 days, hemorrhage was the most expensive ($6388 vs $5753 for dehydration and $4708 for ENT pain)., Conclusions: Complications of adult outpatient tonsillectomies are common and may be associated with significant morbidity, health care utilization, and expenditures.

Zweifel and colleagues have previously proposed that proximity to death is a more important influence on health-care costs than age, suggesting that demographic change per se will not have a large impact on future aggregate health expenditure. However, issues of econometric methodology have led to challenges of the robustness of these findings. This paper revisits the analysis. Using a longitudinal hospital data set from Oxfordshire, England, the two-step Heckman model from the Zweifel study is first replicated, to find that neither age nor proximity to death have a significant effect on hospital costs. Econometric problems with the model are demonstrated, and instead a two-part model shows both age and proximity to death to have significant effects on quarterly hospital costs. Cost predictions, calculated with bootstrapped 95% confidence intervals, further demonstrate that while age may significantly affect quarterly costs, these cost changes are small compared to the tripling of quarterly costs that occurs with approaching death in the last year of life. The analyses show the importance of model selection to properly assess the determinants of health-care expenditures., (Copyright 2003 John Wiley & Sons, Ltd.)