OBJECTIVES: Tympanostomy tube (TT) placement is the most common ambulatory surgery performed on children with otitis media (OM) in the US. Post-TT complications, recurrent tube otorrhea, and recurrent OM require follow-up and treatment; otolaryngologists report that care is often, and inappropriately, sought in the emergency department (ED). The objective is to evaluate ED utilization in pediatric patients with TT.
METHODS: Medical insurance claims data for pediatric patients (less than or equal to 17 years) who underwent TT surgery between 01Jan2010 and 31Dec2013 and had 360 days of continuous enrollment were included. The main endpoint was the proportion of patients with ≥ 1 ED encounters within 360 days post-TT placement, both all-cause and ear-related ED visits (e.g., for otorrhea, OM, otalgia). Differences between Medicaid-enrolled and commercially insured patients were analyzed.
RESULTS: A total of 237,072 patients met the inclusion criteria (88,778 Medicaid and 148,294 commercial). At 360 days, the overall rate of all-cause ED visits was 31.1%, representing 41.3% in Medicaid vs 24.9% in commercial populations (p less than 0.0001). The overall rate of ear-related ED visits was 3.9%; an over three-fold greater rate was seen in the Medicaid vs commercial population (6.9% vs 2.1%, p less than 0.0001).
CONCLUSIONS: Within a year of surgery, nearly one-third of patients with TT visited the ED. Medicaid-enrolled patients visited the ED three times more often than commercially insured patients, indicating the need for better access to appropriate levels of care for the Medicaid popluation. Further research is needed to elucidate the substantial rate of ED utilization in this pediatric population and the reason for the disparity between all-case and ear-related ED visits. Health care decision makers should be aware of the inappropriate utilization of the ED to manage non-emergency conditions.
