J. N. Cooper1, B. Iten1, C. A. Elmaraghy2 1The Research Institute At Nationwide Children’s Hospital,Center For Surgical Outcomes Research,Columbus, OH, USA 2Nationwide Children’s Hospital,Department Of Otolaryngology-Head And Neck Surgery,Columbus, OH, USA
Introduction: Myringotomy with pressure equalization tube (PET) placement is the most common ambulatory surgical procedure performed in children. However, rates of this procedure vary widely across geographic regions and sociodemographic groups in the US. It is unclear to what extent this variation is explained by patient and family characteristics versus health system characteristics. One health system factor that may influence PET utilization is the availability of freestanding ambulatory surgery centers (ASCs). Previous studies have suggested that freestanding, physician-owned ASCs can drive the overutilization of elective surgical procedures in adults. We aimed to determine whether access to freestanding, non-hospital affiliated ASCs is associated with higher PET placement rates in Florida and New York, two states with similar population sizes but very different numbers of ASCs.
Methods: We studied children under age 5 who underwent outpatient PET placement in New York or Florida in 2010-2014. Data came from the Healthcare Cost and Utilization Project State Ambulatory Surgery Databases, which contain all outpatient surgeries at hospital-affiliated and non-hospital-affiliated facilities. Population size estimates and other population characteristics at the zip code level came from the American Community Survey. Rates of PET placement were calculated at the state and zip code level. Weighted linear regression models were used to assess the association between the proportion of PET procedures performed in non-hospital-affiliated ASCs and the rate of PET placement in a zip code.
Results: A total of 106 non-hospital affiliated ASCs in Florida and 29 in New York performed PET placement in young children in 2010-2014. The rate of PET placement was 9.1 procedures per 100 children in Florida and 4.7 procedures per 100 children in New York. The correlation between the zip code level proportion of PET procedures performed in a non-hospital-affiliated ASC and the rate of PET placement was stronger in Florida (r=0.44, p<0.001) than New York (r=0.05, p=0.06). However, after adjustment for zip code level urban/rural status, an index of socioeconomic status, and the proportion of residents of non-Hispanic White race, greater utilization of non-hospital affiliated ASCs was associated with higher rates of PET placement in both states. In Florida, children residing in zip codes in the top tertile of non-hospital affiliated ASC utilization had 68.4% higher PET utilization than children from zip codes in the bottom tertile. In New York, residing in a zip code with any utilization of non-hospital affiliated ASCs was associated with 10.2% higher PET utilization.
Conclusion: Rates of PET placement are higher in communities that utilize non-hospital affiliated ASCs. Future research should evaluate whether recently released guidelines for the use of PET decrease variability in its utilization. However, policies that promote more appropriate utilization may be also needed.