Existence of Important Variations in the United States in the Treatment of Pediatric Mastoiditis

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.