In the current UK model, NHS care is free at point of access so there are no perceived economic barriers to seeking attention with postoperative complications. This study from the US examines surgical and emergency room databases from across California, Iowa, Florida and New York for 2010-11 assessing revisits within 14 days of tonsillectomy in adults. Common presenting symptoms were pain, bleeding and fever / nausea / vomiting / dehydration (FVND). Associations with age, sex, race, median household income and co-morbidity scores were analysed. Ethnicity was identified as White, Black, Hispanic or Other. 17836 tonsillectomies were performed (63.7% female, median age 29.0). Revisit rates for bleeding was 5.1%, FVND was 1.5% and pain 2.8%. Female sex was associated with lower rates of revisit for bleeding but higher rates for pain than males. Similar disparities were seen for revisit rates for pain and FVND between ethnic groups. Lower household income was associated with higher rates of revisit for pain. Multivariate analysis of revisits for bleeding reveals that only female sex was associated with a decreased bleeding rate, the other demographic factors did not impact significantly. Female sex also increased odds for revisits with pain or FVND. Increasing household income decreased the likelihood of visits for pain. Black or Hispanic ethnicity increased likelihood for revisit with pain relative to white patients but did not alter rate for revisits for FNVD. By undertaking a multi-state, cross sectional analysis, this paper highlights that statistically significant disparities exist between groups in their experience of postoperative complications and their healthcare seeking behaviour. Postoperative recovery from tonsillectomy is often difficult for patients. Identification of populations at elevated risk of complications can help to reduce the disparity and relieve some of the associated costs of revisits to the healthcare economy and to the patient.

Healthcare disparities in revisits for complications after adult tonsillectomy.
Bhattacharyya N.
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Rohit Verma

North West Deanery, UK.

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