(457) Socioeconomic Bias in Pediatric Adenotonsillectomy Patients by Surgery Location

Introduction: Adenotonsillectomies (T&As) are commonly performed in the outpatient setting, including both hospital-based facilities (HBFs) and ambulatory surgery centers (ASCs). Our study aimed to compare safety and efficiency of T&As between HBFs and ASCs, with a particular aim to describe socioeconomic bias (household income, race/ethnicity) in operative site selection.

Methods: Retrospective cohort study that enrolled 295 pediatric T&A patients from January through July 2020 at a tertiary care pediatric hospital and 2 nearby ASCs. Sociodemographic variables (race, ethnicity, and median household income) were collected via chart review. Outcomes included postoperative complications and length of procedure. Wilcoxon rank-sum test evaluated median household income and procedure duration. Pearson’s Chi-square test compared race and ethnicity. A logistic regression model controlling for surgery center type, age, and sex compared complication rates.

Results: There was a difference in median household income with a median of $59,745 at the HBF and $53,604 at the ASCs (F=4.78, p=0.03). Distributions of race (p < 0.001) and ethnicity (p=0.002) differed based on location. Length of procedure differed (F=24.3, p< 0.001) with ASCs requiring less time. In the immediate postoperative period, there were 3 complications at the HBF and 0 complications at the ASCs. In the 30 day-postoperative period, there were 12 and 14 complications at the HBF and ASCs, respectively. There was no difference between complication rates at each facility type when controlling age (p=0.0565) or sex (p=0.7411).

Conclusions: While previous studies found that patient populations treated at ASCs have higher household incomes that those treated at HBFs, our analysis demonstrated the opposite for this population. An important consideration is COVID-19 pandemic-related resource constraints which favored directing patients to right-care, right-location care which potentially neutralized previously reported bias towards caring for wealthier children in ASCs. T&As completed in ASCs were as safe and more efficient than those completed at HBF.