Costs of Sleep Endoscopy With Same-Day Versus Staged Surgery for Pediatric Obstructive Sleep Apnea.

Abstract

Objective: To compare the costs of staged versus same-day surgery after drug-induced sleep endoscopy (DISE) for pediatric obstructive sleep apnea (OSA).

Study design: Retrospective cohort study.

Setting: Single tertiary-care center in the United States from 2017 to 2023.

Methods: Patients were grouped into two surgical pathways: (1) DISE with same-day OSA surgery and (2) DISE with staged OSA surgery. Nonparametric tests and log-normal models were used to compare insurance payments, out-of-pocket costs, and hospital costs between pathways and to evaluate predictors of hospital costs.

Results: A total of 57 pediatric OSA patients with a mean (standard deviation [SD]) age of 10.8 (4.0) years were included. The mean insurance payments, out-of-pocket costs, and hospital costs were $12,158 (SD 10,412), $340 (SD 1168), and $11,965 (SD 9615), respectively. Patients who underwent DISE with staged OSA surgery had significantly higher hospital costs than those who underwent DISE with same-day OSA surgery (mean difference $8995, 95% CI 3528-14462; P < .001), and this effect persisted in an adjusted log-normal model (coefficient 0.82, 95% CI 0.34-1.30; P = .001). There were no significant differences in insurance payments or out-of-pocket costs by surgical pathway.

Conclusion: DISE with staged OSA surgery conferred higher hospital costs than DISE with same-day OSA surgery but did not increase financial burden on patients or payers. This finding has important implications for resource utilization for a common pediatric condition.