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Tympanostomy Tube Placement vs Medical Management for Recurrent Acute Otitis Media in TRICARE-Insured Children.

Authors
  • Raol, Nikhila1, 2
  • Sharma, Meesha1
  • Boss, Emily F3, 4
  • Jiang, Wei1
  • Scott, John W1
  • Learn, Peter5
  • Weissman, Joel S1
  • 1 1 Center for Surgery and Public Health, Harvard Medical School and Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, Massachusetts, USA.
  • 2 2 Department of Otolaryngology, Emory University, Atlanta, Georgia, USA. , (Georgia)
  • 3 3 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • 4 4 Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA.
  • 5 5 Department of Surgery, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
Type
Published Article
Journal
Otolaryngology
Publisher
SAGE Publications
Publication Date
Nov 01, 2017
Volume
157
Issue
5
Pages
867–873
Identifiers
DOI: 10.1177/0194599817707718
PMID: 28535362
Source
Medline
Keywords
License
Unknown

Abstract

Objective To compare number of infections and health care utilization in children insured by TRICARE with recurrent acute otitis media (RAOM) managed surgically with tympanostomy tube (TT) placement compared with those managed medically. Study Design Retrospective matched cohort study. Setting TRICARE claims database from 2006 to 2010. Subjects and Methods We matched TRICARE beneficiaries ≤5 years of age diagnosed with RAOM who underwent TT placement with those managed medically using 1:1 coarsened-exact matching on age, sex, race, sponsor rank, and region. We used multivariable negative binomial regression to compare number of infections and health care utilization at 1 and 2 years. Outcomes were adjusted for rate of infection before treatment for RAOM, season of either TT placement or establishment of candidacy for TT placement, and comorbidities. Results Among 6659 pairs identified at 1-year follow-up, the TT group had fewer infections (1.96 vs 2.18, P < .001) and oral antibiotic prescriptions (1.52 vs 1.67, P < .001) but more visits to primary care physicians (4.36 vs 4.06, P < .0001) and otolaryngologists (1.21 vs 0.44, P < .0001) compared with the medically managed group. At 2-year follow-up, the benefits of TT placement were no longer seen. Conclusion TT placement for RAOM is associated with fewer infections and oral antibiotic prescriptions in the first year after surgery but more doctor visits. Benefits of TT placement do not appear to extend through the second year. Future research should investigate costs associated with TT placement vs medical management, as well as real-time health care utilization with impact on patient symptoms and quality of life.

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