Operative utilization of balloon versus traditional endoscopic sinus surgery

Abstract

Objectives To study the utilization of balloon catheter dilation(BCD) compared to traditional endoscopic surgery(ESS). Methods Cases identified by CPT codes as BCD(2,717) or traditional ESS(31,059) were extracted from the State Ambulatory Surgery Databases 2011 for California, Florida, Maryland and New York. Patient demographicss, surgical center and surgeon volume, mean charge and OR time were compared. Results 33,776 patients underwent sinus surgery in the included states in 2011. 4.6% of maxillary, 5.6% of sphenoid and 13.9% of frontal procedures were performed using BCD. Adjusted analyses found increased use of BCD in patients with chronic diseases(p<0.001). Patients who had a limited sinus surgery were less likely to have BCD compared to patients who had all 4 sinuses instrumented(p<0.001). Surgeons who performed a medium[odds ratio 1.38(1.14–1.65)] or high[odds ratio 1.71(1.42–2.07)] volume of ESS were more likely to use BCD compared to those who performed a low volume(p <0.001), however among surgeons who utilized BCD there was minimal relationship between the percentage of surgeries performed with BCD and the surgeon's total number of cases(R squared=0.055). Compared to traditional ESS, the median charges for maxillary/ethmoid procedures(Mini-ESS) involving BCD were approximately $4,500(p<0.001) and maxillary/ethmoid/sphenoid/frontal procedures(Pan-ESS) were approximately $2,950(p=0.003) greater, while the median OR time involving BCD was 8 minutes less for Mini-ESS procedures(p=0.01) but not statistically different for Pan-ESS procedures(p=0.58). Conclusions In the study sample, balloon technology was used in 8.0% of ESS cases in 2011. Procedures using BCD were on average more expensive compared to traditional ESS procedures, with minimal decrease in OR time. Level of Evidence 2c

Balloon dilation of sinus ostia in the Department of Defense: Diagnoses, actual indications, and outcomes

“…Over the past decade, BCD of sinus ostia has gained widespread attention and increased utilization. Ference et al documented that >8% of all endoscopic sinus surgeries (ESS) in 2011 employed BCD . A recent survey of members of the American Rhinologic Society (ARS) indicated that otolaryngologists “are more accepting of this technology now, compared with 5 years ago, and many of them believe that their use of BCT [balloon catheter technology] will increase in the future.” This increase in utilization may be attributed to a variety of factors, including positive clinical trials/studies, in‐office applicability, and lucrative financial reimbursements .…”

How Often is Sinus Surgery Performed for Chronic Rhinosinusitis with versus without Nasal Polyps?

“…These states were selected to gain a wide geographic distribution. 15,16 SASD is a product of the Healthcare Cost and Utilization Project (HCUP), conducted by the federal Agency for Healthcare Research and Quality, and the sources of the data are the specific states that submit data to HCUP. 17 The data bases capture all hospital-based ambulatory surgery encounters in all four states and, in addition, all freestanding ambulatory surgery center encounters in Florida, California, and New York.…”

Patient and surgeon factors explain variation in the frequency of frontal sinus surgery

“…Gender differences have been found in ESS. Ference et al showed that women were more likely to undergo ESS combined with balloon sinus dilation (52.74% vs. 47.26% for men) . Martin et al reviewed the National Survey of Ambulatory Surgery (NSAS) database from 1994 to 1996, and found that women accounted for 52.8% of patients who underwent ESS .…”

“…Some of the variation in resource utilization and in patient outcomes in sinus disease may be explained by patient demographic factors or provider attributes. Gender has been shown to play a role in treatment, as male patients have more extensive ESS and are also less likely to receive balloon catheter dilation . These discrepancies may be related to a difference in disease severity due to hormonal differences.…”