Have rates of sinus surgery changed over the last 10 years?
Background: There are 17 million ambulatory care visits for sinusitis in the United States each year. Patients who do not improve with medical therapy may undergo sinus surgery rather than additional medical treatment. More than 250,000 sinus operations are performed annually.
Study design: Secondary data analysis of 94,152 observations for population-adjusted rates of ambulatory sinus surgery for all adults from 2000 to 2009.
Setting: State Ambulatory Surgery Database of Florida.
Synopsis: Between 2000 and 2009, there was a substantial decrease in the unadjusted proportion of patients who had surgery in a hospital setting versus a freestanding ambulatory surgery facility, and a substantial increase in the proportion of patients who had surgery with image guidance. Population-adjusted rates of sinus surgery cases increased over the study period: Frontal sinus procedure rates more than doubled, and rates of cases in which all four sinuses were treated tripled. Approximately 17% of the observed variance in sinus procedures performed during the study period was attributable to surgeon variation. Hospital location and male gender were predictors of number of sinus procedures per case. Over the last two decades, traditional sinus surgery techniques have been replaced with endoscopic techniques, so endoscopic training is now a routine part of residency training and surgical practice. Limitations of this study include a lack of information on disease severity, referral patterns, and surgeon case mix, and an inability to analyze clinical presentations and outcomes or distinguish unilateral from bilateral procedures.
Bottom line: Rates of sinus surgery increased over the study period, with more patients undergoing surgery and more procedures per surgical case. The strongest predictor was the individual surgeon.
Citation: Pynnonen MA, Davis MM. Extent of sinus surgery, 2000 to 2009: a population-based study. Laryngoscope. 2014;124:820-825.
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