Ference EH, et al. - A comparative scrutiny was carried out of the rate of surgical interventions for chronic rhinosinusitis with nasal polyposis (CRSwNP) and chronic rhinosinusitis without nasal polyposis (CRSsNP) in the United States. The results reported that approximately 30% of endoscopic sinus surgeries (ESS) were performed for CRSwNP. On average, such cases were discovered to be more extensive, used more operating room (OR) time, and more often used image guidance when compared to surgeries for CRSsNP. Findings disclosed variation in the rate of surgery performed for CRSwNP, on the basis of geography, payer, and surgical volume. The data pointed out that patient selection exerted an impact on the surgical management.

Methods

• Using the 2009-2011 State Ambulatory Surgery Databases for California, Florida, Maryland, and New York, researchers extracted cases that were identified by CPT codes.
• A comparative evaluation was carried out of the patient demographics, extent of surgery, mean charges and operating room (OR) time.

Results

• It was noted that 97,228 ESS were performed in the four states; wherein 29.3% of surgeries were for patients with CRSwNP, 66.0% of patients with CRSsNP, and 4.8% for other indications.
• Findings reported variation in the proportion of ESS for CRSwNP across states.
• California presented with the highest percentage (34.6%) and Maryland with the lowest (26.4%) (p < 0.0001).
• Higher rates of surgery for CRSwNP were estimated in patients with Medicaid (33.8%) and Medicare (32.2%) than patients with private insurance (29.9%) (p < 0.001).
• Herein, surgeons who performed a higher volume of sinus surgery compared to lower volume conducted a lower percentage of surgery for CRSwNP (24.4 vs 33.5%; p < 0.001).
• Data pointed out a greater extensive nature of ESS cases for CRSwNP (relative risk of four sinus surgeries of 1.88; p < 0.0001).
• Such cases used image guidance more frequently (relative risk, 1.39; p < 0.0001) and exhibited a lesser tendency of balloon procedure inclusion (relative risk, 0.69; p < 0.0001).
• Compared to patients with CRSsNP who underwent a similar extent of surgery, longer OR times (ESS that involved all four sinuses took 14 minutes longer) (p < 0.0001) were disclosed among patients with CRSwNP.
• However, there were no variations in charges.