Dramatic Increase in Endoscopic Sinus Surgery Since 2000

What are the geographic and temporal trends in sinus surgery and frontal sinus surgery in the United States?

Background: The last 30 years have seen a dramatic change in the frequency and types of surgery performed for chronic rhinosinusitis. While introduction of endoscopic techniques in the 1980s led to a marked decline in open procedures and increase in endoscopic approaches, the impact on treatment patterns of similar introductions of new technology, including balloon catheter dilation in the early 2000s, is unclear.

Study design: Retrospective review of a nationwide database of endoscopic sinus surgery procedures drawn from the Medicare Part B data files from 2000 to 2011 using current procedural terminology (CPT) codes and geographic data. In addition, 2010 U.S. census data was analyzed to determine populations of patients older than 65 in different states, while surgical society websites were analyzed to determine the number of practicing otolaryngologists and rhinologists in different areas.

Setting: U.S. population older than 65 years.

Synopsis: Open approaches to the sinuses decreased by one third during the study period, while endoscopic approaches increased nearly three-fold to 19,262 annually, with the greatest increase from 2007 to 2011. While the overall greatest number of procedures was performed in the South Atlantic states, when controlled for population, the East South Central states had the greatest number. Overall, endoscopic ethmoid surgery increased 50.7% from 2000 to 2011, while endoscopic maxillary surgery increased 96.2%, sphenoid surgery 106.4%, and frontal surgery 198%. Controlling for population, Washington, D.C., had the greatest rate of frontal sinus surgery of all states in 2011 at 18 to 20 procedures per 10,000 people older than 65 years of age; combined, the East South Central region exhibited the highest rate of procedures, at seven to eight procedures per 10,000 people older than 65. An inverse correlation was seen between the number of frontal sinus procedures normalized to population and the number of fellowship trained rhinologists in that region.

Bottom line: Endoscopic sinus surgery has increased dramatically since 2000, with the greatest changes seen in frontal sinus surgery. Marked variation is seen among geographic regions, with the highest rates in the East South Central states when controlling for population. Presence of fellowship-trained rhinologists inversely correlates to the numbers of frontal sinus surgeries performed in a region.

Reference: Svider PF, Sekhsaria V, Cohen DS, et al. Geographic and temporal trends in frontal sinus surgery. Int Forum Allergy Rhinol. 2015;5:46-54.

—Reviewed by Brent Senior, MD