There were 62,700 procedures performed between 2010 and 2012, compared to 50,700 procedures between 2014 and 2016, amounting to a 19% decrease. The 19% drop was comparable between military and civilian cases, Dr. Adams reported.
Explore This Issue
August 2023In 2018, researchers at Weill Cornell Medicine in New York City reported that 16% more cases of AOM and OME were identified in 2014, after the guidelines were published, as compared with 2012, noted Dr. Adams (Otolaryngol Head Neck Surg. 2018;159:914–919). Studies in 2019 and 2023 also examined the number of tympanostomy tube insertions before and after the guidelines were published (Int J Pediatr Otorhinolaryngol. 2019;122:40–43; Otolaryngol Head Neck Surg. [Published online ahead of print Feb. 5, 2023]).
“We know that increased adherence to the guidelines decreases the number of operative procedures,” said Dr. Adams, “thereby decreasing the operative risk for otorrhea, persistent perforation, and repeat tube placement.”
Lower Socioeconomic Status, Medicaid Linked to Lower Chance of OSA Surgery
People with obstructive sleep apnea (OSA) who are on Medicaid or state-subsidized insurance, and those in lower socioeconomic tiers, were less likely to undergo surgery for their condition. The findings, from an analysis of data from Kaiser Permanente Northern California, give insight into the patients who might be more at risk of not obtaining procedures that could help them.
“It’s estimated that 26% of adults between age 30 and 70 have OSA,” said Nikolas Block-Wheeler, MD, MS, an otolaryngology–head and neck surgery specialist and researcher at the Kaiser Permanente Oakland Medical Center. “Its effects are far-reaching and associated with systemic disease.” Up to 50% of those prescribed CPAP will stop using it, he said, and only about 1.3% of the OSA patient population will have soft-tissue surgery. “Very little data exist regarding demographic characteristics or potential disparities in access to surgical care for this population,” he said.
The analysis looked at the adult OSA population treated in the Kaiser Northern California system between 2009 and 2016, excluding those treated with hypoglossal nerve stimulation—which was not yet widely implemented during this period—as well as those receiving tracheostomy and bariatric surgery.
Those not receiving surgery tended to be older, with an average age of 55, compared to 40 for those receiving surgery. A lower proportion of those not receiving surgery were male—62% compared to 67%. Those MDnot receiving surgery also had a higher BMI—34.2 versus 32.0—and had a lower comorbidity burden, with 53% having a 0 score on the Charlson Comorbidity Index, versus 74.1% for those undergoing sleep surgery (P < 0.0001 for all).