Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI.
Int Forum Allergy Rhinol. 2015 Jan;5(1):46-54. doi: 10.1002/alr.21425. Epub 2014 Nov 3.
The purpose of this study was to evaluate geographic and temporal trends in frontal sinus surgery procedures.
Medicare Part B data files from 2000 to 2011 were examined for temporal trends in various frontal sinus procedures, and the most recent year containing geographic information (2010) was evaluated for Current Procedural Terminology (CPT) code use. Additionally, nationwide charges per procedure were recorded. Regional populations of individuals ≥ 65 years old were obtained from the 2010 U.S. Census, and surgical society websites were used to determine the number of practicing rhinologists and otolaryngologists in each region.
The use of open approaches declined by one third, while endoscopic procedures went from 6463 to 19262 annually, with the most marked increases occurring from 2006 through 2011. Geographic variation was noted, with practitioners in the South Atlantic states performing the greatest number of endoscopic procedures in 2010, whereas the East South Central states had the greatest number when controlling for population. There was an inverse relationship between endoscopic procedures performed and number of fellowship-trained rhinologists (controlling for regional populations) (R(2) = 0.66). The first year frontal sinus ballooning had a unique CPT code illustrated decreased reimbursements for non-balloon endoscopic surgery ($609) relative to balloon approaches ($2635).
Declines in open frontal sinus surgery and marked increases in endoscopic approaches have potential implications for residency training. Potential reasons for marked increases in endoscopic approaches include the rising popularity of balloon technologies, although this is speculative. Geographic variation exists in frontal sinus surgery patterns, including an inverse relationship between endoscopic approaches and the number of fellowship-trained rhinologists.
本研究旨在评估额窦手术程序的地域和时间趋势。
对 2000 年至 2011 年医疗保险 B 部分数据文件进行了研究，以了解各种额窦手术程序的时间趋势，并评估了包含地理信息的最近一年（2010 年）的当前操作术语（CPT）代码使用情况。此外，还记录了每个程序的全国收费。从 2010 年美国人口普查中获得了年龄在 65 岁及以上的个人的区域人口数据，并使用外科医师协会网站确定了每个区域的执业鼻科医生和耳鼻喉科医生人数。
开放式方法的使用减少了三分之一，而内窥镜手术从每年 6463 例增加到 19262 例，增幅最大的是 2006 年至 2011 年。注意到地域差异，南大西洋各州的从业者在 2010 年进行了最多的内窥镜手术，而东南中各州在控制人口后则进行了最多的手术。内窥镜手术的数量与接受 fellowship 培训的鼻科医生数量呈反比（控制区域人口）（R²=0.66）。额窦球囊扩张的第一年，具有独特 CPT 代码的非球囊内窥镜手术的报销费用相对较低（609 美元），而球囊方法（2635 美元）。
开放式额窦手术的减少和内窥镜方法的显著增加可能对住院医师培训产生影响。内窥镜方法显著增加的潜在原因包括球囊技术的日益普及，尽管这只是推测。额窦手术模式存在地域差异，包括内窥镜方法与接受 fellowship 培训的鼻科医生数量之间的反比关系。
