Ference Elisabeth H, Sindwani Raj, Tan Bruce K, Chandra Rakesh K, Kern Robert C, Conley David, Smith Stephanie Shintani
Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Am J Rhinol Allergy. 2016 Sep;30(5):360-6. doi: 10.2500/ajra.2016.30.4350.
The advent of endoscopic sinus surgery has created an exciting interface between rhinology and ophthalmology in the area of orbital and optic nerve decompression Objectives: (1) To study the utilization of open versus endoscopic medial orbital decompression based on geography and indication, (2) to describe the demographics of the patient populations who underwent these different techniques, and (3) to compare outcomes, including mean charges and operating room (OR) times Methods: Cases identified by Current Procedural and Terminology codes were extracted from the California, Florida, Maryland, and New York State Ambulatory Surgery Databases from 2009 to 2011. Patient demographics, diagnoses, mean charge, and OR time were compared.
A total of 1009 patients underwent orbital decompression; 93.0% of cases involved the medial wall only; 22.9% of medial decompressions were performed endoscopically, 74.5% were open, and 2.6% were via combined approach. Eighty percent of patients had thyroid eye disease. Analyses adjusted for sex, age, race, state, and diagnosis found that surgeries for infection (N = 47) were more likely to be performed endoscopically compared with procedures for other diagnoses (N = 962) (odds ratio 5.27 [2.67-10.40], p < 0.001). Patients in Florida were more likely to undergo endoscopic decompression compared with patients in California (odds ratio 2.35 [1.42-3.62]). The difference in median charge for endoscopic ($13,119) versus open ($11,291; p = 0.085) procedures was not significant on bivariate analysis but was significant on multivariate analysis (p = 0.04). The median OR time for open procedures was, on average, 33 minutes shorter (endoscopic, 132 minutes; open, 98 minutes; p ≤ 0.001) on bivariate analysis but was not significantly different when controlling for covariables (p = 0.08).
In the study sample, endoscopic orbital decompression was performed in 22.9% of patients, with significant variation in surgical technique based on geography and indication. Procedures that used endoscopic compared with open decompression techniques had no significant difference in charge on bivariate analysis. The OR time for open procedures was shorter on bivariate but not on multivariate analysis. Further research is required regarding the relative effectiveness of open versus endoscopic surgical techniques for various indications.
鼻内镜鼻窦手术的出现，在眼眶及视神经减压领域，为鼻科学和眼科学创造了一个令人兴奋的交叉点。目的：（1）基于地域和适应症，研究开放式与内镜下内侧眼眶减压术的应用情况；（2）描述接受这些不同技术治疗的患者人群的人口统计学特征；（3）比较手术结果，包括平均费用和手术室（OR）时间。方法：通过当前手术操作和术语编码识别出的病例，从2009年至2011年加利福尼亚州、佛罗里达州、马里兰州和纽约州的门诊手术数据库中提取。对患者的人口统计学特征、诊断结果、平均费用和手术室时间进行比较。
共有1009例患者接受了眼眶减压术；93.0%的病例仅涉及内侧壁；22.9%的内侧减压术采用内镜手术，74.5%采用开放式手术，2.6%采用联合手术方式。80%的患者患有甲状腺眼病。在对性别、年龄、种族、州和诊断进行调整后的分析发现，与其他诊断的手术（N = 962）相比，感染相关手术（N = 47）更有可能采用内镜手术（优势比5.27 [2.67 - 10.40]，p < 0.001）。与加利福尼亚州的患者相比，佛罗里达州的患者更有可能接受内镜减压术（优势比2.35 [1.42 - 3.62]）。内镜手术（13,119美元）与开放式手术（11,291美元；p = 0.085）的中位费用差异在双变量分析中不显著，但在多变量分析中显著（p = 0.04）。在双变量分析中，开放式手术的中位手术室时间平均短33分钟（内镜手术132分钟；开放式手术98分钟；p ≤ 0.001），但在控制协变量时差异不显著（p = 0.08）。
在研究样本中，22.9%的患者接受了内镜眼眶减压术，手术技术因地域和适应症存在显著差异。在内镜手术与开放式减压技术的比较中，双变量分析显示费用无显著差异。双变量分析中开放式手术的手术室时间较短，但多变量分析中并非如此。对于各种适应症，开放式与内镜手术技术的相对有效性还需要进一步研究。
