对于伴有和不伴有鼻息肉的慢性鼻-鼻窦炎，鼻窦手术的实施频率如何？
How often is sinus surgery performed for chronic rhinosinusitis with versus without nasal polyps?
作者信息
Ference Elisabeth H, Suh Jeffrey D, Tan Bruce K, Smith Stephanie Shintani
机构信息
From the Rick and Tina Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California.
Department of Head and Neck Surgery, David Geffen School of Medicine of the University of California, Los Angeles, Los Angeles, California.
出版信息
Am J Rhinol Allergy. 2018 Jan 1;32(1):34-39. doi: 10.2500/ajra.2018.32.4495.
BACKGROUND
There currently are no data on the relative frequency of endoscopic sinus surgeries (ESS) performed for chronic rhinosinusitis with nasal polyposis (CRSwNP) versus chronic rhinosinusitis without nasal polyposis (CRSsNP) in the United States.
OBJECTIVES
To compare the rate of surgical interventions for CRSwNP and CRSsNP.
METHODS
Cases identified by CPT codes were extracted from the 2009-2011 State Ambulatory Surgery Databases for California, Florida, Maryland, and New York. Patient demographics, extent of surgery, mean charges, and operating room (OR) time were compared.
RESULTS
A total of 97,228 ESS cases were performed in the four states; 29.3% of surgeries were for patients with CRSwNP, 66.0% of patients with CRSsNP, and 4.8% for other indications. The proportion of ESS for CRSwNP varied across states, with California having the highest percentage (34.6%) and Maryland having the lowest (26.4%) (p < 0.0001). Patients with Medicaid (33.8%) and Medicare (32.2%) had higher rates of surgery for CRSwNP compared with patients with private insurance (29.9%) (p < 0.001). Surgeons who performed a higher volume of sinus surgery compared to lower volume surgeons performed a lower percentage of surgery for CRSwNP (24.4 versus 33.5%; p < 0.001). ESS cases for CRSwNP were more extensive (relative risk of four sinus surgeries of 1.88; p < 0.0001), used image guidance more frequently (relative risk, 1.39; p < 0.0001), and were less likely to include a balloon procedure (relative risk, 0.69; p < 0.0001). Patients with CRSwNP had longer OR times (ESS that involved all four sinuses took 14 minutes longer) (p < 0.0001), but no difference in charges compared with patients with CRSsNP who underwent a similar extent of surgery.
CONCLUSION
Almost 30% of ESS were performed for CRSwNP, and these cases were, on average, more extensive, used more OR time, and more often used image guidance than surgeries for CRSsNP. The rate of surgery performed for CRSwNP varied based on geography, payer, and surgical volume, which indicted that patient selection impacted surgical management.
背景
目前在美国，尚无关于针对伴有鼻息肉的慢性鼻-鼻窦炎（CRSwNP）与不伴有鼻息肉的慢性鼻-鼻窦炎（CRSsNP）进行内镜鼻窦手术（ESS）的相对频率的数据。
目的
比较CRSwNP和CRSsNP的手术干预率。
方法
从加利福尼亚州、佛罗里达州、马里兰州和纽约州2009 - 2011年的州门诊手术数据库中提取由现行程序编码（CPT）识别的病例。比较患者人口统计学特征、手术范围、平均费用和手术室（OR）时间。
结果
这四个州共进行了97228例ESS手术；29.3%的手术针对CRSwNP患者，66.0%针对CRSsNP患者，4.8%针对其他适应症。CRSwNP的ESS比例在各州有所不同，加利福尼亚州比例最高（34.6%），马里兰州最低（26.4%）（p < 0.0001）。与拥有私人保险的患者（29.9%）相比，医疗补助（Medicaid）患者（33.8%）和医疗保险（Medicare）患者（32.2%）的CRSwNP手术率更高（p < 0.001）。与手术量较低的外科医生相比，手术量较高的鼻窦外科医生进行的CRSwNP手术比例更低（24.4%对33.5%；p < 0.001）。CRSwNP的ESS病例范围更广（四次鼻窦手术的相对风险为1.88；p < 0.0001），更频繁地使用图像引导（相对风险，1.39；p < 0.0001），且不太可能包括球囊手术（相对风险，0.69；p < 0.0001）。CRSwNP患者的手术室时间更长（涉及所有四个鼻窦的ESS手术时间长14分钟）（p < 0.0001），但与接受类似手术范围的CRSsNP患者相比，费用没有差异。
结论
近30%的ESS手术是针对CRSwNP进行的，与CRSsNP手术相比，这些病例平均范围更广，使用的手术室时间更多，且更常使用图像引导。CRSwNP的手术率因地理位置、付款方和手术量而异，这表明患者选择影响手术管理。
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