Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.
Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, LA.
Int Forum Allergy Rhinol. 2020 Jun;10(6):755-761. doi: 10.1002/alr.22554. Epub 2020 Mar 26.
Endoscopic sinus surgery (ESS) is a variable combination of individual procedures. Cost estimates for ESS as a single entity have wide variation, likely influenced by variation in procedures performed. We sought to identify operative time, supply costs, and total procedure cost specific to the component procedure combinations comprising ESS.
Bilateral ESS cases at 13 Intermountain Healthcare facilities (2008 to 2016) were identified from a database with corresponding cost and time data. Procedure details were obtained by chart review. Least-squares (LS) means of cost (in 2016 US dollars) and time for specific procedures were obtained by multivariable gamma regression models.
Among 1477 bilateral ESS cases with 19 different procedure combinations, operative time ranged from 59.5 (95% confidence interval [CI], 48.6-73.0) minutes for total ethmoid to 147.1 (95% CI, 126.4-171.2) minutes for full ESS with maxillary and sphenoid tissue removal. Sphenoidotomy had lowest total and supply costs (in US dollars) of $2112 (95% CI, $1672-$2667) and $636 (95% CI, $389-$1040), respectively. Total cost was highest for full ESS with maxillary tissue removal at $4640 (95% CI, $4115-$5232). Supply cost was highest for full ESS with maxillary and sphenoid tissue removal at $2191 (95% CI, $1649-$2909).
Operative time and costs for ESS vary depending on the procedures performed, demonstrating the importance of procedure specificity in assessment of ESS time, cost, and, ultimately, value. These procedure-specific estimates of cost enable nonbinary valuation of ESS, appropriate for the multitude of procedure options intended to optimize individual outcomes.
内窥镜鼻窦手术（ESS）是各种单一手术的组合。ESS 作为单一实体的成本估算存在很大差异，这可能受到所施行手术的差异影响。我们旨在确定 ESS 各组成手术的手术时间、耗材成本和总手术成本。
从数据库中确定了 2008 年至 2016 年间 13 家山间健康医疗设施的双侧 ESS 病例，并附有相应的成本和时间数据。通过病历审查获取手术细节。通过多变量伽马回归模型获得特定手术的成本（以 2016 年美元计）和时间的最小二乘法（LS）平均值。
在 1477 例双侧 ESS 病例中，有 19 种不同的手术组合，手术时间范围从总筛窦手术的 59.5（95%置信区间[CI]，48.6-73.0）分钟到全 ESS 伴上颌窦和蝶窦组织切除的 147.1（95%CI，126.4-171.2）分钟。蝶窦切开术的总费用（美元）和耗材费用（美元）最低，分别为 2112（95%CI，1672-2667）和 636（95%CI，389-1040）。全 ESS 伴上颌窦组织切除的总费用最高，为 4640（95%CI，4115-5232）。全 ESS 伴上颌窦和蝶窦组织切除的耗材费用最高，为 2191（95%CI，1649-2909）。
ESS 的手术时间和成本取决于所施行的手术，这表明在评估 ESS 的时间、成本，最终价值时，手术的特异性非常重要。这些特定于手术的成本估算能够对 ESS 进行非二进制评估，适用于旨在优化个体结果的多种手术选择。
