Trends of ambulatory sinus surgery for chronic rhinosinusitis

We sought to examine the trends in rates and demographics of ambulatory endoscopic and open sinus surgery for chronic sinusitis over a 7-year period in the state of California.

Patient records with Current Procedural Terminology (CPT) codes for endoscopic or open sinus surgery, and diagnosis codes for chronic rhinosinusitis were extracted from the California Ambulatory Surgery Datasets from 2005 to 2011. Population-adjusted surgery rates were calculated as the number of surgeries per 100,000 California residents. Location of surgery was analyzed in 2 contexts: freestanding ambulatory surgery centers (ASCs) vs any hospital setting, and academic (university medical centers) vs nonacademic centers (ASCs and non-university hospitals combined). Patients' demographics were also examined.

A total of 91,984 sinus surgeries were performed during 2005 to 2011. The overall population-adjusted surgery rate declined 24%, from 38.9 to 29.6 (p = 0.004). Although the rates for both endoscopic and open surgeries declined, the percentage of endoscopic procedures increased from 87.3% to 92.5% of all surgeries (p = 0.002). Over the studied period, there was an increase in the proportion of sinus surgeries performed in hospitals (73.2% to 91.3%; p = 0.01), in academic centers (5.9% to 10.1%; p = <0.001), on patients >65 years (14.7% to 17.8%; p = 0.003), and on non-Caucasians (10.3% to 16.9%; p < 0.001). Gender distribution remained unchanged (51% male; p = 0.25).

The overall rate of ambulatory sinus surgery in California declined over the study period. A shift from open to endoscopic procedures, from ASCs to hospitals, and from nonacademic to academic centers was observed. Further investigation of the observed trends may be warranted.