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The use and cost-effectiveness of intraoperative navigation in pediatric sinus surgery
Nandini Govil1, Amber D Shaffer2, Amanda L Stapleton2,3
1Division of Pediatric Otolaryngology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia.
Insights
Intraoperative navigation (IN) in pediatric sinus surgery did not reduce complications or revision rates. While used for training, IN increased surgical time and was not cost-effective for chronic cases.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Medical Technology Assessment
Background:
- Consensus statements exist for adult intraoperative navigation (IN) in sinus surgery, but pediatric guidelines are lacking.
- Intraoperative navigation (IN) is a technology used to guide surgical procedures.
- Assessing the utility and cost-effectiveness of IN in pediatric sinus surgery is crucial.
Purpose of the Study:
- To evaluate demographic and operative factors associated with IN use in pediatric sinus surgery.
- To determine the cost-effectiveness of IN in pediatric sinus surgery.
- To identify potential indications for IN in pediatric sinus surgery.
Main Methods:
- Retrospective chart review of 119 pediatric patients undergoing sinus surgery (2003-2016).
- Analysis of demographic, surgical factors, and costs associated with IN use.
- Calculation of incremental cost-effectiveness ratio (ICER) for different patient groups.
Main Results:
- Sixty patients underwent surgery with navigation (wIN) and 59 without (sIN).
- IN was associated with more complex surgeries, increased surgical time (31.5 minutes), and use by attending surgeons with trainees.
- IN was cost-effective for acute disease ($22,378 per year without revision) but not for chronic disease (-$3,583).
Conclusions:
- Intraoperative navigation (IN) did not decrease complications or revision surgery rates in pediatric sinus surgery.
- IN was primarily utilized as an educational tool or to enhance surgeon confidence.
- Further research is needed to establish clear indications for IN in pediatric sinus surgery.
Objectives/Hypothesis:
There are consensus statements about when to use intraoperative navigation (IN) in adult sinus surgery. However, no corresponding guidelines exist for pediatrics. Our objectives included: 1) assess the demographic and operative factors associated with IN use and 2) calculate the cost-effectiveness of IN use.
Study Design:
Retrospective chart review.
Methods:
One hundred nineteen pediatric patients undergoing sinus surgery between 2003 and 2016 were reviewed. Demographic and surgical factors were collected from medical records. Costs associated with use of IN were gathered from billing records.
Results:
Of the 119 patients, 60 underwent sinus surgery with navigation (wIN) and 59 underwent surgery without navigation (sIN). Children in the wIN group had more complex surgeries with more sinuses opened (P = .008). Individual attending surgeon and presence of trainee were associated with increased use of IN (P < .001 for both). IN resulted in a median of 31.5 minutes longer surgical time (P < .001). IN had an incremental cost/effectiveness ratio (ICER) of $22,378 for each year without revision surgery for patients with acute disease. However, for patients with chronic disease, the probability of undergoing a second surgery was the same between wIN and sIN groups, and navigation was not cost-effective (ICER of -$3,583).
Conclusions:
IN use did not decrease complications or rates of revision surgery. It was used primarily as an educational tool or to increase confidence in intraoperative identification of landmarks. However, the use of IN added surgical time and was not cost-effective. Further research must be completed to determine when IN is indicated in pediatric sinus surgery.
Level Of Evidence:
4 Laryngoscope, 2019.
