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Published on: June 20, 2018
Septoplasty Revision Rates in Pediatric vs Adult Populations
Jay P Shah1, Gun Min Youn1, Eric X Wei2
1Stanford University School of Medicine, Stanford, California.
Insights
Pediatric septoplasty revision rates are higher than in adults, with children also more likely to undergo rhinoplasty for revision. Further research is needed to understand causes for pediatric septoplasty revision.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Health Services Research
Background:
- Septal deviations are common in children, yet large-scale data on pediatric septoplasty revision rates are lacking.
- Pediatric septoplasty is increasingly discussed, highlighting the need for evidence-based practice.
Purpose of the Study:
- To determine the rates of septoplasty revision in the pediatric population within the United States.
- To compare pediatric septoplasty revision rates with those of adult patients.
Main Methods:
- A retrospective, observational cohort study utilizing administrative claims data from the IBM MarketScan Commercial Database (2007-2016).
- Inclusion criteria: Patients aged 18 years or younger (pediatric cohort) and 19-65 years (adult cohort) undergoing septoplasty.
- Exclusion criteria: Initial surgery involving rhinoplasty, nasal vestibular stenosis, or cartilage grafts; revision surgery lacking specific nasal procedures.
Main Results:
- The study identified 24,322 pediatric patients and 286,218 adult patients.
- Pediatric septoplasty revision rate was 2.9% (704/24,322), significantly higher than the adult rate of 1.1% (3,081/286,218).
- Pediatric patients were more likely to have revision surgery converted to rhinoplasty (9.4% vs 5.3% in adults), with the 9-13 year age group showing the highest revision rates (4.3%).
Conclusions:
- Pediatric patients exhibit higher septoplasty revision rates compared to adults.
- Children undergoing septoplasty revision are more frequently converted to rhinoplasty than adults.
- Findings underscore the need for further investigation into the specific causes of pediatric septoplasty revision to inform clinical management.
Importance:
Although septal deviations are highly prevalent in the pediatric population and pediatric septoplasties are garnering more discussion, to date, there are no large-scale studies characterizing pediatric septoplasty revision rates.
Objective:
To identify rates of pediatric septoplasty revision in the US.
Design, Setting, And Participants:
This retrospective, observational cohort study used administrative claims data from the IBM MarketScan Commercial Database (which contains inpatient and outpatient data for millions of patients and dependents covered by employer-sponsored private health insurance in the US) to identify patients undergoing septoplasty between January 1, 2007, and December 31, 2016. Patients 18 years or younger were included in the study as the pediatric cohort, and patients aged 19 to 65 years were included as the adult cohort for comparison. Patients were excluded if the initial surgery included rhinoplasty, nasal vestibular stenosis, or costal cartilage grafts or if the second surgery did not have nasal vestibular stenosis, septoplasty, rhinoplasty, and/or cartilage grafts.
Main Outcomes And Measures:
Outcomes included septoplasty revision rate, septoplasty-to-rhinoplasty conversion rate, and associated risks for revision surgery. Collected data were analyzed between January 1 and July 30, 2022.
Results:
A total of 24 322 pediatric patients (mean [SD] age, 15.7 [2.5] years; 15 121 boys [62.2%]) who underwent an initial septoplasty were identified, of whom 704 (2.9%) received a revision. In the adult cohort of 286 218 patients (mean [SD] age, 41.4 [12.2] years; 162 893 [56.9%] men), 3081 individuals (1.1%) received a revision. Within the pediatric revision group, 66 patients (9.4%) received a rhinoplasty vs 162 (5.3%) in the adult revision group. All pediatric age groups had higher revision rates than the adult population, with the 9- to 13-year-old group having the highest rates of revision (118 of 2763 [4.3%]). Patients in the West and Northeast, along with those with point of service and health maintenance organization health plans, were more likely to receive a revision.
Conclusion And Relevance:
The findings of this cohort study suggest that pediatric patients are more likely to receive a revision surgery than their adult counterparts. Furthermore, pediatric patients are more likely than adults to receive a rhinoplasty as their revision surgery. These findings provide valuable information that may be used to inform clinical decision-making, although further research is needed to better identify the causes for pediatric septoplasty revision.
