Upfront Draf III Strategy Often Less Costly for Severe CRS Requiring Surgery

BackgroundDraf III procedures are considered to be time- and supply-intensive compared to standard functional endoscopic sinus surgery (FESS).ObjectiveTo quantify the cost of a Draf III compared to standard FESS and examine time- and supply-related cost factors.MethodsWe performed a retrospective analysis of inflammatory sinus surgeries at a tertiary care medical center from July 2021 to July 2023. The medical record was reviewed for patient factors and cost variables, and multivariable analysis was performed.ResultsThree hundred and fifty patients were included with a mean age of 50.6 years. One hundred and twenty-nine patients underwent a Draf III, 99 of whom (76.7%) underwent a Draf III as part of a full FESS whereas 30 (23.3%) underwent a targeted revision Draf III. Among all Draf III procedures, operating room and supply costs represented 63.1% ($6231.67) and 16.6% ($1638.46) of total costs, respectively, compared to 54.8% ($4912.46) and 14.5% ($1296.06) for standard FESS (both p < .001). The average total cost for a full FESS with Draf III was $10118.60, compared to $9414.29 for a targeted Draf III, and $8960.31 for standard FESS (n = 221). Using these values, we calculated that the approach of performing an upfront Draf III would be less costly relative to the approach of performing standard FESS with Draf II and then revision Draf III as needed when the expected revision rate exceeds 12.3%.ConclusionsSurgical costs associated with a FESS with Draf III are driven primarily by operating room time costs, to a greater degree even than for standard FESS. The cost of performing a full FESS with Draf III is not considerably higher than a standard FESS or a targeted Draf III revision, suggesting that an upfront Draf III may represent a relatively less costly treatment approach for patients at high risk of recurrent frontal disease.