Surgeon Case Volume Impacts Revision Rate of Endoscopic Sinus Surgery

Area of Science:

• Otolaryngology
• Surgical Outcomes Research
• Health Services Research

Background:

• Surgeon volume is linked to improved patient outcomes in various surgical fields.
• The relationship between surgeon volume and outcomes in endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) is not well-established.
• This study investigates the association between ESS surgeon volume and revision surgery rates or early complications.

Purpose of the Study:

• To determine if a surgeon's annual volume of endoscopic sinus surgery (ESS) impacts revision surgery rates within 5 years.
• To assess the association between ESS surgeon volume and 30-day complications in patients with chronic rhinosinusitis (CRS).

Main Methods:

• A retrospective analysis of 13,562 CRS patients who underwent primary ESS in Ontario, Canada (2014-2018).
• Surgeon volume was categorized into quartiles based on the previous year's procedures.
• Revision ESS within 5 years and 30-day complications (unplanned admission/ED visit) were identified.

Main Results:

• Higher surgeon volume quartiles (> extasciimathy 63/year) were associated with lower revision rates and 30-day hospitalizations (p < 0.05).
• Low-volume surgeons (1-17/year) were independently associated with a higher likelihood of revision surgery (HR: 1.60, 95% CI: 1.17-2.19) after adjusting for covariates.
• High volume was also linked to a higher rate of complete ESS (p < 0.001).

Conclusions:

• This is the first study to establish a surgeon volume-outcome relationship in endoscopic sinus surgery (ESS).
• Practicing as a high-volume ESS surgeon is a significant predictor of reduced revision surgery rates for CRS patients.