title: Trends in endoscopic sinus surgery rates in the Medicare population.
abstract: OBJECTIVE
  To examine the trends in rates of endoscopic sinus surgery, open sinus procedures (open sinus surgery), and the prevalence of diagnosis of chronic rhinosinusitis in the Medicare population from 1998 to 2006.
  
  
  METHODS
  Retrospective cohort analysis.
  
  
  METHODS
  Twenty-percent sample of Medicare beneficiaries aged 65 to 99 years for the years 1998 to 2006.
  
  
  METHODS
  Change in per capita annual rates of endoscopic sinus surgery, open sinus surgery, and chronic rhinosinusitis diagnosis among Medicare beneficiaries.
  
  
  RESULTS
  From 1998 to 2006, the rate of patients undergoing endoscopic sinus surgery per 1000 Medicare beneficiaries increased by 20%, from 0.72 (95% confidence interval [CI], 0.70-0.74) to 0.92 (95% CI, 0.89-0.95). Over the same period, the rate of open sinus surgery declined 40%, from 0.20 (95% CI, 0.19-0.21) to 0.11 (95% CI, 0.10-0.12). However, the per capita rate of beneficiaries diagnosed as having chronic rhinosinusitis declined by 1.4% over the study period. Further analysis by age cohort revealed significantly higher rates of surgery and diagnosis rates in the 65- to 69-year-old beneficiaries relative to older age groups. Over the study period, the per capita rate of diagnosis of chronic rhinosinusitis declined or remained stable across age groups. Despite this, all age groups showed increases in endoscopic sinus surgery rates.
  
  
  CONCLUSIONS
  Our findings indicate that endoscopic sinus surgery is increasingly becoming the mainstay of chronic rhinosinusitis management in the Medicare population. Because of the uncertainty regarding the outcomes of surgical vs medical management, the root causes of the observed increase in endoscopic sinus surgery rates need to be investigated. Given that sinusitis is a common diagnosis necessitating physician visits, comparative effectiveness studies examining medical vs surgical management would be warranted.
authors.affiliation: Section of Otolaryngology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03766, USA. giridhar.venkatraman@hitchcock.org
authors.forename: Giridhar
authors.initials: G
authors.lastname: Venkatraman
authors.forename: Donald S
authors.initials: DS
authors.lastname: Likosky
authors.forename: Weiping
authors.initials: W
authors.lastname: Zhou
authors.forename: Samuel R G
authors.initials: SR
authors.lastname: Finlayson
authors.forename: David C
authors.initials: DC
authors.lastname: Goodman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D004724:Endoscopy / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D010254:Paranasal Sinus Diseases / Q000453:epidemiology / Q000601:surgery*; D015995:Prevalence; D012189:Retrospective Studies; D012220:Rhinitis / Q000453:epidemiology / Q000601:surgery; D012852:Sinusitis / Q000453:epidemiology / Q000601:surgery; D014481:United States / Q000453:epidemiology