title: Regional variation and factors associated with image guidance utilization during endoscopic sinus surgery in the ambulatory setting.
abstract: OBJECTIVE
  Determine regional variation and factors associated with the use of image guidance (IG) during endoscopic sinus surgery (ESS) in the ambulatory surgery center setting.
  
  
  METHODS
  All cases of ESS in 2010 were extracted from the state ambulatory surgery databases for New York, North Carolina, Florida, Iowa, and California. Current Procedural Terminology codes for individual sinusotomies and IG and International Classification of Diseases codes along with insurance and regional data were analyzed to determine factors that were associated with the use of IG during ESS.
  
  
  RESULTS
  Among 36 646 ambulatory ESS procedures (mean age 46.0 years; 49.0% female), 6676 cases utilized IG (18.2%). Polyps were present in 27.9% of cases. North Carolina had the highest utilization rate for IG (26.0%), whereas Iowa had the lowest (12.8%). On multivariate analysis, use of IG was associated with state, insurance status, community setting, total ethmoidectomy, frontal sinusotomy, sphenoidotomy, and polyps (all P < .001), but not maxillary antrostomy (P = .197). The highest procedural odds ratio for IG use was noted for total ethmoidectomy (2.07), followed by frontal sinusotomy (1.97) and sphenoidotomy (1.26).
  
  
  CONCLUSIONS
  Although IG is utilized in a relative minority of ESS cases, there is considerable regional variation in use. Factors other than complexity of surgery influence IG utilization as well.
authors.forename: Neil
authors.initials: N
authors.lastname: Bhattacharyya
mesh_terms: D000556:Ambulatory Surgical Procedures; D016208:Databases, Factual; D004724:Endoscopy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010256:Paranasal Sinuses / Q000601:surgery*; D011127:Polyps / Q000601:surgery; D019035:Rural Health Services / Q000706:statistics & numerical data; D025321:Surgery, Computer-Assisted / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D019037:Urban Health Services / Q000706:statistics & numerical data