Inter-hospital variation in the frequency of sinus surgery in children with cystic fibrosis.
BACKGROUND
Chronic rhinosinusitis and nasal polyposis are common conditions in cystic fibrosis (CF). Approximately 2-3% of pediatric CF patients per year have sinus disease requiring surgery. The purpose of this study was to evaluate the variation of sinus surgery rates in pediatric CF patients across multiple US pediatric hospitals.


METHODS
The Pediatric Health Information System (PHIS) compiles inpatient administrative data from 42 pediatric hospitals. We conducted a retrospective analysis of PHIS for the period January 1, 2008 to January 1, 2011 to evaluate frequency of sinus surgery at each hospital. We identified CF patients and sinus surgery during inpatient encounters using ICD-9 codes. Demographic data and data for each hospital on hospital size, number of pediatric otolaryngologists, average FEV1, and percentage of patients meeting minimum care guidelines were collected. Twenty-nine hospitals were included in analysis using mixed-effects logistic regression models for occurrence of sinus surgery.


RESULTS
We identified 5,194 CF patients, accounting for 18,788 unique encounters among 29 hospitals. 880 patients underwent 1,397 sinus operations. Total number of CF patients at each institution ranged from 39 to 364 and total number of sinus surgeries ranged from 4 to 205, over the 3-year period. Variation in the rate of sinus surgery with hospital encounter was observed (1-24%). Hospital-average lung function (P = 0.56), number of otolaryngologists (P = 0.65) were not found to be predictors of sinus surgery. The size of the CF center (P = 0.01), hospital size (P = 0.05), and age at admission (P ≤ 0.0001) were associated with an increased frequency of sinus surgery. However, with multivariable analysis, only size of the CF center and age of admission remained statistically significant predictors of surgery with admission.


CONCLUSIONS
There is large variation in the incidence of sinus surgery for CF in 29 of the largest freestanding pediatric hospitals. This study highlights remarkable variation in clinical practice and underscores the need for further research into the indications and benefits of sinus surgery in pediatric patients with CF. Pediatr Pulmonol. 2015; 50:231-235. © 2014 Wiley Periodicals, Inc.
Division Pediatric Otolaryngology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
Frank W
FW
Virgin
Department of Biostatistics, Children's Hospital Boston, Boston, Massachusetts.
Lin
L
Huang
Department of Otolarynogolgy, Department of Otology and Laryngology Harvard Medical School, Children's Hospital Boston, Boston, Massachusetts.
David W
DW
Roberson
Division of Respiratory Diseases, Children's Hospital Boston, Boston, Massachusetts.
Gregory S
GS
Sawicki
PHIS; cystic fibrosis; endoscopic sinus surgery; inter-hospital; sinusitis; variation