title: Operative utilization of balloon versus traditional endoscopic sinus surgery.
abstract: OBJECTIVE
  To study the utilization of balloon catheter dilation (BCD) compared to traditional endoscopic sinus surgery (ESS) STUDY DESIGN: Cross-sectional analysis
  
  
  METHODS
  Cases identified by Current Procedural Terminology codes as BCD (2,717) or traditional ESS (31,059) were extracted from the State Ambulatory Surgery Databases 2011 for California, Florida, Maryland, and New York. Patient demographics, surgical center and surgeon volume, mean charge, and operating room (OR) time were compared.
  
  
  RESULTS
  There were 33,776 patients who underwent sinus surgery in the included states in 2011. Of these, 4.6% of maxillary, 5.6% of sphenoid, and 13.9% of frontal procedures were performed using BCD. Adjusted analyses found increased use of BCD in patients with chronic diseases(P < .001). Patients who had limited sinus surgery were less likely to have BCD compared to patients who had all four sinuses instrumented (P < .001). Surgeons who performed a medium (odds ratio 1.38 [1.14-1.65]) or high (odds ratio 1.71 [1.42-2.07]) volume of ESSs were more likely to use BCD compared to those who performed a low volume (P < .001). However, among surgeons who utilized BCD, there was a minimal relationship between the percentage of surgeries performed with BCD and the surgeon's total number of cases (R(2) = 0.055). Compared to traditional ESS, the median charges for maxillary/ethmoid procedures (mini-ESS) involving BCD were approximately $4,500 (P < .001) and maxillary/ethmoid/sphenoid/frontal procedures (pan-ESS) were approximately $2,950 (P = .003) greater, whereas the median OR time involving BCD was 8 minutes less for mini-ESS procedures(P = .01) but not statistically different for pan-ESS procedures (P = .58).
  
  
  CONCLUSIONS
  In the study sample, balloon technology was used in 8.0% of ESS cases in 2011. Procedures using BCD were on average more expensive compared to traditional ESS procedures, with minimal decrease in OR time.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Elisabeth H
authors.initials: EH
authors.lastname: Ference
authors.forename: Madeline
authors.initials: M
authors.lastname: Graber
authors.forename: David
authors.initials: D
authors.lastname: Conley
authors.forename: Rakesh K
authors.initials: RK
authors.lastname: Chandra
authors.forename: Bruce K
authors.initials: BK
authors.lastname: Tan
authors.forename: Charlesnika
authors.initials: C
authors.lastname: Evans
authors.forename: Melissa
authors.initials: M
authors.lastname: Pynnonen
authors.forename: Stephanie S
authors.initials: SS
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000706:statistics & numerical data; D002404:Catheterization / Q000706:statistics & numerical data*; D002983:Clinical Competence; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D004106:Dilatation / Q000706:statistics & numerical data*; D004724:Endoscopy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010256:Paranasal Sinuses / Q000601:surgery*; D012220:Rhinitis / Q000601:surgery*; D012852:Sinusitis / Q000601:surgery*; D014481:United States; D014600:Utilization Review / Q000706:statistics & numerical data
keywords: State Ambulatory Surgery Databases; balloon sinus dilation; cost; sinus surgery