title: Geographic and temporal trends in frontal sinus surgery.
abstract: BACKGROUND
  The purpose of this study was to evaluate geographic and temporal trends in frontal sinus surgery procedures.
  
  
  METHODS
  Medicare Part B data files from 2000 to 2011 were examined for temporal trends in various frontal sinus procedures, and the most recent year containing geographic information (2010) was evaluated for Current Procedural Terminology (CPT) code use. Additionally, nationwide charges per procedure were recorded. Regional populations of individuals ≥ 65 years old were obtained from the 2010 U.S. Census, and surgical society websites were used to determine the number of practicing rhinologists and otolaryngologists in each region.
  
  
  RESULTS
  The use of open approaches declined by one third, while endoscopic procedures went from 6463 to 19262 annually, with the most marked increases occurring from 2006 through 2011. Geographic variation was noted, with practitioners in the South Atlantic states performing the greatest number of endoscopic procedures in 2010, whereas the East South Central states had the greatest number when controlling for population. There was an inverse relationship between endoscopic procedures performed and number of fellowship-trained rhinologists (controlling for regional populations) (R(2) = 0.66). The first year frontal sinus ballooning had a unique CPT code illustrated decreased reimbursements for non-balloon endoscopic surgery ($609) relative to balloon approaches ($2635).
  
  
  CONCLUSIONS
  Declines in open frontal sinus surgery and marked increases in endoscopic approaches have potential implications for residency training. Potential reasons for marked increases in endoscopic approaches include the rising popularity of balloon technologies, although this is speculative. Geographic variation exists in frontal sinus surgery patterns, including an inverse relationship between endoscopic approaches and the number of fellowship-trained rhinologists.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Svider
authors.forename: Vibhav
authors.initials: V
authors.lastname: Sekhsaria
authors.forename: David S
authors.initials: DS
authors.lastname: Cohen
authors.forename: Jean Anderson
authors.initials: JA
authors.lastname: Eloy
authors.forename: Michael
authors.initials: M
authors.lastname: Setzen
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Folbe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D039702:Current Procedural Terminology; D004724:Endoscopy / Q000191:economics / Q000379:methods* / Q000639:trends; D005626:Frontal Sinus / Q000601:surgery*; D015522:Frontal Sinusitis / Q000191:economics / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D016345:Medicare Part B; D010036:Otolaryngology / Q000639:trends; D012189:Retrospective Studies; D014481:United States
keywords: endoscopic frontal sinus surgery; frontal sinus balloon; frontal sinus obliteration; frontal sinus surgery; frontal sinusotomy; osteoplastic flap