title: Open versus endoscopic medial orbital decompression: Utilization, cost, and operating room time.
abstract: BACKGROUND
  The advent of endoscopic sinus surgery has created an exciting interface between rhinology and ophthalmology in the area of orbital and optic nerve decompression Objectives: (1) To study the utilization of open versus endoscopic medial orbital decompression based on geography and indication, (2) to describe the demographics of the patient populations who underwent these different techniques, and (3) to compare outcomes, including mean charges and operating room (OR) times Methods: Cases identified by Current Procedural and Terminology codes were extracted from the California, Florida, Maryland, and New York State Ambulatory Surgery Databases from 2009 to 2011. Patient demographics, diagnoses, mean charge, and OR time were compared.
  
  
  RESULTS
  A total of 1009 patients underwent orbital decompression; 93.0% of cases involved the medial wall only; 22.9% of medial decompressions were performed endoscopically, 74.5% were open, and 2.6% were via combined approach. Eighty percent of patients had thyroid eye disease. Analyses adjusted for sex, age, race, state, and diagnosis found that surgeries for infection (N = 47) were more likely to be performed endoscopically compared with procedures for other diagnoses (N = 962) (odds ratio 5.27 [2.67-10.40], p < 0.001). Patients in Florida were more likely to undergo endoscopic decompression compared with patients in California (odds ratio 2.35 [1.42-3.62]). The difference in median charge for endoscopic ($13,119) versus open ($11,291; p = 0.085) procedures was not significant on bivariate analysis but was significant on multivariate analysis (p = 0.04). The median OR time for open procedures was, on average, 33 minutes shorter (endoscopic, 132 minutes; open, 98 minutes; p ≤ 0.001) on bivariate analysis but was not significantly different when controlling for covariables (p = 0.08).
  
  
  CONCLUSIONS
  In the study sample, endoscopic orbital decompression was performed in 22.9% of patients, with significant variation in surgical technique based on geography and indication. Procedures that used endoscopic compared with open decompression techniques had no significant difference in charge on bivariate analysis. The OR time for open procedures was shorter on bivariate but not on multivariate analysis. Further research is required regarding the relative effectiveness of open versus endoscopic surgical techniques for various indications.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Elisabeth H
authors.initials: EH
authors.lastname: Ference
authors.forename: Raj
authors.initials: R
authors.lastname: Sindwani
authors.forename: Bruce K
authors.initials: BK
authors.lastname: Tan
authors.forename: Rakesh K
authors.initials: RK
authors.lastname: Chandra
authors.forename: Robert C
authors.initials: RC
authors.lastname: Kern
authors.forename: David
authors.initials: D
authors.lastname: Conley
authors.forename: Stephanie Shintani
authors.initials: SS
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D019299:Decompression, Surgical / Q000191:economics; D004724:Endoscopy / Q000191:economics; D005260:Female; D049970:Graves Ophthalmopathy / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms; D009915:Orbit / Q000601:surgery*; D010256:Paranasal Sinuses / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome