Extent of sinus surgery, 2000 to 2009: a population-based study.

OBJECTIVES/HYPOTHESIS Sinus surgery is one of the most frequently performed surgical operations. The objective was to determine if rates of surgery have changed over the last 10 years. STUDY DESIGN Secondary data analysis of the State Ambulatory Surgery Database of Florida. METHODS We calculated population adjusted rates of ambulatory sinus surgery for all adults, 2000 to 2009. RESULT There was a substantial decrease in the proportion of patients who had surgery in a hospital setting and a substantial increase in patients who had surgery with image guidance. Population-adjusted rates of sinus surgery increased over the study period, from a mean of 104 cases per 100,000 population in 2000 to 129 per 100,000 in 2009 (P <0.001). Procedure rates also increased, from a mean of 226 per 100,000 in 2000 to 316 per 100,000 in 2009 (P <0.001). Rates of frontal sinus procedures more than doubled, and rates of cases in which all four sinuses were treated tripled during the same time period. A greater number of sinus procedures was associated with use of image guidance and high annual surgical case volume. The strongest predictor was the individual surgeon. CONCLUSION Rates of sinus surgery increased over the study period, with more patients undergoing surgery and more procedures per surgical case. The strong association of procedural patterns with specific surgeons in sinusitis care highlights the importance of future investigations to examine training, technological, and reimbursement factors that may influence surgeons' clinical decision making for this common condition. LEVEL OF EVIDENCE 2b.