In‐office balloon catheter dilation: Analysis of 628 patients from an administrative claims database

Abstract

Objectives/Hypothesis: Balloon catheter dilation (BCD) of the paranasal sinuses is increasingly described as a standalone procedure in the office for minimally invasive treatment of patients with chronic rhinosinusitis (CRS). This study evaluates CRS-related healthcare utilization before and after in-office treatment as performed by otolaryngologists within the United States in an all-comer population.Study Design: Retrospective claims database analysis. Methods: The MarketScan database was queried for patients undergoing BCD (Current Procedural Terminology [CPT] 31295-31297) for CRS (International Classification of Diseases Ninth Edition 473.x) since 2011 in the office (place of service: 11). Exclusion criteria included <1 year preoperative enrollment, <6 months postoperative history, and concurrent (630 days) endoscopic sinus surgery (CPT 31254-31288). A cohort of 628 patients was identified. Analyses included preoperative comorbidities and CRS-related healthcare use.Results: Preoperative comorbidities included asthma (29.0%), polyps (11.5%), and aspirin sensitivity (9.9%). An average of 3.0 sinuses (95% confidence interval: 2.91-3.17) were dilated at index. Maxillary, frontal, and sphenoid dilations were performed in 88.9%, 74.5%, and 33.8% of cases, respectively. There were two orbital complications and seven cases of hemorrhage potentially associated with the procedure, but no postoperative cerebrospinal fluid leaks. No blood transfusion, lateral canthotomy, or canthoplasty were reported. CRS-related postoperative healthcare use declined rapidly from the immediate preoperative state. Twenty-one patients underwent revisions, with one patient undergoing two surgeries for a total of 22 reoperations (3.5%).Conclusions: In-office BCD is associated with low risks of complications and revisions. Whereas not significant for patients with polyps, decreases in healthcare utilization pre-to postsurgery were significant for patients without polyps.

Balloon dilation of sinus ostia in the Department of Defense: Diagnoses, actual indications, and outcomes

“…The observed complication rate after BCD was almost double compared to previously reported values. In 2015, Sillers et al identified seven cases of hemorrhage and two orbital complications in 628 in‐office BCD cases . The higher rate described here is possibly secondary to the combination of the BCD procedure with other sinonasal procedures (i.e., septoplasty and FESS), which carry a higher risk of complications on their own.…”

“…In 2015, Sillers et al identified seven cases of hemorrhage and two orbital complications in 628 in-office BCD cases. 21 The higher rate described here is possibly secondary to the combination of the BCD procedure with other sinonasal procedures (i.e., septoplasty and FESS), which carry a higher risk of complications on their own. Of interest, the cases of serious complications (orbital chemosis/proptosis and facial subcutaneous emphysema) were both in patients who underwent BCD in isolation and who had Lund-Mackay scores of 0.…”

Long-term follow-up after ESS and balloon sinuplasty: Comparison of symptom reduction and patient satisfaction

“…Further controlled prospective studies with increased patient numbers are, thus, needed to show which patients benefit the most from the balloon sinuplasty, so that the obvious benefits of this tool can be efficiently utilized. Moreover, it could be possible to speculate that balloon sinuplasty might establish a position as an in-office treatment option for CRS patients with plain obstructive disease [20].…”

Systematic literature review of humanistic and economic burdens of chronic rhinosinusitis with nasal polyposis

“…Health care resource utilization and costs HCRU and costs related to CRSwNP were reported in five studies ( Supplementary Table 15) [97][98][99][100][101] . Four studies were conducted in the United States 97,99-101 and one study in China 98 .…”