The Case Against Stapedectomy as a Core Competency for General Practice: A Study of Care Patterns in the Department of Defense

Abstract

Objective: Stapedectomy remains a key indicator case reportable to the Accreditation Council of Graduate Medical Education despite the decline in the incidence of otosclerosis over the last half century. This study compared the rates of stapedectomy performed by otolaryngologists at academic and nonacademic centers. Study Design: Retrospective review. Setting: Tertiary referral academic centers, nonacademic centers, and civilian purchased-care across the Department of Defense between 2015 and 2020. Patients: Department of Defense beneficiaries with otosclerosis near a military treatment facility with an otolaryngologist. Interventions: Stapedectomy (Current Procedural Terminology codes 69,660, 69,661, and 69,662). Main Outcome Measures: Number of stapedectomies performed by setting.Results: From 2015 to 2020, 426 stapedectomies were performed at or near a military treatment facility with an otolaryngologist (274 directly by military otolaryngologists, 152 by community providers). Military providers performed 94% of stapedectomies at or near military academic centers, versus only 30% at or near nonacademic centers ( p < 0.0001). Among the 60 stapedectomies performed at nonacademic centers, only 30 were performed by general otolaryngologists (7% of all stapedectomies performed; 11% of procedures by military providers) while the rest were performed by fellowship-trained otologist or neurotologist. Conclusions: Low stapes surgical volume by military general otolaryngologists reinforces recent epidemiologic trends and suggests that few general otolaryngologists graduate residency with sufficient competency to pursue independently performing stapedectomy or have difficulty maintaining competency after graduation.

Modern Trends in Otologic Surgery and Implications for Residency Training

“…This reflected the decreasing incidence of otosclerosis, as well as the decreased comfort with performing stapedectomy in general otolaryngology practice. 11 The decrease in stapedectomies has been well-reported, but here we show declines in ossiculoplasty as well.…”

“…In 2019, the ACGME changed the name of the key indicator “Stapedectomy/Ossiculoplasty” to “Ossicular Chain Surgery.” 6,10 This de‐emphasized stapedectomy as an essential case for otolaryngology residency education, while still incorporating it as part of an important expected competency for graduation. This reflected the decreasing incidence of otosclerosis, as well as the decreased comfort with performing stapedectomy in general otolaryngology practice 11 . The decrease in stapedectomies has been well‐reported, but here we show declines in ossiculoplasty as well.…”

“…Similar to previous work on cochlear implantation, 7 rates of change and average annual growth rates (AAGR) were calculated, along with Pearson correlations. AAGR between groups was compared with two‐sided t ‐tests.…”