Use of drug-induced sleep endoscopy in Germany—an analysis based on claims data

Abstract

Background Drug-induced sleep endoscopy (DISE) has recently gained relevance as a diagnostic tool for obstructive sleep apnea (OSA). However, it is unclear to what extent and in which patient cohorts DISE is used in Germany. With introduction of specific coding for this method in 2021 (Operationen- und Prozedurenschluessel, OPS code), usage can now be analyzed based on diagnosis-related groups (DRG) claims data. Methods Aggregated data from all inpatient DISE procedures conducted in German hospitals in 2021 were obtained from the publicly available Institut fuer das Entgeltsystem im Krankenhaus (InEK) database. Patient-relevant information as well as data on hospitals providing the examinations were exported and analyzed. Results Between January and December 2021, a total of 2765 DISE procedures were conducted and documented using the newly introduced specific code (1-611.01). Most patients were male (75.6%), in the age categories 30–39 (15.2%) and 40–49 years (17.2%), and presented with the lowest patient clinical complexity level (PCCL; class 0 = 81.88%). Pediatric use was rare (1.8%). Leading main diagnoses of patients were G47.31 (OSA) and J34.2 (deviation of nasal septum). The most common procedures conducted together with DISE were nasal surgery, and the examination was mostly provided in large public hospitals with more than 800 beds. Conclusion Though the OSA prevalence in Germany is high, use of DISE as a diagnostic tool is low and represented only 4.4% of cases with a main diagnosis of OSA in 2021. Since specific coding was only introduced in January 2021, trends cannot yet be identified. Noticeable is the frequent combination of DISE with nasal surgery, which is not obviously related to a diagnosis of OSA. Limitations of the study are mainly related to the underlying data, which are available for the inpatient sector only, and due to potentially limited use of the OPS code, which was introduced recently and might not be known to all hospitals.

Sociodemographic and Healthcare System Barriers to PAP Alternatives for Adult OSA: A Scoping Review

“…44 This disparity in ease of prescription was especially notable in studies reporting a lower number of referrals to otolaryngology specialty clinics from primary care physicians, which may reflect a more complex referral process prior to diagnostic sleep, 34 whereas larger hospitals were more inclined to perform DISE for presurgical evaluation of OSA. 27 Patient education from providers was also a noteworthy factor in patient decision-making. 30 A 2011 study noted that general otolaryngologists often report a lack of requisite training and education for certain hypopharyngeal procedures.…”

“…24 Sex disparities were also evident, with a 2016 study highlighting a greater surgical inclination among women, 25 whereas studies from Germany reported that women had a higher likelihood of receiving MAD as the preferred choice of treatment 26 and were also more likely to undergo DISE for presurgery evaluation. 27 Some studies also reported racial and ethnic disparities but had varied associations based on the type of study. Two large national database studies from the United States reported a lower likelihood of surgery among Black and Hispanic individuals, 25,28 whereas another single institutional study from the United States observed a higher number of Hispanic patients undergoing surgical treatment for OSA.…”

“…34 In contrast, larger hospitals in Germany (>800 hospital beds) were more inclined to perform surgical evaluation procedures such as DISE in OSA patients. 27 Another qualitative study from the United States identified that factors such as referral delays, and scheduling waitlists were associated with barriers to patients receiving surgery for OSA. 30…”