Use of balloon sinuplasty in patients with chronic rhinosinusitis in the United States

Abstract

Over the past decade, the use of balloon sinuplasty has increased widely in the United States. Since its introduction, no nationally representative, population-based study has examined its use among chronic rhinosinusitis (CRS) patients. We conducted a retrospective cohort study of patients diagnosed with CRS between 2011 and 2014, and compared the prevalence of conventional functional endoscopic sinus surgery (FESS), balloon sinuplasty, and hybrid sinus surgery according to surgical site and calendar year. Out of 11 million to 11.4 million enrollees per year, a total of 661,738 patients with the diagnosis of CRS were included in the analyses. There was an increase in the use of balloon sinuplasty as a stand-alone procedure from 5% in 2011 to 22.5% in 2014. Conventional FESS continued to be the most commonly performed sinus procedure over the study period. Multinomial logistic regression analyses showed a linear increase in balloon sinuplasty and hybrid procedures from 2011 to 2014. Compared to patients over 60 years, patients younger than 30 years had lower odds of having a balloon sinuplasty as a stand-alone procedure compared to FESS. Compared to patients in the West, patients in the South, Northeast, and Midwest were significantly more likely to have balloon sinuplasty as a stand-alone procedure. Assessment of the sinus surgery site showed that patients with additional frontal sinus surgery were more likely to have a balloon-only procedure (odds ratio [OR], 4.67; 95% confidence interval [CI], 4.21 to 5.17) or a hybrid procedure (OR, 8.69; 95% CI, 7.48 to 10.11) than conventional FESS when compared to patients with conventional maxillary surgery only. From 2011 to 2014 there was an increase in the use of balloon sinuplasty and a modest decrease in the use of conventional FESS in the United States. Patients with frontal or sphenoid sinus surgical sites were more likely to have a balloon or hybrid procedure.