Large-scale studies characterizing septoplasty revision rates are lacking.
Objectives:
To identify rates of septoplasty revision in the United States.
Methods:
Patients undergoing initial septoplasty between January 1, 2007 and December 31, 2013 were identified using the IBM® MarketScan® Commercial Database. Patients were excluded if they had nasal vestibular stenosis, rhinoplasty, or costal cartilage grafts for the initial surgery, or did not have either septoplasty, nasal vestibular stenosis, rhinoplasty, and/or costal cartilage grafts for the second surgery.
Results:
295,236 patients received an initial septoplasty, and 3213 (1.1%) patients underwent a revision. Among the revision group, 178 (5.4%) patients received a septorhinoplasty, among which 13 (7.3%) required a costal cartilage graft. Older patients were less likely to need revision surgery (RS). Patients in the Northeast and West were significantly more likely than patients in the Midwest to undergo RS. Insurance plans such as comprehensive and point-of-service were associated with greater odds of RS, whereas others such as high-deductible health plans were associated with lower odds.
Conclusion:
Septoplasty revision rates are relatively low at 1.1% but influenced by age, region, and insurance plan.
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References
1.
GrayLP, AustraliaW. Deviated nasal septum incidence and etiology. Ann. Otol. Rhinol. Laryngol. 2016; 87(3 III SUPP.50). DOI: 10.1177/00034894780873S201.
2.
Ang-GiY, MinH, WonJ, KimCS. Prevalence study of nasal septal deformities in Korea: results of a nation-wide survey. Rhinology. 1995; 33(2):61–65.
3.
FettmanN, SanfordT, SindwaniR. Surgical management of the deviated septum: techniques in septoplasty. Otolaryngol Clin North Am. 2009; 42(2):241–252.
4.
AzizT, BironVL, AnsariK, Flores-MirC. Measurement tools for the diagnosis of nasal septal deviation: a systematic review. J Otolaryngol Head Neck Surg. 2014; 43(1):1–9.
5.
BeckerSS, DobratzEJ, StowellN, BarkerD, ParkSS. Revision septoplasty: review of sources of persistent nasal obstruction. Am J Rhinol. 2008; 22(4):440–444.
6.
van EgmondMMHT, RoversMM, HanninkG, HendriksCTM, van HeerbeekN. Septoplasty with or without concurrent turbinate surgery versus non-surgical management for nasal obstruction in adults with a deviated septum: a pragmatic, randomised controlled trial. Lancet. 2019; 394(10195):314–321.
7.
RudySF, KandathilC, SpataroEA, MoubayedSP, MostSP. Effect of nasal steroids on nasal obstruction in septal deviation: a double-blind randomized controlled trial. Facial Plast Surg Aesthetic Med. 2020; 22(4):243–248.
8.
SpataroEA, SaltychevM, KandathilCK, MostSP. Outcomes of extracorporeal septoplasty and its modifications in treatment of severe L-strut septal deviation: a systematic review and meta-analysis. JAMA Facial Plast Surg. 2019; 21(6):542–550.
9.
TetiVP, AkdagliS, MostSP. Cost-effectiveness of corticosteroid nasal spray vs surgical therapy in patients with severe to extreme anatomical nasal obstruction. JAMA Facial Plast Surg. 2016; 18(3):165–170.
10.
Van EgmondMMHT, GruttersJPC, HanninkG, Van HeerbeekN, RoversMM. Septoplasty versus non-surgical management for nasal obstruction in adults with a deviated septum: economic evaluation alongside a randomized controlled trial. BMC Med. 2020; 18(1):1–11.
11.
SiegelNS, GliklichRE, TaghizadehF, ChangY. Outcomes of septoplasty. Otolaryngol Head Neck Surg. 2000; 122(2):228–232.
12.
StewartEL, TanSZ, LiuG, TsaoMS. Known and putative mechanisms of resistance to EGFR targeted therapies in NSCLC patients with EGFR mutations-a review. Transl Lung Cancer Res. 2015; 4(1):67–81.
13.
JinHR, KimDW, JungHJ. Common sites, etiology, and solutions of persistent septal deviation in revision septoplasty. Clin Exp Otorhinolaryngol. 2018; 11(4):288.
14.
DerinS, SahanM, DeveerM, ErdoganS, TetikerH, KoseogluS. The causes of persistent and recurrent nasal obstruction after primary septoplasty. J Craniofac Surg. 2016; 27(4):828–830.
15.
KarlssonTR, ShakeelM, SupriyaM, RamB, Ah-SeeKW. Septoplasty with concomitant inferior turbinate reduction reduces the need for revision procedure. Rhinology. 2015; 53(1):59–65.
16.
KarlssonTR, ShakeelM, Al-AdhamiA, SuhaileeS, RamB, Ah-SeeKW. Revision nasal surgery after septoplasty: trainees versus trainers. Eur Arch Otorhinolaryngol. 2013; 270(12):3063–3067.
17.
GubischW. Extracorporeal septoplasty for the markedly deviated septum. Arch Facial Plast Surg. 2005; 7(4):218–226.
18.
GadkareeSK, McCartyJC, SiuJ, et al.Variation in the geographic distribution of the otolaryngology workforce: a national geospatial analysis. Otolaryngol Head Neck Surg. 2020; 162(5):649–657.
19.
LangoMN, HandorfE, ArjmandE. The geographic distribution of the otolaryngology workforce in the United States. Laryngoscope. 2017; 127(1):95–101.
20.
RudmikL, HolyCE, SmithTL. Geographic variation of endoscopic sinus surgery in the United States. Laryngoscope. 2015; 125(8):1772–1778.
RezaeianF, GubischW, JankuD, HaackS. New suturing techniques to reconstruct the keystone area in extracorporeal septoplasty. Plast Reconstr Surg. 2016; 138(2):374–382.
23.
PedersenL, SchiölerL, HolmbergK, Ahlström EmanuelssonC, HellgrenJ. Age and unplanned postoperative visits predict outcome after septoplasty: a national Swedish register study. Int J Otolaryngol. 2018; 2018:1–6. DOI: 10.1155/2018/2379536.
24.
ChungBJ, BatraPS, CitardiMJ, LanzaDC. Endoscopic septoplasty: revisitation of the technique, indications, and outcomes. Am J Rhinol. 2007; 21(3):307–311.
25.
ChhabraKR, FanZ, ChaoGF, DimickJB, TelemDA. The Role of Commercial Health Insurance Characteristics in Bariatric Surgery Utilization. Ann Surg. 2021; 273(6):1150–1156.
26.
BossEF, MarstellerJA, SimonAE. Outpatient tonsillectomy in children: demographic and geographic variation in the United States, 2006. J Pediatr. 2012; 160(5):814–819.
27.
SolankiG, SchaufflerHH. Cost-sharing and the utilization of clinical preventive services. Am J Prev Med. 1999; 17(2):127–133.
28.
ShapiroMF, WareJE, Donald SherbourneC, AngelesL, MonicaS. Effects of cost sharing on seeking care for serious and minor symptoms. Results of a randomized controlled trial. Ann Intern Med. 1986; 104(2):246–251.
29.
WongMD, AndersenR, SherbourneCD, HaysRD, ShapiroMF. Effects of cost sharing on care seeking and health status: results from the medical outcomes study. Am J Public Health. 2001; 91(11):1889.
30.
BurkeRM, TateJE, DahlRM, et al.Rotavirus vaccination and type 1 diabetes risk among US children with commercial insurance. JAMA Pediatr. 2020; 174(4):383–385.
31.
LeeLN, QuatelaO, BhattacharyyaN. The epidemiology of autologous tissue grafting in primary and revision rhinoplasty. Laryngoscope. 2019; 129(7):1549–1553.
32.
LeeJW, McHughJ, KimJC, BakerSR, MoyerJS. Age-related histologic changes in human nasal cartilage. JAMA Facial Plast Surg. 2013; 15(4):256–262.
33.
LindemannJ, TsakiropoulouE, KonstantinidisI, LindemannK. Normal aging does not deteriorate nose-related quality of life: assessment with “NOSE” and “SNOT-20” questionnaires. Auris Nasus Larynx. 2010; 37(3):303–307.
34.
BirkmeyerJD, ReamesBN, McCullochP, CarrAJ, CampbellWB, WennbergJE. Understanding of regional variation in the use of surgery. Lancet. 2013; 382(9898):1121–1129.
ReamesBN, ShubeckSP, BirkmeyerJD. Strategies for reducing regional variation in the use of surgery a systematic review. Ann Surg. 2014; 259(4):616.
37.
HanJK, StringerSP, RosenfeldRM, et al.Clinical consensus statement: septoplasty with or without inferior turbinate reduction. Otolaryngol Head Neck Surg. 2015; 153(5):708–720.
38.
LohrKN, BrookRH, KambergCJ, et al.Use of medical care in the rand health insurance experiment: diagnosis- and service-specific analyses in a randomized controlled trial on JSTOR. https://www.jstor.org/stable/3764706?seq=1#metadata_info_tab_contents. Accessed December17, 2021.
39.
ReiterD. Current concepts in functional rhinoplasty. Curr Opin Otolaryngol Head Neck Surg. 2001; 9(4):256–264.
40.
ButlerAM, NickelKB, OvermanRA, BrookhartMA. IBM MarketScan Research Databases. In: Sturkenboom M, Schink T, eds. Databases for Pharmacoepidemiological Research. Springer, Cham: Springer Series on Epidemiology and Public Health; 2021. DOI: 10.1007/978-3-030-51455-6_20.
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