RECENT TRENDS IN UTILIZATION OF PROCEDURES IN OTOLARYNGOLOGY HEAD ANDNECK-SURGERY

The development of minimally invasive techniques and increasing perfor mance of surgery in outpatient settings have had a major influence on otolaryngology-head and neck surgery (OLHNS), but little is known abou t the extent to which these forces have affected the overall distribut ion and total rate of performance of OLHNS procedures. The aims of thi s study were to determine whether there has been a change in the total number of people undergoing OLHNS procedures between 1989 and 1992 in Maryland and to identify those procedures for which there has been a significant change in utilization. Data were obtained on 171,579 patie nts undergoing OLHNS procedures between 1989 and 1992 in Maryland's no nfederal, acute care hospitals, hospital-based outpatient centers, and freestanding multispecialty surgical centers. Age-adjusted annual sur gical rates were calculated by direct standardization using 1990 Maryl and census data, and changes in rates over time were examined using li near regression. From 1989 to 1992, there was no significant change in the total age-adjusted annual rate of performance of the most commonl y performed OLHNS procedures (P>0.05), yet there was a significant inc rease (P<0.05) in the rates of ethmoidectomy from 37/100,000 to 73/100 ,000, intranasal antrotomy from 25/100,000 to 44/100,000, and septopla sty from 70/100,000 to 89/100,000, and a significant decrease (P>0.05) in the rate of rhinoplasty from 44/100,000 to 36/100,000. The data sh ow an annual average decrease in inpatient surgery of 5.2% (P=0.006), and a corresponding increase in outpatient surgery of 5.1% (P=0.005). Maryland surgery rates for commonly performed procedures in OLHNS rema ined stable overall, except for an increase in sinus surgery and septo plasty rates and a decrease in rhinoplasty rates.