Office based surgery

[Pir8DeacDoc]

What are you guys doing in terms of in office stuff?

We are hearing a lot about value..we are seeing a lot of stuff coming out from the sinus companies. I'm not sold on balloons for people..I'm also not interested in septoplasty and turbinates in the office. Don't have much interest in ethmoids in the office either. Anyone have thoughts? I don't want to be overly negative. But so little of what we do is surgical it seems a bad idea to shift things in the office and for most of it get the same reimbursement with more potential headaches and/or complications. I know we can re-negotiate with insurance once we reduce our economic footprint but I'm not sold overall.

Some opinions from you guys with more experience would be great

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[OtoHNS]

What are you guys doing in terms of in office stuff?

We are hearing a lot about value..we are seeing a lot of stuff coming out from the sinus companies. I'm not sold on balloons for people..I'm also not interested in septoplasty and turbinates in the office. Don't have much interest in ethmoids in the office either. Anyone have thoughts? I don't want to be overly negative. But so little of what we do is surgical it seems a bad idea to shift things in the office and for most of it get the same reimbursement with more potential headaches and/or complications. I know we can re-negotiate with insurance once we reduce our economic footprint but I'm not sold overall.

Some opinions from you guys with more experience would be great

I do a pretty good number of balloons and turbinates in the office. If you learn how to anesthetize the nose properly, it's generally smooth sailing with these. FYI I do give balloon patients IM versed as well. If anything the difficulty is lower than in the OR because there is no increased bleeding due to vasodilation from general anesthesia.

I've occasionally done a septo in the office if it's an easy one and I'm also doing a balloon. Otherwise I don't see a great reason to do them in the office.

I have done a fair number of RFA procedures of the base of tongue for OSA in the past 2 years but have cut back on these due to underwhelming results.

Other than those, I do the occasional skin lesion or sebaceous cyst in the office.

Leaving aside the issue of how well balloons work (which I know continues to be controversial despite dozens of favorable studies and a mountain of anecdotal evidence), I think doing them in the office makes sense ultimately because that's what patients want.

In my experience, no one wants to fast overnight, spend most of the day at the hospital, get general anesthesia, pay the hospital and anesthesiologist (in addition to my fee) for something they could get done in an hour in the office.

 

[Pikevillemedstudent]

What are you guys doing in terms of in office stuff?

We are hearing a lot about value..we are seeing a lot of stuff coming out from the sinus companies. I'm not sold on balloons for people..I'm also not interested in septoplasty and turbinates in the office. Don't have much interest in ethmoids in the office either. Anyone have thoughts? I don't want to be overly negative. But so little of what we do is surgical it seems a bad idea to shift things in the office and for most of it get the same reimbursement with more potential headaches and/or complications. I know we can re-negotiate with insurance once we reduce our economic footprint but I'm not sold overall.

Some opinions from you guys with more experience would be great

I basically agree with your thoughts. Balloons are underwhelming. Regardless of the published evidence, I've found few patients that would benefit. My experience might be jaded but those performing balloons regularly seem more interested in the financial aspect than patient care. We've decided against that trend here at the moment. The majority of my sinus cases are polyps anyway. Besides scopes and ear tubes, I perform few in-office procedures.

And I can't really buy into the idea that we should change practice because that's what patients want. Plenty of studies have shown patient satisfaction results in poor outcomes. Interesting discussion

 

[chad5871]

Granted I am still in residency, but I could see myself doing some balloons in practice eventually. I'm planning on going into laryngology, where the trend has been to do more and more in-office procedures, (TNEs, injections, airway dilations). I see potential benefit to being able to do in-office balloons for patients with simple, uncomplicated sinus disease. I think that the utility of balloon sinuplasty for a fellowship-trained rinologist in academics is likely low since the majority of their practice is refractory sinusitis or polyps or something else that would make a balloon likely to fail. However, for those in general practice, I'm sure there are quite a few patients who could benefit from at least a trial of an in-office balloon. Like OtoHNS said above, there is a lot of compelling evidence that balloon sinuplasty can have good results in the properly selected patient. And morbidity (aside from undergoing a potentially ineffective procedure) is low.

 

[OtoHNS]

I basically agree with your thoughts. Balloons are underwhelming. Regardless of the published evidence, I've found few patients that would benefit. My experience might be jaded but those performing balloons regularly seem more interested in the financial aspect than patient care. We've decided against that trend here at the moment. The majority of my sinus cases are polyps anyway. Besides scopes and ear tubes, I perform few in-office procedures.

I think it takes a very special (and not in the good way) type of person to repeatedly perform a procedure just to make money and then see those patients return not feeling any better. I've found that patients with CRS without significant polyps and patients with recurrent acute sinusitis do extremely well following balloon sinuplasty, and that is the primary reason I offer this procedure.

And I can't really buy into the idea that we should change practice because that's what patients want. Plenty of studies have shown patient satisfaction results in poor outcomes. Interesting discussion

I agree if you are putting patient satisfaction ahead of patient safety or standard of care treatment. In the case of balloon sinuplasty in the office vs. in the OR, I don't think either is the case.