Peter M Vila1, Margaret A Olsen1, Jay F Piccirillo1, M Allison Ogden2. 1. Department of Otolaryngology-Head and Neck Surgery. 2. Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, U.S.A.
Abstract
OBJECTIVE: To determine frequencies and trends in sialoendoscopy and sialoadenectomy for the treatment of obstructive, nonneoplastic submandibular gland disease in the United States. METHODS: Epidemiologic study of insurance claims from 2006 to 2013 in a large, private insurance claims database. Rates were calculated for patients undergoing one or both index procedures. RESULTS: A total of 5,111 adults with sialadenitis who underwent sialoendoscopy or submandibular gland excision were included. Mean age was 47.6 years, and patients undergoing sialoendoscopy were less likely to be male (relative risk [RR] = 0.84; 95% confidence interval [CI], 0.78-0.89), more likely to have sialoadenitis without stones (RR = 1.60; 95% CI, 1.53-1.66), and had a similar number of comorbidities (RR = 1.00; 95% CI, 0.91-1.06) compared to patients undergoing sialoadenectomy. The most common complication after sialoadenectomy was surgical site infection (1.4%; 95% CI, 1.1-1.8%), and complications after sialoendoscopy were rare. From 2007 to 2013, use of sialoendoscopy increased from 0.13 (95% CI, 0.08-0.18) to 0.42 (95% CI, 0.40-0.45) per 100 thousand people, and sialoadenectomy decreased from 2.41 (95% CI, 2.39-2.42) to 1.43 (95% CI, 1.40-1.44) per 100 thousand. The highest mean rate of sialadenectomy was seen in the south (2.15 per 100,000; 95% CI, 2.13-2.16), the lowest was in the west (1.6 per 100,000; 95% CI, 1.57-1.62), and it decreased in all regions over time. CONCLUSION: Utilization of sialoendoscopy has increased over time, and the overall rate of sialoadenectomy is decreasing. Both procedures are safe for treatment of patients with sialadenitis and sialolithiasis. Future research should examine whether availability of sialoendoscopy leads to a decreased rate of sialoadenectomy in patients with salivary gland disease. LEVEL OF EVIDENCE: 2c Laryngoscope, 129:602-606, 2019.
OBJECTIVE: To determine frequencies and trends in sialoendoscopy and sialoadenectomy for the treatment of obstructive, nonneoplastic submandibular gland disease in the United States. METHODS: Epidemiologic study of insurance claims from 2006 to 2013 in a large, private insurance claims database. Rates were calculated for patients undergoing one or both index procedures. RESULTS: A total of 5,111 adults with sialadenitis who underwent sialoendoscopy or submandibular gland excision were included. Mean age was 47.6 years, and patients undergoing sialoendoscopy were less likely to be male (relative risk [RR] = 0.84; 95% confidence interval [CI], 0.78-0.89), more likely to have sialoadenitis without stones (RR = 1.60; 95% CI, 1.53-1.66), and had a similar number of comorbidities (RR = 1.00; 95% CI, 0.91-1.06) compared to patients undergoing sialoadenectomy. The most common complication after sialoadenectomy was surgical site infection (1.4%; 95% CI, 1.1-1.8%), and complications after sialoendoscopy were rare. From 2007 to 2013, use of sialoendoscopy increased from 0.13 (95% CI, 0.08-0.18) to 0.42 (95% CI, 0.40-0.45) per 100 thousand people, and sialoadenectomy decreased from 2.41 (95% CI, 2.39-2.42) to 1.43 (95% CI, 1.40-1.44) per 100 thousand. The highest mean rate of sialadenectomy was seen in the south (2.15 per 100,000; 95% CI, 2.13-2.16), the lowest was in the west (1.6 per 100,000; 95% CI, 1.57-1.62), and it decreased in all regions over time. CONCLUSION: Utilization of sialoendoscopy has increased over time, and the overall rate of sialoadenectomy is decreasing. Both procedures are safe for treatment of patients with sialadenitis and sialolithiasis. Future research should examine whether availability of sialoendoscopy leads to a decreased rate of sialoadenectomy in patients with salivary gland disease. LEVEL OF EVIDENCE: 2c Laryngoscope, 129:602-606, 2019.