Septoplasty Revision Rates in Pediatric vs Adult Populations

Jay P Shah; Gun Min Youn; Eric X Wei; Cherian Kandathil; Sam P Most

doi:10.1001/jamaoto.2022.3041

. 2022 Oct 6;148(11):1044–1050. doi: 10.1001/jamaoto.2022.3041

Septoplasty Revision Rates in Pediatric vs Adult Populations

Jay P Shah ¹, Gun Min Youn ¹, Eric X Wei ², Cherian Kandathil ², Sam P Most ^2,^✉

¹Stanford University School of Medicine, Stanford, California

²Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California

Accepted for Publication: August 20, 2022.

Published Online: October 6, 2022. doi:10.1001/jamaoto.2022.3041

^✉

Corresponding Author: Sam P. Most, MD, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, 801 Welch Rd, Stanford, CA 94303 (smost@stanford.edu).

Author Contributions: Mr Shah and Mr Youn had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Mr Shah and Mr Youn contributed equally to this work.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Shah, Youn, Wei.

Drafting of the manuscript: Shah, Youn, Kandathil.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Shah, Youn.

Administrative, technical, or material support: Wei, Kandathil, Most.

Supervision: Wei, Kandathil, Most.

Conflict of Interest Disclosures: None reported.

Funding/Support: The Data Core at the Stanford Center for Population Health Sciences (Stanford PHS) is supported by a National Institutes of Health (NIH) National Center for Advancing Translational Science Clinical and Translational Science Award (UL1 TR001085) and from internal funding from Stanford University.

Role of the Funder/Sponsor: Neither Stanford PHS nor the NIH had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation or approval of the manuscript; and decision to submit the manuscript for publication. Stanford PHS reviewed the manuscript to ensure that the data use agreement was met.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Additional Information: Data for this project were accessed through the Stanford PHS Data Core.³¹ IBM Watson Health and MarketScan are trademarks of IBM Corporation in the United States, other countries, or both.

^✉

Corresponding author.

PMCID: PMC9539730 PMID: 36201221

Key Points

Question

What is the revision rate for septoplasty in the pediatric and adult populations in the US?

Findings

In this cohort study of 24 322 pediatric patients and 286 218 adult patients undergoing septoplasty, the revision surgery rate was higher among pediatric patients (2.9%) than among the adult comparison cohort (1.1%).

Meaning

This study’s findings provide valuable statistics and risk factors for both clinicians and patients to consider to make more informed clinical decisions regarding septoplasty.

This cohort study used data from the IBM MarketScan Commercial Database to compare rates of revision surgery among pediatric vs adult patients undergoing septoplasty.

Abstract

Importance

Although septal deviations are highly prevalent in the pediatric population and pediatric septoplasties are garnering more discussion, to date, there are no large-scale studies characterizing pediatric septoplasty revision rates.

Objective

To identify rates of pediatric septoplasty revision in the US.

Design, Setting, and Participants

This retrospective, observational cohort study used administrative claims data from the IBM MarketScan Commercial Database (which contains inpatient and outpatient data for millions of patients and dependents covered by employer-sponsored private health insurance in the US) to identify patients undergoing septoplasty between January 1, 2007, and December 31, 2016. Patients 18 years or younger were included in the study as the pediatric cohort, and patients aged 19 to 65 years were included as the adult cohort for comparison. Patients were excluded if the initial surgery included rhinoplasty, nasal vestibular stenosis, or costal cartilage grafts or if the second surgery did not have nasal vestibular stenosis, septoplasty, rhinoplasty, and/or cartilage grafts.

Main Outcomes and Measures

Outcomes included septoplasty revision rate, septoplasty-to-rhinoplasty conversion rate, and associated risks for revision surgery. Collected data were analyzed between January 1 and July 30, 2022

Results

A total of 24 322 pediatric patients (mean [SD] age, 15.7 [2.5] years; 15 121 boys [62.2%]) who underwent an initial septoplasty were identified, of whom 704 (2.9%) received a revision. In the adult cohort of 286 218 patients (mean [SD] age, 41.4 [12.2] years; 162 893 [56.9%] men), 3081 individuals (1.1%) received a revision. Within the pediatric revision group, 66 patients (9.4%) received a rhinoplasty vs 162 (5.3%) in the adult revision group. All pediatric age groups had higher revision rates than the adult population, with the 9- to 13-year-old group having the highest rates of revision (118 of 2763 [4.3%]). Patients in the West and Northeast, along with those with point of service and health maintenance organization health plans, were more likely to receive a revision.

Conclusion and Relevance

The findings of this cohort study suggest that pediatric patients are more likely to receive a revision surgery than their adult counterparts. Furthermore, pediatric patients are more likely than adults to receive a rhinoplasty as their revision surgery. These findings provide valuable information that may be used to inform clinical decision-making, although further research is needed to better identify the causes for pediatric septoplasty revision.

Introduction

Septal deviation has been associated with respiratory problems, epistaxis, sinusitis, and obstructive sleep apnea in both adults and children.^1,2,3,4 Although surgical correction of the deviated nasal septum via septoplasty has been shown to be safe and effective in adults, pediatric septoplasties remain controversial.^4,5,6,7,8 Historically, this controversy stems in part from concern that the repair of septal deviation in pediatric patients could impact facial growth, an idea that has largely been based on older animal studies investigating the role of trauma and surgery on growth disruption.^{9,10,11,12,13} Thus, practice patterns for pediatric septoplasty have often been more conservative with indications limited to severe pathology including septal hematoma, severe deformity related to trauma, or cleft lip and nose.^4,13,14

However, over the past few decades, several studies have found that nasal surgery is not significantly associated with nasal growth, giving surgeons more confidence to operate on the pediatric population.^{4,15,16,17,18,19,20} For example, Tasca and Compadretti¹⁶ followed pediatric patients for a mean of 12 years and found that nasal surgery had no overall negative effects on nasal development. With the growing body of evidence demonstrating the safety and efficacy of septoplasty in children, this procedure is being performed with increasing frequency for expanded indications.^{15,16,17,18,19}

Unfortunately, like all other surgical procedures, pediatric septoplasties are not immune to the need for revision surgery, with studies reporting revision rates from 4% to 20%.^4,5,6,21 A recent nationwide study by Youn et al²² found that septoplasty revision rates are low in the adult population, but the literature on pediatric revisions remain sparse, with the vast majority of studies originating from single institutions. In addition, the sample sizes in these studies are inadequate to capture the complex interaction that exists throughout medicine between various factors such as age, sex, region, insurance status, number of revisions, and outcomes.^{23,24,25,26,27,28,29,30} Thus, we aimed to identify septoplasty revision rates in the pediatric population, along with factors associated with higher risk for revisions. We hypothesized that compared with adults, the pediatric population would have an increased septoplasty revision rate.

Methods

This retrospective observational cohort study was conducted using the IBM MarketScan Research Database,³¹ which contains inpatient and outpatient data from more than 20 million patients and their dependents who are covered under employer-sponsored private health insurance in the US.²² Data access was provided through the Stanford Center for Population Health Sciences. This study was approved by the institutional review board at Stanford University and was determined to be exempt from review because all data collected from the database were deidentified.

Patients aged 65 years or younger who received a septoplasty without nasal vestibular stenosis, rhinoplasty, or a costal cartilage graft as determined by the Current Procedural Terminology codes (eTable 2 in the Supplement) were included in the study. Individuals aged 18 years or younger were classified as pediatric patients, and individuals aged 19 to 65 years were classified as adults. The adult cohort was used as a comparison group for the pediatric cohort. Among those who received a septoplasty, patients were included in the revision septoplasty cohort if they received a second surgery including septoplasty, nasal vestibular stenosis, or rhinoplasty with or without a costal cartilage graft (eTable 2 in the Supplement). The first 12 Current Procedural Terminology codes were used to identify patients for the initial and revision surgery. Medical claims from January 1, 2007, to December 31, 2016, were available through our institution. However, we examined a subset of the claims where the initial septoplasty had taken place between January 1, 2007, to December 31, 2013, to allow for a minimum of 3-year follow-up time for revision surgery, with the maximum follow-up time being 10 years. Patients who did not meet the inclusion criteria for the first surgery or had key sociodemographic variables missing were excluded.

Because some insurance plan types had cell sizes smaller than 16, they were collapsed with other plan types so analyses could be conducted without having to remove data. We recategorized insurance data in the following ways: Comprehensive, exclusive provider organization, and high-deductible health plan were grouped together as “other,” and point-of-service (POS) and POS with capitation were grouped together as “POS + POS with capitation” owing to similarities in plan types. Health maintenance organization (HMO), preferred provider organization (PPO), and consumer-directed health plan insurance plans were included as is. We categorized individuals aged 18 years or younger into 3 pediatric categories: younger than 8 years, 9 to 13 years, and 14 to 18 years. As in the study conducted by van der Heijden et al,⁸ these cutoffs were chosen because age 13 to 14 years is around the time when boys and girls complete their nasofacial growth spurt. Furthermore, children younger than 8 years were grouped into 1 category because our data access policy precludes us from publishing results for cell sizes smaller than 16.

Statistical Analysis

The main outcome of our study was the revision rate of pediatric septoplasty, and the secondary outcome was the septoplasty-to-septorhinoplasty conversion rate. Univariate analyses were conducted for sociodemographic variables between surgical cohorts. Continuous and categorical variables were tested for the magnitude of the differences using appropriate effect size metrics, and 95% CIs were used to describe the precision of the estimates. The associations between these sociodemographic variables and the rate of pediatric septoplasty revision were evaluated using multivariate logistic regression models. Crude and adjusted odds ratios and 95% CIs were calculated. Statistical analysis was performed between January 1 and July 30, 2022 using RStudio, version 1.4.1103 (R Foundation), with P < .05, calculated using 2-sided t tests and χ² tests, set as the threshold for statistical significance.

Results

A total of 24 322 pediatric patients (mean [SD] age, 15.7 [2.5] years; 15 121 boys [62.2%] and 9201 girls [37.8%]) met the inclusion criteria for this study, of whom 704 (2.9%) received a revision septoplasty procedure. The adult cohort that was used for comparison consisted of 286 218 adult patients (mean [SD] age, 41.4 [12.2] years; 162 893 men [56.9%] and 123 325 women [43.1%]) who received a septoplasty. Within the adult cohort, 3081 patients (1.1%) received a revision septoplasty. Pediatric patients who underwent revision surgery were younger (mean [SD] age, 15.2 [2.7] years) than pediatric patients who did not undergo revision septoplasty (mean [SD] age, 15.7 [2.5] years) at the time of their initial procedure. The mean (SD) age at which a revision surgery occurred was 17.8 (3.0) years.

Among pediatric patients, the composition of the revision surgery cohort and no revision surgery cohort differed by age, insurance plan, and region (Table 1). The distribution of age in the revision surgery cohort (704 patients) and no revision surgery cohort (23 618 patients), respectively, are as follows: 8 years or younger (22 [3.1%] for revision surgery vs 586 [2.5%] for no revision surgery; difference, 0.6% [95% CI, −0.7% to 1.9%]), 9 to 13 years (118 [16.8%] vs 2645 [11.2%]; difference, 5.6% [95% CI, 2.8% to 8.4%]), and 14 to 18 years (564 [80.1%] vs 20 387 [86.3%]; difference, 6.2% [95% CI, 3.2% to 9.2%]). There was a small difference in sex composition, with the revision surgery cohort having 281 girls [39.9%] and the no revision surgery cohort having 8920 girls [37.8%], for a difference of 2.1% (95% CI, −1.6% to 5.8%). For insurance, the greatest difference between revision surgery cohort and no revision surgery cohort was found in the PPO (452 [64.2%] for revision surgery vs 16 135 [68.3%] for no revision surgery; difference, 4.1% [95% CI, 0.5% to 7.7%]) and HMO (108 [15.3%] vs 2951 [12.5%]; difference, 2.8% [95% CI, 0.1% to 5.5%]) plan types. Smaller differences were found with other insurance plan types, which are shown in Table 1. The distribution of the regions in the revision surgery cohort and no revision surgery cohort, respectively, are as follows: South, 271 patients (38.5%) for revision surgery vs 9362 (39.6%) for no revision surgery (difference, 1.1% [95% CI, −4.8% to 2.5%]); Northeast, 125 patients (17.8%) vs 3514 (14.9%) (difference, 2.9% [95% CI, 0.0% to 5.8%]); Midwest, 140 patients (19.9%) vs 6191 (26.2%) (difference, 6.3% [95% CI, 3.3% to 9.3%]); and West, 168 patients (23.9%) vs 4551 (19.3%) (difference, 4.6% [95% CI, −1.4% to 7.8%]).

Table 1. Characteristics of the Study Sample by Pediatric Revision Septoplasty Status, IBM MarketScan Commercial Database 2007-2016.

Characteristic	Pediatric surgical cohort, No. (%)			Odds of revision surgery, OR (95% CI)
Characteristic	Revision septoplasty (n = 704)	No revision surgery (n = 23 618)	Difference in percentage (95% CI)	Unadjusted	Adjusted
Age group, y
<8	22 (3.1)	586 (2.5)	0.6 (−0.7 to 1.9)	1.36 (0.85-2.04)	1.39 (0.88-2.10)
9-13	118 (16.8)	2645 (11.2)	5.6 (2.8 to 8.4)	1.61 (1.31-1.97)	1.64 (1.34-2.01)
14-18	564 (80.1)	20 387 (86.3)	6.2 (3.2 to 9.2)	1 [Reference]	1 [Reference]
Sex
Male	423 (60.1)	14 698 (62.2)	2.1 (−5.8 to 1.6)	1 [Reference]	1 [Reference]
Female	281 (39.9)	8920 (37.8)	2.1 (−1.6 to 5.8)	1.10 (0.94-1.28)	1.11 (0.95-1.29)
Insurance plan type
Other (comprehensive, EPO, HDHP)	28 (4.0)	1500 (6.4)	2.4 (0.9 to 3.9)	0.67 (0.44-0.96)	0.65 (0.43-0.94)
HMO	108 (15.3)	2951 (12.5)	2.8 (0.1 to 5.5)	1.31 (1.05-1.62)	1.27 (1.02-1.56)
POS + POS with capitation	77 (10.9)	2001 (8.5)	2.4 (0.1 to 4.7)	1.37 (1.07-1.75)	1.33 (1.032-1.70)
PPO	452 (64.2)	16 135 (68.3)	4.1 (0.5 to 7.7)	1 [Reference]	1 [Reference]
CDHP	39 (5.5)	1031 (4.4)	1.1 (−0.6 to 2.8)	1.35 (0.95-1.86)	1.38 (0.972-1.90)
Region
South	271 (38.5)	9362 (39.6)	1.1 (−4.8 to 2.5)	1 [Reference]	1 [Reference]
Northeast	125 (17.8)	3514 (14.9)	2.9 (0.0 to 5.8)	1.230 (0.99-1.52)	1.28 (1.03-1.59)
Midwest	140 (19.9)	6191 (26.2)	6.3 (3.3 to 9.3)	0.78 (0.63-0.96)	0.81 (0.66-1.00)
West	168 (23.9)	4551 (19.3)	4.6 (1.4 to 7.8)	1.28 (1.05-1.55)	1.32 (1.09-1.61)

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Abbreviations: CDHP, consumer-directed health plan; EPO, comprehensive exclusive provider organization; HDHP, high-deductible health plan; HMO, health maintenance organization; OR, odds ratio; POS, point of service; PPO, preferred provider organization.

Primary and Secondary Outcomes

Within the pediatric cohort, 704 patients (2.9%) received a revision surgery, of whom 66 (9.4%) received a rhinoplasty for the revision procedure. The mean (SD) age at initial septoplasty for children who converted to a rhinoplasty was 15.3 (2.4) years compared with 15.2 (2.8) years for those who did not. In terms of sex, 36 patients who converted to rhinoplasty were female (54.6%), compared with 245 (38.4%) in the nonrhinoplasty revision group (difference, 16.2%; 95% CI, 9.8% to 22.6%).

Among the adult revision surgery cohort, 162 of 3081 patients (5.3%) received a rhinoplasty for the revision procedure. The adult revision cohort had a mean (SD) age of 37.4 (13.2) years. Whereas the pediatric revision cohort receiving a rhinoplasty was 54.6% female, the adult cohort comprised 90 women (55.5%), which is a 0.9% (95% CI, −6.4% to 8.2%) difference.

Analyses of the Pediatric Population

Within the overall pediatric cohort, univariate and multivariate analyses were conducted to assess for risk factors associated with increased rates of revision (Table 1). Compared with patients aged 14 to 18 years (564 revisions among 20 951 patients [2.7%]), those 8 years or younger (22 revisions among 608 patients [3.6%]) and those aged 9 to 13 years (118 revisions among 2763 patients [4.3%]) had higher rates for revision surgery. The revision rates by sex were similar (Table 2). Within insurance plan types, the HMO (108 of 3059 [3.5%]), POS + POS with capitation (77 of 2078 [3.7%]), and consumer-directed health plan (39 of 1070 [3.6%]) groups all had slightly greater revision rates than the PPO group (452 of 16 587 [2.7%]) as well as the overall revision rate for children (2.9%). When comparing regions, the Northeast (125 of 3639 [3.4%]) and West (168 of 4719 [3.6%]) had slightly higher revision rates than the South (271 of 9633 [2.8%]) and the Midwest (140 of 6331 [2.2%]).

Table 2. Characteristics of the Revision Septoplasty Study Sample by Age Cohort, IBM MarketScan Commercial Database 2007-2016.

Characteristic	Revision surgery cohort, No. (%)
Characteristic	Adult revision surgery (n=3081)	Pediatric revision surgery (n=704)	Difference in percentage (95% CI)	Unadjusted	Adjusted
Sex
Male	1705 (55.3)	423 (60.1)	4.8 (0.8 to 8.8)	1 [Reference]	1 [Reference]
Female	1376 (44.7)	281 (39.9)	4.8 (0.8 to 8.8)	1.22 (1.03-1.45)	1.21 (1.03-1.43)
Insurance plan type
Other (comprehensive, EPO, HDHP)	182 (5.9)	28 (4.0)	1.9 (0.2 to 3.6)	1.49 (1.00-2.28)	1.48 (1.00-2.28)
HMO	431 (14.0)	108 (15.3)	1.3 (−1.6 to 4.2)	0.91 (0.72-1.16)	0.92 (0.73-1.17)
POS + POS with capitation	359 (11.7)	77 (10.9)	0.8 (−3.4 to 1.8)	1.07 (0.82-1.40)	1.08 (0.83-1.42)
PPO	1979 (64.2)	452 (64.2)	0.0 (3.9 to 3.9)	1 [Reference]	1 [Reference]
CDHP	130 (4.2)	39 (5.5)	1.3 (−0.5 to 3.1)	0.76 (0.53-1.12)	0.76 (0.53-1.11)
Region
South	1195 (38.8)	271 (38.5)	0.3 (−4.3 to 3.7)	1 [Reference]	1 [Reference]
Northeast	527 (17.1)	125 (17.8)	0.7 (−2.4 to 3.8)	0.96 (0.76-1.21)	0.94 (0.75-1.20)
Midwest	650 (21.1)	140 (19.9)	1.2 (−4.5 to 2.1)	1.05 (0.84-1.32)	1.04 (0.83-1.31)
West	709 (23.0)	168 (23.9)	0.9 (−2.5 to 4.4)	0.96 (0.77-1.19)	0.96 (0.77-1.19)

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Abbreviations: CDHP, consumer-directed health plan; EPO, comprehensive exclusive provider organization; HDHP, high-deductible health plan; HMO, health maintenance organization; POS, point of service; PPO, preferred provider organization.

In addition, the pediatric revision septoplasty cohort was stratified by sex, and univariate and multivariate analyses were conducted to identify differences between sex cohorts. Although we did not find any clinically significant differences, these results can be found in eTable 1 in the Supplement.

Pediatric Population vs Adult Population

The pediatric revision septoplasty cohort had a slightly smaller percentage of female patients than the adult revision septoplasty cohort, whereas other differences in distribution of sociodemographic factors were not clinically meaningful (Table 2). Overall, the pediatric cohort was found to have a higher rate for revision surgery (704 of 24 322 patients [2.9%]) than the adult cohort (3081 of 286 218 patients [1.1%]; difference, 1.8%; 95% CI, 1.6% to 1.9%). After categorizing the pediatric cohort into age groups, all of the age groups had higher rates of revision than the adult population (8 years or younger, 22 of 608 patients [3.6%]; 9 to 13 years, 118 of 2763 [4.3%]; and 14 to 18 years, 564 of 20 951 [2.7%], compared with 1.1% among adults).

Discussion

Our study is a large-scale analysis of pediatric septoplasty revisions across the US. When compared with the adult septoplasty population, pediatric patients as a whole were significantly more likely to receive a revision, with the highest odds in the 9- to 13-year-old age group. Patients in the West and Northeast along with patients who had POS and HMO health plans had higher odds of receiving a revision.

Whereas revision rates for pediatric septoplasty have ranged from 4% to 20% in previous studies,^4,5,6,21 our study found the overall revision rate to be lower. One reason for this disparity, as Youn et al²² suggested while looking at adult septoplasties, is that differing surgical techniques have been shown to produce distinct revision rates. For example, studies have found the extracorporeal septoplasty approach to have higher revision rates than the standard endoscopic septoplasty approach.^22,32,33 Another possible reason for disparate revision rates is that most of the previous studies were single-institutional studies and/or had very small sample sizes, which may not truly represent health trends on a national scale.^4,5,6,7,21 Although rhinoplasties are not common in children, it is nevertheless important to note that the IBM MarketScan Commercial Database is based on insurance claims and does not include out-of-pocket rhinoplasties. This limitation may lead to an underestimation of our revision rate, which may not include teenagers who may have elected to receive rhinoplasties.²²

Within the pediatric cohort, children aged 9 to 13 years had a higher risk for revision septoplasty compared with the other age brackets. In line with our study, Bishop et al⁶ found that children younger than 14 years had a significantly higher revision rate than children older than 14 years. Other studies looking at rhinoplasties and sinus surgery have found similar results.^7,21 As the absolute indications for pediatric septoplasty are severe in nature, particularly significant nasal trauma, we hypothesize that sometimes 1 procedure may not be sufficient and revision surgery may be recommended.³⁴ Furthermore, research has shown a greater incidence of high-impact nasal trauma in the age cohorts that had the highest rates of revision.^35,36 Muñante-Cárdenas et al³⁵ found that compared with children younger than 6 years, children older than 6 years are more likely to have higher-impact injuries from bicycle accidents, sports-related injuries, and violence, which may require subsequent procedures. Similarly, Perkins et al³⁶ found that more than 50% of nasal fractures for children younger than 17 years were from sports-related injuries, notably baseball and softball. Thus, the severity of absolute indications and increased incidence of high-impact injuries can help explain the increased revision risk in the 9- to 13-year-old cohort.

Recent studies have shown that pediatric septoplasty is unlikely to have a long-term impact on pediatric facial development and thus indicate that septoplasties can be safely performed in children of all ages.^{16,17,18,19,20} There are even data to suggest that performing septal surgery in children with severe deviation may result in improved facial growth compared with watchful waiting until the child is older. However, clinicians should be aware that some studies suggest that certain surgical septoplasty techniques could impact long-term postsurgical nasal angles.^6,16,30 For example, the study by Tasca et al¹⁶ suggests that patients treated with extracorporeal septoplasty had different nasolabial angles, whereas septoplasty using the endonasal approach did not interfere with nasal growth. One of the limitations of the current study is our inability to assess whether procedure type was associated with differences in revision rates. While septoplasty can be safely and effectively performed in children, our current study highlights the need to counsel parents about the potential need for revision surgery to achieve desired outcomes.

Our analysis also found geographic variations in revisions rates across the pediatric cohort, with higher rates in the Northeast and West. This variation may be partially explained by the fact that there are significantly more otolaryngologists in these regions, allowing for more operations and thus more revisions to be conducted.^22,28,29 These findings also support another study that found increased revision risk for nasal surgery in the Northeast and West, which the researchers noted might be because patients in the Northeast are less likely to have high-deductible health plans that discourage revision procedures.^22,27 Additionally, as is the case for adult septoplasty, there are currently no established clinical guidelines for pediatric septoplasty. Thus, as noted by Youn et al,²² there may be increased physician-to-physician variation in indications for surgery, which can greatly impact outcomes.

Another important finding was that patients on HMO and POS health plans were more likely to receive revision surgery. This finding of a higher rate of revision surgery for POS plans is similar to another study that found increased odds of revision in the POS and comprehensive insurance groups but did not find higher rates in the HMO group.²² The higher revision rates for POS and HMO plans may partially be attributed to the fact that POS and HMO plans facilitate lower out-of-pocket sharing and thus high health care utilization.^22,27 Although the discrepancy in HMO findings with the study by Youn et al²² is not entirely understood, we hypothesize that it may be attributed partially to the differences in sample sizes between the studies. At the same time, it is important to consider the possible impact socioeconomic factors might have on increased revision rates in the pediatric HMO population. In 2021, Peltz et al²⁶ found that Hispanic children and non-Hispanic Black children were significantly more likely to be enrolled in HMO plans compared with non-Hispanic White children. Although our analysis did not include race owing to database limitations, it is indisputable that minority populations face significant barriers in access to care as well as less favorable health outcomes.^23,24,25,37 Although it is not possible to detect this complex interaction from our study, future studies should analyze the role of health inequity and race in outcomes for patients in the otolaryngologic setting.

Limitations

This study has some limitations. First, this is a retrospective cohort study that uses convenience sampling of data derived from insurance claims. Thus, we were unable to include individuals on public insurance, such as Medicaid or Medicare, which may shape the generalizability of our findings. Second, various events including death, a switch in insurance coverage, or a change in employer would lead to de-enrollment of patients in our database and would make it impossible to link with previous data. Additionally, we allowed for minimum and maximum follow-up times of 3 and 10 years, respectively; this time frame likely led to an underestimation of the lifetime revision risk, which may be especially pronounced in a pediatric cohort. Third, we were unable to study the role of race or socioeconomic status, as our database license does not include these variables. Additionally, the lack of granularity along with the study design did not allow us to tease apart the reasons or indications for the original surgery (ie, nasal trauma, congenital abnormality, septal hematoma), as the severity of the injury or condition may inherently increase the risk for revision surgery.

Finally, for observational studies of this nature, Grimes et al³⁸ have recommended that only risk ratios from cohort studies that exceed 2 to 3 should be considered credible. As none of our odds ratio reached this magnitude, the findings of this study should be interpreted with caution especially in regard to the associations of revision surgery.

Conclusions

In this cohort study, we found an overall revision rate of 2.9% among pediatric patients who underwent septoplasty, with 10.5% of those undergoing revision surgery subsequently receiving rhinoplasty. Patients aged 9 to 13 years had the highest odds of receiving revision, and pediatric patients overall were more likely to undergo revision surgery than were adults. Although further research is needed to better identify the causes for revision pediatric septoplasty, our study provides valuable information that physicians and patients may use to inform clinical decision-making.

Supplement.

eTable 1. Characteristics Associated with Pediatric Septoplasty Revision by Sex, IBM MarketScan Commercial Database 2007-2016

eTable 2. CPT Procedure Codes

Click here for additional data file.^{(33.5KB, pdf)}

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5.Raghavan M, Carr M. Age and indication for pediatric septoplasty in the NSQIP-P database. Int J Pediatr Otorhinolaryngol. 2022;154:111046. doi: 10.1016/j.ijporl.2022.111046 [DOI] [PubMed] [Google Scholar]
6.Bishop R, Sethia R, Allen D, Elmaraghy CA. Pediatric nasal septoplasty outcomes. Transl Pediatr. 2021;10(11):2883-2887. doi: 10.21037/tp-21-359 [DOI] [PMC free article] [PubMed] [Google Scholar]
7.Gupta A, Svider PF, Rayess H, et al. Pediatric rhinoplasty: a discussion of perioperative considerations and systematic review. Int J Pediatr Otorhinolaryngol. 2017;92:11-16. doi: 10.1016/j.ijporl.2016.10.027 [DOI] [PubMed] [Google Scholar]
8.van der Heijden P, Korsten-Meijer AG, van der Laan BF, Wit HP, Goorhuis-Brouwer SM. Nasal growth and maturation age in adolescents: a systematic review. Arch Otolaryngol Neck Surg. 2008;134(12):1288-1293. doi: 10.1001/archoto.2008.501 [DOI] [PubMed] [Google Scholar]
9.Sarnat BG, Wexler MR. Growth of the face and jaws after resection of the septal cartilage in the rabbit. Am J Anat. 1966;118(3):755-767. doi: 10.1002/aja.1001180306 [DOI] [PubMed] [Google Scholar]
10.Verwoerd CD, Urbanus NA, Nijdam DC. The effects of septal surgery on the growth of nose and maxilla. Rhinology. 1979;17(2):53-63. [PubMed] [Google Scholar]
11.Meeuwis J, Verwoerd-Verhoef HL, Verwoerd CDA. Normal and abnormal nasal growth after partial submucous resection of the cartilaginous septum. Acta Otolaryngol. 1993;113(3):379-382. doi: 10.3109/00016489309135829 [DOI] [PubMed] [Google Scholar]
12.Siegel MI. A longitudinal study of facial growth in Papio cynocephalus after resection of the cartilagenous nasal septum. J Med Primatol. 1979;8(2):122-127. doi: 10.1159/000460186 [DOI] [PubMed] [Google Scholar]
13.Funamura JL, Sykes JM. Pediatric septorhinoplasty. Facial Plast Surg Clin North Am. 2014;22(4):503-508. doi: 10.1016/j.fsc.2014.07.005 [DOI] [PubMed] [Google Scholar]
14.Christophel JJ, Gross CW. Pediatric septoplasty. Otolaryngol Clin North Am. 2009;42(2):287-294, ix. doi: 10.1016/j.otc.2009.01.013 [DOI] [PubMed] [Google Scholar]
15.Béjar I, Farkas LG, Messner AH, Crysdale WS. Nasal growth after external septoplasty in children. Arch Otolaryngol Neck Surg. 1996;122(8):816-821. doi: 10.1001/archotol.1996.01890200008002 [DOI] [PubMed] [Google Scholar]
16.Tasca I, Compadretti GC. Nasal growth after pediatric septoplasty at long-term follow-up. Am J Rhinol Allergy. 2011;25(1):e7-e12. doi: 10.2500/ajra.2011.25.3536 [DOI] [PubMed] [Google Scholar]
17.Walker PJ, Crysdale WS, Farkas LG. External septorhinoplasty in children: outcome and effect on growth of septal excision and reimplantation. Arch Otolaryngol Neck Surg. 1993;119(9):984-989. doi: 10.1001/archotol.1993.01880210074010 [DOI] [PubMed] [Google Scholar]
18.El-Hakim H, Crysdale WS, Abdollel M, Farkas LG. A study of anthropometric measures before and after external septoplasty in children: a preliminary study. Arch Otolaryngol Neck Surg. 2001;127(11):1362-1366. doi: 10.1001/archotol.127.11.1362 [DOI] [PubMed] [Google Scholar]
19.Adil E, Goyal N, Fedok FG. Corrective nasal surgery in the younger patient. JAMA Facial Plast Surg. 2014;16(3):176-182. doi: 10.1001/jamafacial.2013.2302 [DOI] [PubMed] [Google Scholar]
20.Can İH, Ceylan Ka, Bayiz U, Ölmez A, Samim E. Acoustic rhinometry in the objective evaluation of childhood septoplasties. Int J Pediatr Otorhinolaryngol. 2005;69(4):445-448. doi: 10.1016/j.ijporl.2004.09.013 [DOI] [PubMed] [Google Scholar]
21.Ramadan HH. Revision endoscopic sinus surgery in children: surgical causes of failure. Laryngoscope. 2009;119(6):1214-1217. doi: 10.1002/lary.20230 [DOI] [PubMed] [Google Scholar]
22.Youn GM, Shah JP, Wei EX, Kandathil C, Most SP. Revision rates of septoplasty in the United States. Facial Plast Surg Aesthetic Med. Published online April 7, 2022. doi: 10.1089/fpsam.2022.0009 [DOI] [PMC free article] [PubMed] [Google Scholar]
23.Megwalu UC, Ma Y. Racial/ethnic disparities in use of high-quality hospitals among thyroid cancer patients. Cancer Invest. 2021;39(6-7):482-488. doi: 10.1080/07357907.2021.1938108 [DOI] [PubMed] [Google Scholar]
24.Megwalu UC, Ma Y. Racial/ethnic disparities in use of high-quality hospitals among oral cancer patients in California. Laryngoscope. 2022;132(4):793-800. doi: 10.1002/lary.29830 [DOI] [PubMed] [Google Scholar]
25.Ruthberg JS, Khan HA, Knusel KD, Rabah NM, Otteson TD. Health disparities in the access and cost of health care for otolaryngologic conditions. Otolaryngol Head Neck Surg. 2020;162(4):479-488. doi: 10.1177/0194599820904369 [DOI] [PubMed] [Google Scholar]
26.Peltz A, Kan K, Garg A, Pomerantz A, Bilaver LA, Davis MM. Racial and ethnic differences in managed care enrollment among US children. JAMA Netw Open. 2021;4(4):e214162. doi: 10.1001/jamanetworkopen.2021.4162 [DOI] [PMC free article] [PubMed] [Google Scholar]
27.Chhabra KR, Fan Z, Chao GF, Dimick JB, Telem DA. The role of commercial health insurance characteristics in bariatric surgery utilization. Ann Surg. 2021;273(6):1150-1156. doi: 10.1097/SLA.0000000000003569 [DOI] [PubMed] [Google Scholar]
28.Gadkaree SK, McCarty JC, Siu J, et al. Variation in the geographic distribution of the otolaryngology workforce: a national geospatial analysis. Otolaryngol Head Neck Surg. 2020;162(5):649-657. doi: 10.1177/0194599820908860 [DOI] [PubMed] [Google Scholar]
29.Lango MN, Handorf E, Arjmand E. The geographic distribution of the otolaryngology workforce in the United States. Laryngoscope. 2017;127(1):95-101. doi: 10.1002/lary.26188 [DOI] [PMC free article] [PubMed] [Google Scholar]
30.Dispenza F, Saraniti C, Sciandra D, Kulamarva G, Dispenza C. Management of naso-septal deformity in childhood: long-term results. Auris Nasus Larynx. 2009;36(6):665-670. doi: 10.1016/j.anl.2009.02.005 [DOI] [PubMed] [Google Scholar]
31.Stanford Center for Population Health Sciences . IBM MarketScan Databases (v2.0). Redivis. Dataset; 2019, doi: 10.57761/ray7-1g16 [DOI] [Google Scholar]
32.Karlsson TR, Shakeel M, Supriya M, Ram B, Ah-See KW. Septoplasty with concomitant inferior turbinate reduction reduces the need for revision procedure. Rhinology. 2015;53(1):59-65. doi: 10.4193/Rhino12.059 [DOI] [PubMed] [Google Scholar]
33.Gubisch W. Extracorporeal septoplasty for the markedly deviated septum. Arch Facial Plast Surg. 2005;7(4):218-226. doi: 10.1001/archfaci.7.4.218 [DOI] [PubMed] [Google Scholar]
34.Justicz N, Choi S. When should pediatric septoplasty be performed for nasal airway obstruction? Laryngoscope. 2019;129(7):1489-1490. doi: 10.1002/lary.27602 [DOI] [PubMed] [Google Scholar]
35.Muñante-Cárdenas JL, Olate S, Asprino L, de Albergaria Barbosa JR, de Moraes M, Moreira RWF. Pattern and treatment of facial trauma in pediatric and adolescent patients. J Craniofac Surg. 2011;22(4):1251-1255. doi: 10.1097/SCS.0b013e31821c696c [DOI] [PubMed] [Google Scholar]
36.Perkins SW, Dayan SH, Sklarew EC, Hamilton M, Bussell GS. The incidence of sports-related facial trauma in children. Ear Nose Throat J. 2000;79(8):632-634, 636, 638. doi: 10.1177/014556130007900819 [DOI] [PubMed] [Google Scholar]
37.Hur K, Zhou S, Bertelsen C, Johns MM III. Health disparities among adults with voice problems in the United States. Laryngoscope. 2018;128(4):915-920. doi: 10.1002/lary.26947 [DOI] [PubMed] [Google Scholar]
38.Grimes DA, Schulz KF. False alarms and pseudo-epidemics: the limitations of observational epidemiology. Obstet Gynecol. 2012;120(4):920-927. doi: 10.1097/AOG.0b013e31826af61a [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplement.

eTable 1. Characteristics Associated with Pediatric Septoplasty Revision by Sex, IBM MarketScan Commercial Database 2007-2016

eTable 2. CPT Procedure Codes

Click here for additional data file.^{(33.5KB, pdf)}

[ooi220061r1] 1.Fettman N, Sanford T, Sindwani R. Surgical management of the deviated septum: techniques in septoplasty. Otolaryngol Clin North Am. 2009;42(2):241-252, viii. doi: 10.1016/j.otc.2009.01.005 [DOI] [PubMed] [Google Scholar]

[ooi220061r2] 2.Aziz T, Biron VL, Ansari K, Flores-Mir C. Measurement tools for the diagnosis of nasal septal deviation: a systematic review. J Otolaryngol Head Neck Surg. 2014;43(1):11. doi: 10.1186/1916-0216-43-11 [DOI] [PMC free article] [PubMed] [Google Scholar]

[ooi220061r3] 3.Becker SS, Dobratz EJ, Stowell N, Barker D, Park SS. Revision septoplasty: review of sources of persistent nasal obstruction. Comparative Study. 2008;22(4):440-444. doi: 10.2500/AJR.2008.22.3200 [DOI] [PubMed] [Google Scholar]

[ooi220061r4] 4.Cingi C, Muluk NB, Ulusoy S, et al. Septoplasty in children. Am J Rhinol Allergy. 2016;30(2):e42-e47. doi: 10.2500/ajra.2016.30.4289 [DOI] [PubMed] [Google Scholar]

[ooi220061r5] 5.Raghavan M, Carr M. Age and indication for pediatric septoplasty in the NSQIP-P database. Int J Pediatr Otorhinolaryngol. 2022;154:111046. doi: 10.1016/j.ijporl.2022.111046 [DOI] [PubMed] [Google Scholar]

[ooi220061r6] 6.Bishop R, Sethia R, Allen D, Elmaraghy CA. Pediatric nasal septoplasty outcomes. Transl Pediatr. 2021;10(11):2883-2887. doi: 10.21037/tp-21-359 [DOI] [PMC free article] [PubMed] [Google Scholar]

[ooi220061r7] 7.Gupta A, Svider PF, Rayess H, et al. Pediatric rhinoplasty: a discussion of perioperative considerations and systematic review. Int J Pediatr Otorhinolaryngol. 2017;92:11-16. doi: 10.1016/j.ijporl.2016.10.027 [DOI] [PubMed] [Google Scholar]

[ooi220061r8] 8.van der Heijden P, Korsten-Meijer AG, van der Laan BF, Wit HP, Goorhuis-Brouwer SM. Nasal growth and maturation age in adolescents: a systematic review. Arch Otolaryngol Neck Surg. 2008;134(12):1288-1293. doi: 10.1001/archoto.2008.501 [DOI] [PubMed] [Google Scholar]

[ooi220061r9] 9.Sarnat BG, Wexler MR. Growth of the face and jaws after resection of the septal cartilage in the rabbit. Am J Anat. 1966;118(3):755-767. doi: 10.1002/aja.1001180306 [DOI] [PubMed] [Google Scholar]

[ooi220061r10] 10.Verwoerd CD, Urbanus NA, Nijdam DC. The effects of septal surgery on the growth of nose and maxilla. Rhinology. 1979;17(2):53-63. [PubMed] [Google Scholar]

[ooi220061r11] 11.Meeuwis J, Verwoerd-Verhoef HL, Verwoerd CDA. Normal and abnormal nasal growth after partial submucous resection of the cartilaginous septum. Acta Otolaryngol. 1993;113(3):379-382. doi: 10.3109/00016489309135829 [DOI] [PubMed] [Google Scholar]

[ooi220061r12] 12.Siegel MI. A longitudinal study of facial growth in Papio cynocephalus after resection of the cartilagenous nasal septum. J Med Primatol. 1979;8(2):122-127. doi: 10.1159/000460186 [DOI] [PubMed] [Google Scholar]

[ooi220061r13] 13.Funamura JL, Sykes JM. Pediatric septorhinoplasty. Facial Plast Surg Clin North Am. 2014;22(4):503-508. doi: 10.1016/j.fsc.2014.07.005 [DOI] [PubMed] [Google Scholar]

[ooi220061r14] 14.Christophel JJ, Gross CW. Pediatric septoplasty. Otolaryngol Clin North Am. 2009;42(2):287-294, ix. doi: 10.1016/j.otc.2009.01.013 [DOI] [PubMed] [Google Scholar]

[ooi220061r15] 15.Béjar I, Farkas LG, Messner AH, Crysdale WS. Nasal growth after external septoplasty in children. Arch Otolaryngol Neck Surg. 1996;122(8):816-821. doi: 10.1001/archotol.1996.01890200008002 [DOI] [PubMed] [Google Scholar]

[ooi220061r16] 16.Tasca I, Compadretti GC. Nasal growth after pediatric septoplasty at long-term follow-up. Am J Rhinol Allergy. 2011;25(1):e7-e12. doi: 10.2500/ajra.2011.25.3536 [DOI] [PubMed] [Google Scholar]

[ooi220061r17] 17.Walker PJ, Crysdale WS, Farkas LG. External septorhinoplasty in children: outcome and effect on growth of septal excision and reimplantation. Arch Otolaryngol Neck Surg. 1993;119(9):984-989. doi: 10.1001/archotol.1993.01880210074010 [DOI] [PubMed] [Google Scholar]

[ooi220061r18] 18.El-Hakim H, Crysdale WS, Abdollel M, Farkas LG. A study of anthropometric measures before and after external septoplasty in children: a preliminary study. Arch Otolaryngol Neck Surg. 2001;127(11):1362-1366. doi: 10.1001/archotol.127.11.1362 [DOI] [PubMed] [Google Scholar]

[ooi220061r19] 19.Adil E, Goyal N, Fedok FG. Corrective nasal surgery in the younger patient. JAMA Facial Plast Surg. 2014;16(3):176-182. doi: 10.1001/jamafacial.2013.2302 [DOI] [PubMed] [Google Scholar]

[ooi220061r20] 20.Can İH, Ceylan Ka, Bayiz U, Ölmez A, Samim E. Acoustic rhinometry in the objective evaluation of childhood septoplasties. Int J Pediatr Otorhinolaryngol. 2005;69(4):445-448. doi: 10.1016/j.ijporl.2004.09.013 [DOI] [PubMed] [Google Scholar]

[ooi220061r21] 21.Ramadan HH. Revision endoscopic sinus surgery in children: surgical causes of failure. Laryngoscope. 2009;119(6):1214-1217. doi: 10.1002/lary.20230 [DOI] [PubMed] [Google Scholar]

[ooi220061r22] 22.Youn GM, Shah JP, Wei EX, Kandathil C, Most SP. Revision rates of septoplasty in the United States. Facial Plast Surg Aesthetic Med. Published online April 7, 2022. doi: 10.1089/fpsam.2022.0009 [DOI] [PMC free article] [PubMed] [Google Scholar]

[ooi220061r23] 23.Megwalu UC, Ma Y. Racial/ethnic disparities in use of high-quality hospitals among thyroid cancer patients. Cancer Invest. 2021;39(6-7):482-488. doi: 10.1080/07357907.2021.1938108 [DOI] [PubMed] [Google Scholar]

[ooi220061r24] 24.Megwalu UC, Ma Y. Racial/ethnic disparities in use of high-quality hospitals among oral cancer patients in California. Laryngoscope. 2022;132(4):793-800. doi: 10.1002/lary.29830 [DOI] [PubMed] [Google Scholar]

[ooi220061r25] 25.Ruthberg JS, Khan HA, Knusel KD, Rabah NM, Otteson TD. Health disparities in the access and cost of health care for otolaryngologic conditions. Otolaryngol Head Neck Surg. 2020;162(4):479-488. doi: 10.1177/0194599820904369 [DOI] [PubMed] [Google Scholar]

[ooi220061r26] 26.Peltz A, Kan K, Garg A, Pomerantz A, Bilaver LA, Davis MM. Racial and ethnic differences in managed care enrollment among US children. JAMA Netw Open. 2021;4(4):e214162. doi: 10.1001/jamanetworkopen.2021.4162 [DOI] [PMC free article] [PubMed] [Google Scholar]

[ooi220061r27] 27.Chhabra KR, Fan Z, Chao GF, Dimick JB, Telem DA. The role of commercial health insurance characteristics in bariatric surgery utilization. Ann Surg. 2021;273(6):1150-1156. doi: 10.1097/SLA.0000000000003569 [DOI] [PubMed] [Google Scholar]

[ooi220061r28] 28.Gadkaree SK, McCarty JC, Siu J, et al. Variation in the geographic distribution of the otolaryngology workforce: a national geospatial analysis. Otolaryngol Head Neck Surg. 2020;162(5):649-657. doi: 10.1177/0194599820908860 [DOI] [PubMed] [Google Scholar]

[ooi220061r29] 29.Lango MN, Handorf E, Arjmand E. The geographic distribution of the otolaryngology workforce in the United States. Laryngoscope. 2017;127(1):95-101. doi: 10.1002/lary.26188 [DOI] [PMC free article] [PubMed] [Google Scholar]

[ooi220061r30] 30.Dispenza F, Saraniti C, Sciandra D, Kulamarva G, Dispenza C. Management of naso-septal deformity in childhood: long-term results. Auris Nasus Larynx. 2009;36(6):665-670. doi: 10.1016/j.anl.2009.02.005 [DOI] [PubMed] [Google Scholar]

[ooi220061r31] 31.Stanford Center for Population Health Sciences . IBM MarketScan Databases (v2.0). Redivis. Dataset; 2019, doi: 10.57761/ray7-1g16 [DOI] [Google Scholar]

[ooi220061r32] 32.Karlsson TR, Shakeel M, Supriya M, Ram B, Ah-See KW. Septoplasty with concomitant inferior turbinate reduction reduces the need for revision procedure. Rhinology. 2015;53(1):59-65. doi: 10.4193/Rhino12.059 [DOI] [PubMed] [Google Scholar]

[ooi220061r33] 33.Gubisch W. Extracorporeal septoplasty for the markedly deviated septum. Arch Facial Plast Surg. 2005;7(4):218-226. doi: 10.1001/archfaci.7.4.218 [DOI] [PubMed] [Google Scholar]

[ooi220061r34] 34.Justicz N, Choi S. When should pediatric septoplasty be performed for nasal airway obstruction? Laryngoscope. 2019;129(7):1489-1490. doi: 10.1002/lary.27602 [DOI] [PubMed] [Google Scholar]

[ooi220061r35] 35.Muñante-Cárdenas JL, Olate S, Asprino L, de Albergaria Barbosa JR, de Moraes M, Moreira RWF. Pattern and treatment of facial trauma in pediatric and adolescent patients. J Craniofac Surg. 2011;22(4):1251-1255. doi: 10.1097/SCS.0b013e31821c696c [DOI] [PubMed] [Google Scholar]

[ooi220061r36] 36.Perkins SW, Dayan SH, Sklarew EC, Hamilton M, Bussell GS. The incidence of sports-related facial trauma in children. Ear Nose Throat J. 2000;79(8):632-634, 636, 638. doi: 10.1177/014556130007900819 [DOI] [PubMed] [Google Scholar]

[ooi220061r37] 37.Hur K, Zhou S, Bertelsen C, Johns MM III. Health disparities among adults with voice problems in the United States. Laryngoscope. 2018;128(4):915-920. doi: 10.1002/lary.26947 [DOI] [PubMed] [Google Scholar]

[ooi220061r38] 38.Grimes DA, Schulz KF. False alarms and pseudo-epidemics: the limitations of observational epidemiology. Obstet Gynecol. 2012;120(4):920-927. doi: 10.1097/AOG.0b013e31826af61a [DOI] [PubMed] [Google Scholar]

PERMALINK

Septoplasty Revision Rates in Pediatric vs Adult Populations

Jay P Shah, BA

Gun Min Youn, BA

Eric X Wei, MD

Cherian Kandathil, MD

Sam P Most, MD

Key Points

Question

Findings

Meaning

Abstract

Importance

Objective

Design, Setting, and Participants

Main Outcomes and Measures

Results

Conclusion and Relevance

Introduction

Methods

Statistical Analysis

Results

Table 1. Characteristics of the Study Sample by Pediatric Revision Septoplasty Status, IBM MarketScan Commercial Database 2007-2016.

Primary and Secondary Outcomes

Analyses of the Pediatric Population

Table 2. Characteristics of the Revision Septoplasty Study Sample by Age Cohort, IBM MarketScan Commercial Database 2007-2016.

Pediatric Population vs Adult Population

Discussion

Limitations

Conclusions

References

Associated Data

Supplementary Materials

ACTIONS

PERMALINK

RESOURCES

Cite

Add to Collections

PERMALINK

Septoplasty Revision Rates in Pediatric vs Adult Populations

Jay P Shah, BA

Gun Min Youn, BA

Eric X Wei, MD

Cherian Kandathil, MD

Sam P Most, MD

Key Points

Question

Findings

Meaning

Abstract

Importance

Objective

Design, Setting, and Participants

Main Outcomes and Measures

Results

Conclusion and Relevance

Introduction

Methods

Statistical Analysis

Results

Table 1. Characteristics of the Study Sample by Pediatric Revision Septoplasty Status, IBM MarketScan Commercial Database 2007-2016.

Primary and Secondary Outcomes

Analyses of the Pediatric Population

Table 2. Characteristics of the Revision Septoplasty Study Sample by Age Cohort, IBM MarketScan Commercial Database 2007-2016.

Pediatric Population vs Adult Population

Discussion

Limitations

Conclusions

References

Associated Data

Supplementary Materials

ACTIONS

PERMALINK

RESOURCES

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