Comparison of Long-Term Revision Rates and Health Care Utilization Between Standalone Balloon Sinus Dilation and Endoscopic Sinus Surgery in Chronic Rhinosinusitis Patients Without Nasal Polyps: Is the Balloon Value Proposition Overinflated?

Background Previous research has reported inconsistent results when evaluating long-term revision rates of patients undergoing balloon sinus dilation (BSD) compared to primary endoscopic sinus surgery (ESS). Objective We aimed to compare outcomes and long-term rates of revision surgery in patients with chronic rhinosinusitis without nasal polyps (CRSsP) who underwent primary standalone BSD versus primary ESS. We also wanted to better understand the post-procedure utilization of major healthcare resources between these groups. Methods Retrospective cohort study using the TriNetX platform to identify patients with CRSsP undergoing standalone BSD versus primary ESS. 1:1 propensity score matching was performed to balance age and gender in each cohort. The primary outcome was revision ESS rates at 1 and 10 years. Secondary outcomes were rates of healthcare utilization and complications, including orbital, cerebrospinal fluid (CSF) leak, and epistaxis within 90 days. Results After matching, each cohort had 2112 patients. At 1 year, the revision ESS rate was 3.5% in the balloon cohort and 3.5% in the ESS cohort (OR = 0.97, 95% CI: 0.70–1.35). Extending follow-up to 10 years, revision rates were also not statistically different: 5.8% in the balloon cohort and 6.3% in the ESS cohort (OR = 0.92, 95% CI: 0.72–1.19). Patients in the balloon cohort had a lower 90-day risk of inpatient encounters (OR = 0.29, 95% CI: 0.23–0.38), CRS-related patient visits (OR = 0.63, 95% CI: 0.55–0.71), diagnostic nasal endoscopies (OR = 0.57, 95% CI: 0.50–0.65), antibiotic prescriptions (OR = 0.53, 95% CI: 0.43–0.66), and corticosteroid prescriptions (OR = 0.62, 95% CI: 0.53–0.71). Conclusion No significant difference was observed in revision ESS rates in CRSsP patients who underwent primary BSD versus ESS after 10 years in this large database study. Findings suggest that in appropriately selected patients, BSD offers a durable response and a favorable value proposition in the management of patients with CRSsP.