Objective: Stapedectomy remains a key indicator case reportable to the ACGME despite the decline in the incidence of otosclerosis over the last half-century. This study compared the rates of stapedectomy performed by otolaryngologists at academic and non-academic centers.
Study Design: Retrospective review.
Setting: Tertiary referral academic centers, non-academic centers, civilian purchased care across the Department of Defense between 2015 and 2020.
Patients: Tricare beneficiaries with otosclerosis near a military treatment facility with an otolaryngologist.
Interventions: Stapedectomy (CPT codes 69660, 69661, and 69662).
Main Outcome Measures: Number of stapedectomies performed by setting.
Results: From 2015 to 2020, 426 stapedectomies were performed at or near a military treatment facility with an otolaryngologist (274 directly by military otolaryngologists, 152 by community providers). At tertiary care centers (n=7), 214 were performed by military otolaryngologists and 14 were performed in the surrounding area (direct care rate =94%). At non-academic centers (n=65), 60 stapedectomies were performed by military otolaryngologists and 138 were performed in the community (direct care rate = 30%). Among the 60 stapedectomies performed at non-academic centers, 43 were performed by fellowship trained neurotologists and 17 were performed by general otolaryngologists (4% of stapedectomies). The difference in the rate of direct care was statistically significant between stapedectomies performed at academic and non-academic centers (p < 0.0001).
Conclusions: Low surgical volume by general otolaryngologists reinforces recent epidemiologic trends and suggests that stapes surgery should most appropriately be considered a key indicator case for fellows pursuing otology subspecialty training, rather than a key indicator for otolaryngology residents.
Professional Practice Gap & Educational Need: Recent population-based data suggest the incidence of otosclerosis is likely too low to support the development of meaningful proficiency in stapes surgery at most otolaryngology training programs. Despite the strongly suggestive epidemiologic trends, limited data characterizes the surgical implications of modern incidence rates and the resultant stapes surgery rates after graduation from residency.
Learning Objective: Describe the differences in rates of stapedectomy performed at comprehensive general otolaryngology centers and academic specialty otolaryngology centers within a single healthcare system.
Desired Result: Given the declining incidence of otosclerosis, in combination with the infrequency of stapes surgery performed by general comprehensive otolaryngologists, stapedectomy should be removed as a key indicator case for otolaryngology trainees and instead emphasized as a fellowship-level case.
Level of Evidence – Level III
Indicate IRB or IACUC: Approved IRB number C.2022.002n.