Should I Get My Sinus Procedure Done In the Office or Operating Room?

What you’ll learn

Listen to the audio version below.

Audio Transcript:

Dr. Reddy:

Hey guys, welcome back to another episode of We Nose Noses. I’m Dr. Reddy, I’m joined by Dr. Smith. And today we are going to be discussing a topic that we get asked all the time by our patients that come into the office for an evaluation, sometimes for second opinions. And that is, should I get my nose procedure done in the office or should I have it done in the operating room under anesthesia?

Dr. Smith:

Often patients are concerned that maybe if they have something done in the office, it’s going to be a lesser than procedure or something that’s not maybe going to be as, you know, curing for their problem or their symptoms that they’re complaining about. So frequently, you know, we may see a patient, Dr. Reddy and myself, Dr. Undavia, and we may determine that someone has a deviated septum or a turbinate problem or a nasal valve problem creating nasal obstruction.

They may have a sinus issue where the sinus is obstructed, leading to recurrent acute sinus infections or chronic sinus disease. They may have post -natal drip or running of the nose, kind of non -allergic and allergic rhinitis with significant quality of life impact on their symptoms. And they’re kind of trying to figure out like, is this something that I have to go through and be asleep for in the operating room or is this something that I can do?

Because maybe they’ve seen some advertisements or maybe they’ve seen some or heard some podcasts about these more minimally invasive or in office type procedures that can be done to address their problems as well. So that’s kind of the gist of what we were thinking about when deciding to do this podcast was to help with some of those questions that patients already kind of come in with. And, you know, us as clinicians also think about those things when we’re deciding what to do for a patient.

Dr. Reddy:

So the way that I think about this question is first from the perspective of should you have a procedure done in the office versus the operating room based on your specific problem? Are you even a candidate for getting it done in the office versus the operating room? And that’s more of like a question that’s specifically going to be between you and your physician. But some broad rules for that are – one, if you have a fungal sinusitis, if you have a fungal ball that’s kind of inside of your sinus cavities, generally speaking, that should probably be done in the operating room setting. However, we’ve done cases in the office even where we were able to do that and take care of that in the office under local anesthesia, but that’s just a general rule.

The other thing to consider is if you have anything that’s unusual, like an unusual anatomy, where you’ve had maybe previous sinus surgery, revision surgery, and you need instrumentation in the operating room that requires things like drills and things like that. And, you know, in those cases, like if you’re having advanced frontal sinus disease that requires a lot of drilling, then that should be done, generally speaking, in the operating room.

If you have extensive nasal polyps, you know ,traditionally, extensive nasal polyps has been taken care of in the operating room. Myself and you, we’ve done nasal polyp cases in the office. We have the instrumentation to do it in the office, but that’s just a broad rule is if you have terrible polyps, then maybe you should be going to the operating room first and maybe consider in -office procedures for future procedures and things like that.

That’s one perspective. And then the other perspective is the patient perspective. And maybe you can kind of go over that part of it, but that’s an important consideration, whether you’re considering an office or says, are sure.

Dr. Smith:

Yeah. So from a patient perspective, you know, certainly I get patients that come in all the time and I recommend something to be done in the office. And their first thought is, wait, everybody else I know that has had this done, had this done asleep under general anesthesia.

And they think that their first thought is, well, there’s no way I can have this done in the office awake. And in reality, I haven’t had a patient yet that I haven’t been able to do awake under local anesthesia. So local anesthetic principles and procedures have become significantly advanced, allowing us to do more and more and more. As Dr. Reddy said, like in the past, typically people were doing small, minimally invasive type of procedures in the in the sinuses or minimally invasive turbinate reductions. Now we can do pretty traditional sinus surgery in the office, traditional turbinate reduction, septoplasties, all of these things, even open rhinoplasties in the office with appropriate local anesthesia. So the first thing I do is try to debunk or despell any myths that you have to have general anesthesia for a lot of these things, because you really don’t have to.

Some people do have like a stress component and they’re really nervous about things in their nose. And so, you know, the clinician and the patient typically have a good conversation about, you know, what their tolerance level is as far as ability, stress mainly is the thing pain and all those things we can numb and block any discomfort. Stress is sometimes something that is a little bit harder to control. Typically myself, Dr. Reddy, Dr. Undavia and many others that do these procedures do offer some element of anxiolytics or mild sedatives that can help kind of relax a patient, make it a little bit easier to have something done inside the nose. Just as if someone had dental procedures, sometimes people need medications to help kind of relax them as well to have things done in the office. We can kind of employ a lot of those things in the office as well.

Sometimes it’s just natural things, just like soothing music or dimming the lights or talking calmly. Those things can also help de-stress a patient. So I often, the first thing I try to let patients know is, you know, the stress level thing is something that’s manageable and we will kind of address and help patients get through whatever, you know, whatever the procedure is that we’re going to offer and do. The numbing and so local anesthetic principles, it’s a slow kind of steady, typically I tell patients that’s the thing that takes me the longest when I do these procedures is the numbing up protocol and procedure because really we just want to make sure we do slow and steady and make sure that everybody is well anesthetized locally. They can’t feel anything. They have minimal discomfort without irritating other things like swallowing and breathing. And so that’s something that we’ve all kind of adopted and adapted over time to improve patient experience because it really is about not only improving the disease process or the problem at hand, but also giving a patient a good experience while having that. So I think anybody is a candidate to have something done in the office as far as the patient themselves. And certainly some patients as they get older are more risky to have general anesthetic done. And so these local anesthetic procedures do offer a nice lower risk option to doing a lot of these procedures.

Dr. Reddy:

Generally speaking, the most patients are a candidate. There’s far more patients who are a candidate for an in -office procedure than they are a candidate for a procedure in the operating room. So if you have a cardiac issue, for example, if you’re, if you’re on blood thinners, if you’re even just elderly and you have a propensity to have sensitivities to anesthesia, you know, all, if you have pulmonary issues, all of those things make it more risky to get a procedure done in the operating room under general anesthesia and actually arguably the anesthesia component may be a higher risk than the actual surgery itself. And so when you’re doing things in the office, you’re eliminating the anesthesia component, you’re eliminating the general anesthesia risk. And so oftentimes it’s probably safer to do these procedures in the office than it is in an operating room setting.

How about cost perspective? Should patients consider cost in this equation at all?

Dr. Smith:

The one thing that we all started thinking about in training was not just cost to the patient, but cost to the entire system. So from an economic standpoint, you think about the overall cost to treat a disease process or a nasal obstruction or a sinus disease, and what’s the cost to treat that in each individual patient. And so cost in doing in -office procedures are substantially lower than doing things in big fancy facilities that may have a lot more employees to run and more equipment and more, and rightfully so. They have, they take care of more medically complex patients, so they need all the employees and the staff and the facilities.

So procedures in general are typically on par. Drastically cheaper to be done without general anesthesia, without a hospital or facility in office type settings. So there’s less cost associated with those. So when it comes to a patient.

Dr. Reddy:

When we’re talking about cost to start to interrupt, there’s three main components, right? There’s a surgery fee, the surgeon fee, there’s the anesthesia fee, and then there’s the facility fee. Generally speaking, the facility fee is by far the biggest cost.

Dr. Smith:

Correct.

Dr. Reddy:

And so if you’re able to eliminate the facility fee, it reduces costs substantially. The anesthesia fee is oftentimes comparable to the surgeon fee. And so again, you’re eliminating a surge, an anesthesia fee as well. Other things to consider other than the cost.

Dr. Smith:

Yeah. Or it’d be like cost, like patient downtime. And, and so that’s another…

Dr. Reddy:

Even going back to cost real quick. So if you are, if you have a high deductible plan, or if you’re paying for something fully out of pocket, even your personal cost for the procedure may be substantially less if you’re getting that procedure done in the office rather than in the operating room. And then you alluded to patient recovery.

Dr. Smith:

Yeah, so yeah, costs for missed work and recovery and all the time after, childcare, all those types of things that may add to the cost of a procedure.

So typically I tell patients recovery is usually about half and sometimes less than that of what it is in surgical procedure where with general anesthesia, it seems to be less pain, less bleeding for relatively similar procedures done in the office versus in a hospital or surgical facility.

Dr. Reddy:

Yeah, I mean, a lot of our patients, after getting an in -office sinus procedure done are back to work even the next day.

Dr. Smith:

Yeah, in the next day or a couple days for sure.

Dr. Reddy:

It’s reasonable to consider that as an option. So anything else, to add?

Dr. Smith:

No, I think that’s pretty good. Yeah, so if you’re considering having a nasal obstruction or sinus procedure or any nasal procedures for rhinitis or anything that you’ve had, make sure that you, you know, discuss with your physician all the options that are available. Get the kind of the full gamut and don’t think that, you know, I was told that this can’t be done in the office. That’s typically not always true. There are typically options for most things to be done in the office. You know, sometimes I have a patient that I’ll say, you know, certainly, you know, your septum is really, really, really bad. Like this might be something that you may not want to be awake for, depending on what type of instruments as Dr. Reddy had alluded to earlier. So I think a very open and reasonable conversation with your physician will kind of let you know what things that you can have done and what options there are for you.

Dr. Reddy:

Yep.

Dr. Smith:

But be open-minded for sure to office procedures as they are a great way to expand what you can have done with decreasing downtime, cost, morbidity, and all the other issues that typically people are afraid of when it comes to general surgeries.

Dr. Reddy:

Great. Awesome. Great. So we’ll catch you guys on the next episode. Take care.