Nasal valve repair (NVR) utilization and economic impact in the U.S. medicare population: 18-year trends.

PURPOSE: Nasal valve repair (NVR) is an otolaryngological procedure indicated for the surgical correction of airway obstruction or collapse. Despite its growing popularity, the deployment and financial impact for NVR have not been well-described. Here, we evaluate trends in NVR utilization in the U.S. Medicare population on the state and national levels from 2001 to 2018. MATERIALS AND METHODS: Historical utilization and reimbursement databases compiled by the U.S. Centers for Medicare & Medicaid Services (CMS) were queried for current procedural terminology (CPT) code 30465. Analyses were performed using Microsoft Excel v16. RESULTS: Nationally, we observed a 989.60% increase in the total number of NVRs performed annually (611.07% adjusted to growing enrollment). Concomitantly, total reimbursement increased by 2025.52% (878.29% adjusted), though the average cost per procedure only rose moderately (37.58%). From 2013 to 2018, the majority of providers were male (74.79%), with an M.D. (71.37%), practicing as individuals (76.5%), operating in a facility setting (93.59%), and classified as otolaryngologists (63.25%). In 2018, Indiana had the highest utilization rate, whereas Oregon received the largest reimbursement. Connecticut had the lowest values in both categories. CONCLUSIONS: The utilization and financial impact of NVR have increased substantially among the U.S. Medicare population over the last two decades.

The relative citation ratio (RCR) as a novel bibliometric among 2511 academic orthopedic surgeons.

Objectively measuring research output is important for grant awards, promotion, and tenure, or self-evaluation of productivity. However, certain shortcomings limit common bibliometric indicators. The time- and field-independent relative citation ratio (RCR) was proposed to overcome these limitations. The objective of this study was to determine whether the RCR correlates with academic rank, gender, and PhD degree status among US academic orthopedic surgeons. Full-time faculty surgeons at Accreditation Council for Graduate Medical Education-accredited orthopedic surgery residency programs were included in this study. Mean (mRCR) and weighted (wRCR) RCR scores were collected from the National Institutes of Health iCite database to quantify scholarly "impact" and "production," respectively, and were compared by academic rank, gender, and PhD status. All information was collected from publicly available faculty listings on departmental websites. A total of 2511 orthopedic surgeons from 132 residency programs were assessed. Overall, the median (interquartile range) mRCR score was 1.56 (1.05-2.12) and the median wRCR score was 27.6 (6.97-88.44). Both metrics increased with each successive academic rank, except for department chairs. There was no difference in mRCR between male and female surgeons. Among assistant professors, males had higher wRCR scores. Both metrics were higher among surgeons with a PhD degree. The RCR offers key advantages over other indices, which are reflected in differences in score distributions compared with the widely used h-index. Nevertheless, implementation of the RCR should be preceded with careful consideration of its own limitations.