Nasal septal deviation and hypertrophic rhinitis frequently cause nasal obstruction. When adequate medical treatment fails to improve these conditions, surgical interventions are considered [1-4]. Septoplasty is the procedure of choice for nasal septal deviation. For hypertrophic rhinitis, a variety of surgical techniques, including turbinoplasty and submucosal inferior turbinectomy, are utilized. Additionally, tools such as microdebriders, lasers, and radiofrequency devices are employed in inferior turbinate surgery (ITS) [1-4].

Historically, septoplasty and ITS were primarily performed by otorhinolaryngologists. However, the landscape began to shift in 2016 when nasal valve reconstruction surgery was classified as a non-covered surgery [5]. This change has led to an increase in the practice of integrating valve surgery as an adjunct procedure in plastic surgery. As a result, valve surgery is now more frequently performed by plastic surgeons than by otorhinolaryngologists [6]. As most patients requiring nasal valve reconstruction surgery also present with nasal septal deviation and hypertrophic rhinitis, these procedures are frequently performed concurrently. This has resulted in a significant increase in the number of septoplasty and ITS procedures being carried out in plastic surgery practices. However, there has been no prior reporting of statistical data on the trends of septoplasty and ITS, which is crucial for the development of future strategies.

In this study, we analyzed data from the Health Insurance Review and Assessment Service (HIRA) Bigdata Open portal (https://opendata.hira.or.kr/home.do) to examine trends in the performance of septoplasty and ITS from 2010 to 2022. We assessed the number of procedures performed, the sex and age distribution of patients, the types of medical institutions performing the procedures, and changes in the specialization of healthcare providers.

We extracted the data from healthcare statistics provided by the HIRA Bigdata Open portal (https://opendata.hira.or.kr/home.do). Within the healthcare statistics, we searched for procedure-specific statistics about septoplasty and ITS (Table 1) under the disease/procedure-specific healthcare statistics category. At the time of the search on July 8, 2023, the maximum search period provided by the HIRA Bigdata Open portal was from 2010 to 2022. However, endoscopic septoplasty (O1005, O1006, O1007) was added to the reimbursement list in August 2021 (Ministry of Health and Welfare Notification No. 2021-227), so the corresponding data were only available for 2021 and 2022. The analysis included endoscopic septoplasty within the category of septoplasty, and a sub-analysis was conducted distinguishing between procedures performed endoscopically and those performed non-endoscopically. ITS was mostly performed on both sides, making it challenging to compare with septoplasty; hence the number of procedures was aggregated based on the number of patients. Additionally, analyses were conducted according to the type of healthcare facility, patient sex, and age group. Regarding the healthcare facility classification, tertiary general hospitals and general hospitals were merged into one category (hereafter referred to as “general hospitals”), while other hospitals and clinics were analyzed separately. Age groups were categorized as under 19, 20–29, 30–39, 40–49, 50–59, and 60 or older. Furthermore, we obtained data about specialized departments that performed septoplasty (O1001, O1002, O1003) from 2010 to 2021, excluding the three types of endoscopic septoplasty defined by the Korean Medical Association and conducted an analysis. Since this study used publicly available statistical data and did not utilize individual patient information, it did not require Institutional Review Board (IRB) approval.

From 2012 to 2017, there was a gradual decline in both septoplasty and ITS procedures. However, these began to rise again in 2018, two years after nasal valve reconstruction was reclassified as a non-covered surgery. This uptick is likely attributable to an increase in nasal valve reconstructions, which are performed in conjunction with septoplasty and ITS.

When analyzing trends by types of medical institutions, it becomes clear that ITS procedures have been performed more than twice as often in clinics than in general hospitals (48,239 cases vs. 21,365 cases) since 2010. ITS is viewed as a relatively simple procedure, which may explain why many clinics opt to perform this surgery. From 2021, general hospitals have experienced a decline in the number of ITS cases to 15,812, while the number of cases in clinics has remained relatively stable. In 2010, septoplasty cases were evenly distributed between general hospitals (21,296 cases) and clinics (24,249 cases). However, general hospitals have since seen a reduction of over 30%, while clinics have experienced an increase of over 50%. This trend could be attributed to the growing number of otorhinolaryngology clinics performing various surgical procedures, including nasal valve reconstruction, and plastic surgery clinics also offering nasal valve reconstruction [6].

Males outnumbered females by more than two-fold among patients undergoing septoplasty and ITS. There have been reports of a higher prevalence of nasal septal deviation in Korean males (56.9%) compared to females (40.4%) and the prevalence of chronic rhinitis was higher in females (7.5% for females vs. 34.7% for males) [7,8]. Therefore, the difference in prevalence rates does not appear to be the primary reason for the sex disparity in surgery. The number of patients aged 19 and under undergoing both procedures has dramatically decreased, which may attributed to the rapid decline in birth rates in Korea. An intriguing observation is the nearly twofold increase in septoplasty and ITS procedures among females aged 20–29 from 2018 to 2022. This trend is likely due to the fact that young women, who are the main recipients of cosmetic rhinoplasty, often undergo concurrent procedures such as nasal valve reconstruction, septoplasty, and ITS [9].

The majority of medical specialists performing septoplasty are otorhinolaryngologists. However, since 2018, there has been a notable rise in the number of plastic surgeons and general practitioners conducting this type of surgery.

This study has several limitations. First, the study relied on claims data, which may not always accurately reflect the exact surgical procedure. Second, it was not possible to determine the number of cases in which both septoplasty and ITS were performed simultaneously. Third, while it appears that nasal valve reconstruction may have had an impact on the increase in septoplasty and ITS, data on nasal valve reconstruction surgery were not available. Last, the analysis of specialists’ departments only encompassed septoplasty.

In summary, there has been a steady increase in the number of septoplasty and ITS procedures since 2018. These procedures are increasingly being performed in clinics rather than general hospitals. Overall, more male patients underwent these operations than female patients, but a significant increase has been observed among young female patients since 2018. Although otorhinolaryngologists have traditionally been the primary practitioners performing these surgical procedures, an increasing number of other medical specialists are becoming involved.