Nationwide orbital decompression volume, surgical approach, and subspecialty distribution patterns within the center for medicare and medicaid services population in the era of teprotumumab.

Purpose: To evaluate nationwide practice patterns in orbital decompression surgery for thyroid eye disease (TED) after approval of teprotumumab in January 2020.

Methods: This retrospective study analyzed the Centers for Medicare and Medicaid Services (CMS) database before (2016-2019) and after teprotumumab approval (2020-2023). External (CPT codes 67414 and 67445) and endoscopic (CPT 31292 and 31293) approaches were included. Controls were cataract surgery (CPT 66984) and upper blepharoplasty (CPT 15822 and 15823). Main outcomes were orbital decompression volume, surgical approach, and subspecialty distribution.

Results: In total 4,534 orbital decompressions were billed to CMS from 2016 to 2023. Nationwide orbital decompression volume significantly declined (-37%, p < 0.001) in the post-teprotumumab period, even when controlling relative to cataract surgery (p < 0.001) or upper blepharoplasty (p = 0.010). This was attributed to decreased external orbital decompressions (-41%, p < 0.001), while endoscopic approach was less impacted (-28%, p = 0.007). Specialty distribution trended away from oculofacial plastic surgeons (-10%) toward otolaryngologists (+18%) (p < 0.001). The proportion of endoscopic approach significantly grew (+13%, p < 0.001).

Conclusions: A nationwide evolution in surgical patterns for TED was observed after teprotumumab approval. Notable trends included decreased orbital decompressions, otolaryngologists performing proportionately more decompressions, and increased endoscopic approaches.