Endoscopic Sinus Surgery: What's the Cost in India?

Dr. K. R. Meghanadh

Sinus surgery involves removing fluids from the sinuses and creating clear pathways to prevent future blockages. This requires operating on as many sinuses as possible.

The number of sinuses a surgeon can access depends on their expertise and available equipment. However, as this equipment is expensive, only some surgeons can access the best equipment, leading to significant differences in prices and results.

The expense of sinus surgery may fluctuate depending on the type of procedure and the equipment utilized. High-quality equipment in sinus surgery can improve a surgeon's precision, shorten the duration of the surgery, and lower the risk of complications.

You can read our article "Sinusitis Surgery: An Overview of the Different Technologies" for details on how important each technique and equipment is for the surgery.

Note: The prices mentioned in this article are comprehensive and include all necessary expenses such as bed charges, surgeon fees, nursing charges, operation theater charges, medicines cost, anesthesia charges, and consumables. Always ensure that while comparing any surgery rates, check if all the charges are included to avoid surprises. However, these costs may vary depending on the hospital, location, and your personal medical needs. Our intention in this article is to provide you with an idea of the costs involved so that you can make an informed decision about the technique and methods used for sinus surgery. We do not intend to promote any hospital or doctor here. The costs stated in this article are the basic prices for general ward stay at the author, Dr. K. R. Meghanath's hospital, located in Hyderabad in March 2023.

FESS: Functional Endoscopic Sinus Surgery's Cost

Nowadays, the most basic type of sinus surgery being performed is FESS. Open sinus surgery, used in the past, is rarely employed today. FESS, which stands for Functional Endoscopic Sinus Surgery, is widely and loosely used for various techniques due to its popularity in recent years, as mentioned in the article 'Sinusitis Surgery: An Overview of the Different Technologies.'

In India, currently with Dr. K. R. Meghanadh, Functional Endoscopic Sinus Surgery (FESS), only 4 to 5 sinuses are opened. The all-inclusive cost of FESS, or basic endoscopic sinus surgery, is around 70,000 INR(around 850 USD) for a general ward stay. These fees include bed fees to medical costs with mostly no hidden costs. Few online sources and doctors could give you the surgery cost that doesn't include bed charges, nursing charges, operation theater fees, anesthesia charges, medicines, and reusables used in surgery. Whenever comparing the costs of a sinus or any other surgery between two places or doctors, it's important to inquire beforehand about the other associated charges. This will help you make an informed decision and avoid unexpected expenses later.

ENT doctors perform FESS at varying rates, but it's worth noting that the term FESS is loosely defined so that each doctor may have their own unique set of steps and definition. There's no standardized procedure being used for FESS these days. Unfortunately, Messer Klinger's original FESS technique only clears 4 or 5 sinuses out of around 40 and has a success rate of only 30%, which takes less than an hour.

TFSE surgery cost in India

On the other hand, unlike FESS in TFSE, opening all sinuses can take 2 to 4 hours but has a much higher success rate of 80 to 90 percent. As the duration of the procedure increases, so does the cost.

A TFSE surgery can cost starting from 2,00,000 INR (without hidden costs for the general ward), which could translate to 2,400 USD.

Additionally, the equipment and version used for surgery significantly contribute to the success rate and price.

Debriders Cost in sinus surgery in India

When performing sinus surgery, utilizing debriders can raise the cost to a range of 40,000 to 50,000 INR (500 USD to 625 USD approximately) due to the expense of the debrider blades.

The cost of a debrider in sinus surgery depends on how many and what kind of blades we need. For most cases, we need at least two blades. A straight blade costs around 8,500 INR (around 100 USD), while an angled blade costs between 13,000 and 14,000 INR (155 to 175 USD).

We also have debrider blades in different versions, including M1, M2, M3, M4, and M5. As you move up in versions, the precision and safety of the blades increase, which also means the cost goes up. The latest version, M5, has a rotatable head that improves its performance and precision, making it the most expensive option.

In medicine or surgery, precision is critical, which is why our blades can be costly. Additionally, we include safety mechanisms that further increase the price.

Image Guided Sinus Surgery Cost in India

We have various types of navigation machines used for sinus surgery, including electromagnetic, optical, and combined options. These machines use a supercomputer with powerful RAM to create a 3D map of our head using a CT scan as input, allowing surgeons to navigate inside our heads with precision and safety, similar to how Google Maps helps us navigate on Earth.

What sets these machines apart from Google Maps is their exceptional accuracy, with precision as high as 0.1 to 1 millimeter. Additionally, the navigation system has a lag time of just 0.1 microseconds between the actual and displayed positions.

Navigation systems are an incredible tool that can greatly enhance the accuracy and safety of sinus surgery, leading to better outcomes and faster recovery times for patients. While the cost of purchasing a navigation system may seem high, ranging from 45 to 65 lakhs INR or 55K to 80K USD in India, it is a worthwhile investment for any medical practice looking to provide top-notch care. In addition to the initial equipment cost, there are also running costs and annual maintenance charges.

So, a patient will have to pay around an additional 50,000 INR for having an image-guided sinus surgery, which includes a consumable component worth 30,000 INR. While these machines may not have an exceptionally long lifespan, they are electronic devices, just like our phones, but can provide tremendous benefits during their operational life.

Endoscopic Balloon Sinuplasty (EBS) price

Endoscopic Balloon sinuplasty can be used for an isolated procedure on frontal sinuses. EBS or Endoscopic balloon sinuplasty cost in India is 70,000 INR, i.e., around 850 USD.

Endoscopic Balloon Sinuplasty (EBS) is a highly effective technique that can greatly improve the success rate of sinus surgeries when used in conjunction with debriders and a navigation system during a procedure called TFSE. This technique can achieve a success rate of over 99.9% by clearing drainage pathways for small sinuses, which can otherwise close during the healing process and cause scarring.

It is important to note that using Endoscopic Balloon Sinuplasty will add a cost of around 70,000 INR (around 850 USD) to the sinus surgery's overall bill. However, the benefits of this technique in terms of improved success rates and reduced scarring make it a worthwhile investment for many patients seeking relief from sinus issues.

Sinus surgery with the best technology cost in India

Achieving optimal results from sinus surgery requires choosing the TFSE technique and utilizing cutting-edge technology, including endoscopes, navigation systems, debriders, and endoscopic balloon sinuplasty. With the latest advancements in medical technology, patients can expect a success rate of over 99.9%, demonstrating the unparalleled efficacy of this groundbreaking approach.

To get the best results, we must choose Total Fronto Spheno Ethmoidectomy (TFSE) sinus surgery over basic FESS. If we choose to stay in the general ward, the total cost for TFSE alone would be approximately 2,00,000 INR (around 2,500 USD).

In addition, the use of debriders during the surgery would add approximately 50,000 INR (around 610 USD) to the total cost.

A navigation system would add 50,000 INR (around 610 USD) to the overall cost to further enhance the procedure's precision and accuracy.

Finally, including endoscopic balloon sinuplasty (EBS) would increase the total price by another 70,000 INR or 850 USD.

Therefore, the comprehensive cost of sinus surgery with all these advanced technological features would be around 3,70,000 INR or approximately 4,500 USD. This price reflects the state-of-the-art medical equipment and the expertise required for successful sinus surgery.

Anesthesia

While our preferred method is General Anesthesia, some physicians opt for the use of local anesthesia, resulting in a reduction in the cost of medicines and eliminating anesthetist charges.

Other factors affecting the costs

Please note that several factors, such as the cost of infrastructure, influence the cost of any surgery. The better the infrastructure, the higher the expenses will be. Building and maintaining hospital infrastructure is super expensive in any part of the world.

The surgeon's charges could include more than the primary surgeon's fee. The surgeon's costs include his team of doctors. It is crucial for the primary surgeon to be excellent and for his team to be competent. While the primary surgeon cannot be available around the clock, his team can. A good team can provide better post-operative care for the patient and assistance for a doctor.

Similarly, the expertise and experience of other medical staff, such as nurses, are also essential factors impacting costs. The more skilled and experienced the medical team, the better they will spot any issues. Sometimes an experienced nurse in that field might be able to identify an abnormality or complication quicker than a rookie doctor. These nurses and medical staff will rightfully have a higher salary than inexperienced ones.

The cost of the room package can also impact the total cost of the surgery.

The location of a hospital affects the cost of infrastructure and staff salaries. Tier 1 and Tier 2 cities have different prices. It may be tempting to go to a hospital in a Tier 2 city to save money, but it's important to think about the quality of care you'll receive. Doctors in Tier 1 cities often see a wider range of patients so that they may have more experience with complex cases. However, many highly skilled doctors are also in Tier 2 and Tier 3 cities, so don't overlook them. They may not have as expensive equipment because they serve a smaller population, but some doctors are exceptions. They have good skills that make them popular in their area, so they can afford to invest in equipment.

Safety mechanisms that cost a lot of money

Generally, other businesses like hotels have a single generator, but hospitals need double generators. Each generator alone can power the entire building automatically. If one fails, the other operates. On top of it, we have to use a UPS. There are two types of UPS available: online and offline.

The Jubilee Hills branch of Maa Hospitals (Dr. K. R. Meghanadh's place of practice), has two generators with a capacity of 250kV, which can automatically switch on, and a 120kB online UPS. If we use offline UPS power, there is a possibility of power being off for .3 seconds, and then it switches on later. This can cause interruptions in our surgeries as our machines, especially supercomputers, may lose important data and take some time to restart and input the data again, thus increasing the surgery time. It is essential to perform surgeries quickly as the surgery time directly affects the time taken for the patient's recovery. For instance, in the case of ventilators, if the machine is switched off, all the patient-tailored settings will be lost, requiring human intervention to retune them. To avoid such issues, we use online UPS that continuously works, and the power is generated by online UPS only. Most of our equipment only gets power from online UPS, and we don't use direct raw power from the electricity department. This is because raw power can fluctuate, and high voltages can damage the equipment, costing us significant money. Even if we need to repair equipment, we might have to send them abroad or to another part of the country. This would cost us loads of money and a lot of time. Therefore, we prefer online UPS, which generates the safest power, although it is 4 to 5 times costlier than offline ones.

Unlike a hotel or shopping, safety measures are crucial for a hospital building. Not just installing but maintaining them will cost money, which will reflect on patients' bills. A hospital with lesser safety measures will cost lesser than one with.

Stay, or rooms cost

Generally, the cost of your stay increases by approximately 15% as you upgrade your accommodation. For example, if a general ward costs 100 bucks, a shared room would cost 115 bucks (100 * 1.15). Similarly, a single room would cost 132.25 bucks (115 * 1.15), and upgrading to a super deluxe room (or a similarly named room) could increase the cost by an additional 10-15%, bringing the total cost to 145 to 152 bucks.

Dr. K. R. Meghanadh