Is sinus surgery successful in providing relief and reducing cost?
Explore this issue:July 2014
Background: Patients with chronic rhinosinusitis (CRS) have continuing and often worsening symptoms, causing increased healthcare utilization. We are increasingly looking at cost analysis as we justify the most effective treatments for our patients. This study compares the cost of CRS with endoscopic sinus surgery (ESS) treatment and post-surgery costs. Using a large data base of 9,105 patients, pre-operative and post-operative records were retrospectively reviewed using database analysis.
Study design: Retrospective administrative data analysis.
Setting: Head and Neck Institute Cleveland Clinic, Cleveland, Ohio.
Synopsis: Records of patients who received endoscopic sinus surgery and who had at least 104 weeks of pre- and post-operative medical therapy were included. Patient care visits were reviewed pre- and post-operatively. The records showed that medical costs leading up to the surgery increased only to fall significantly post-operatively. Few complications in surgery patients were noted, with hemorrhage the most common. Healthcare was constant up to six months pre-operatively. At 26 weeks pre-operatively, a continuous increase in healthcare utilization occurred up to three weeks pre-operatively. At that point another significant increase in healthcare utilization occurred related to a decision for surgery and pre-operative management. Post-operatively, cost declined rapidly, reaching baseline at 13 weeks.
Bottom line: CRS-related healthcare needs were eight-fold greater than baseline. Patients with operable CRS are truly ill as seen by healthcare utilization. The marked drop in healthcare use post-operatively serves as verification of the decision for surgery, an important lessening of healthcare use, and enhanced overall quality of life to the patients. This occurred despite 6.2% of patients requiring revision surgeries.
Citation: Berringer MS, Holy CE. Endoscopic sinus surgery provides effective relief as observed by health care use pre- and postoperatively. Otolaryngol Head Neck Surg. 2014;150:893-900.