Are differences in quality-of-life (QOL) outcomes detectable in patients treated for chronic rhinosinusitis (CRS) by endoscopic sinus surgery (ESS) at different medical centers?
Bottom line: Comparison of surgeon outcomes of ESS is feasible, but must take into account a number of baseline patient characteristics including baseline QOL, septal deviation, and steroid-dependent illnesses.
Explore this issue:January 2017
Background: Numerous systems of collecting and describing patient-reported outcome measures (PROMs) can be used to measure processes of care, health service delivery, and institutional performance. For ESS for CRS, a change or improvement in disease-specific QOL has been adopted as a primary PROM of interest. A comparison of ESS outcomes for CRS between institutions is, however, currently lacking.
Study design: Prospective, multicenter, observational cohort of 228 patients selecting ESS for CRS randomly selected in equal numbers (76 from each site) from three academic clinical practices in North America between April 2011 and May 2015.
Setting: Oregon Sinus Center, Division of Rhinology and Sinus Surgery, Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University.
Synopsis: The primary PROM of interest was the 22-item Sino-Nasal Outcome Test (SNOT-22); the secondary outcome was the Rhinosinusitis Disability Index (RSDI). Important baseline factors (age, gender, prior sinus surgery, polyposis, aspirin sensitivity, allergy, depression, and tobacco abuse) and average, preoperative QOL status (with the exception of worse sleep dysfunction domain scores) were similar among the sites. Septal deviation and oral corticosteroid-dependent condition prevalence and clinical measures of disease severity were significantly different between enrollment sites.
Study participants used similar durations of preoperative medications across enrollment sites. All enrollment sites reported significant postoperative improvement six months after ESS across QOL measures. The magnitude of mean improvement was significantly different between enrollment sites for some QOL outcomes, including the primary outcome SNOT-22. Significant differences were found in topical steroid use postoperatively. After adjusting for all independent cofactors, enrollment site was no longer a significant variable associated with six-month postoperative improvement in SNOT-22 scores. Important improvement predictors were identified, including baseline SNOT-22 total scores and the prevalence of oral steroid-dependent comorbidity.