How predictive is the Sino-Nasal Outcome Test (SNOT-22) patient-reported outcome measure regarding elective endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS)?
Background: CRS patients must often decide to either continue with repeated medical therapy options or undergo surgery. In the absence of adequate understanding of the potential outcomes from either option, CRS patients often defer to the physician. This analysis was undertaken to determine if the SNOT-22 has the same predictive value in the U.S. and U.K. populations.
Study design: National Comparative Audit of Surgery for Nasal Polyposis and Chronic Rhinosinusitis Prospective observational cohort study of a total of 2,263 patients electing ESS in 87 U.K. hospitals.
Setting: Department of Otolaryngology, Guy’s and St. Thomas’ National Health Service Trust, London, United Kingdom; U.K. National Health Service Trust.
Synopsis: At three months, both the absolute score and percentage change increased with greater pre-operative severity. Only those with a score of more than 21 to 30 had a mean change greater than or equivalent to the minimal clinically important difference (MCID). Those with the highest pre-operative scores remained more symptomatic after surgery. There was a slight decline in scores between three and 12 months, but the difference did not reach statistical significance.
Overall, 66.2% of patients achieved a SNOT-22 score reduction greater than the MCID at three months. A greater percentage of those rating the results of surgery as excellent or very good achieved the MCID; this group had significantly lower post-operative scores at three months and greater change in score from baseline. The revision surgery rate was lower in those achieving MCID compared with those who did not.
Other factors to predict outcomes after ESS included older age, male gender, shorter symptom duration prior to surgery, polyp presence (associated with greater benefit), and previous surgery and asthma (adversely associated). Limitations included the possibility of a significant placebo effect.
Bottom line: Medically recalcitrant CRS patients considering surgery should make decisions guided by their pre-operative quality of life impairment, as measured using the SNOT-22.
Citation: Hopkins C, Rudmik L, Lund VJ. The predictive value of the preoperative sinonasal outcome test-22 score in patients undergoing endoscopic sinus surgery for chronic rhinosinusitis. Laryngoscope. 2015; 125:1779-1784.