Analysis of factors associated with electing endoscopic sinus surgery

Adam S. DeConde; Jess C. Mace; Vijay R. Ramakrishnan; Jeremiah A. Alt; Timothy L. Smith

doi:10.1002/lary.26788

Analysis of factors associated with electing endoscopic sinus surgery

Adam S. DeConde, Jess C. Mace, Vijay R. Ramakrishnan, Jeremiah A. Alt, Timothy L. Smith

Otolaryngology

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

Objective: Medically refractory chronic rhinosinusitis (CRS) can be managed with appropriate continued medical therapy (CMT) or surgery followed by CMT. Patients who initially elect CMT and do not experience adequate symptom resolution may “cross over” to endoscopic sinus surgery (ESS). Our objective was to identify patient covariates associated with this subset of patients who elect this change in treatment modality. Study Design: Retrospective analysis of a prospective, multi-center cohort of adult patients with CRS enrolled between March 2011 and June 2015 in academic, tertiary referral clinics. Methods: Subjects who initially elected CMT were followed up to 18 months, provided a comprehensive medical history, and completed the 22-item SinoNasal Outcome Test (SNOT-22) at baseline and during 6-month follow-up intervals. Hazard regression modeling was used to identify covariates associated with elective change in treatment modality. Results: One hundred seventy-nine subjects were followed for an average 15.1 (standard deviation ± 4.6) months. Subjects who elected ESS (55 of 179) had significantly worse average endoscopy scores and reported worse SNOT-22 sleep dysfunction scores at baseline (P ≤ 0.026). For each single increasing (worsening) point of Lund-Kennedy endoscopy score, the hazard ratio (HR) of crossover increased by ∼6%. Similarly, for every point of worsening in baseline SNOT-22 total score, the hazard of treatment crossover increased by ∼2%. After covariate adjustment, only baseline SNOT-22 sleep dysfunction scores were associated with an increased risk of treatment crossover (HR = 1.07; 95% confidence interval: 1.02–1.11; P = 0.003). Conclusion: Baseline total SNOT-22 and endoscopy scores are associated with treatment crossover, but reported sleep dysfunction is the only significant independent predictor of treatment crossover. Level of Evidence: 2c. Laryngoscope, 128:304–310, 2018.

Original language	English (US)
Pages (from-to)	304-310
Number of pages	7
Journal	Laryngoscope
Volume	128
Issue number	2
DOIs	https://doi.org/10.1002/lary.26788
State	Published - Feb 1 2018

Keywords

Sinusitis
chronic disease
endoscopy
outcome assessment (health care)
therapeutics

ASJC Scopus subject areas

Otorhinolaryngology

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10.1002/lary.26788

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@article{1665bea7eb95435da0cffd0075ec4fc8,

title = "Analysis of factors associated with electing endoscopic sinus surgery",

abstract = "Objective: Medically refractory chronic rhinosinusitis (CRS) can be managed with appropriate continued medical therapy (CMT) or surgery followed by CMT. Patients who initially elect CMT and do not experience adequate symptom resolution may “cross over” to endoscopic sinus surgery (ESS). Our objective was to identify patient covariates associated with this subset of patients who elect this change in treatment modality. Study Design: Retrospective analysis of a prospective, multi-center cohort of adult patients with CRS enrolled between March 2011 and June 2015 in academic, tertiary referral clinics. Methods: Subjects who initially elected CMT were followed up to 18 months, provided a comprehensive medical history, and completed the 22-item SinoNasal Outcome Test (SNOT-22) at baseline and during 6-month follow-up intervals. Hazard regression modeling was used to identify covariates associated with elective change in treatment modality. Results: One hundred seventy-nine subjects were followed for an average 15.1 (standard deviation ± 4.6) months. Subjects who elected ESS (55 of 179) had significantly worse average endoscopy scores and reported worse SNOT-22 sleep dysfunction scores at baseline (P ≤ 0.026). For each single increasing (worsening) point of Lund-Kennedy endoscopy score, the hazard ratio (HR) of crossover increased by ∼6%. Similarly, for every point of worsening in baseline SNOT-22 total score, the hazard of treatment crossover increased by ∼2%. After covariate adjustment, only baseline SNOT-22 sleep dysfunction scores were associated with an increased risk of treatment crossover (HR = 1.07; 95% confidence interval: 1.02–1.11; P = 0.003). Conclusion: Baseline total SNOT-22 and endoscopy scores are associated with treatment crossover, but reported sleep dysfunction is the only significant independent predictor of treatment crossover. Level of Evidence: 2c. Laryngoscope, 128:304–310, 2018.",

keywords = "Sinusitis, chronic disease, endoscopy, outcome assessment (health care), therapeutics",

author = "DeConde, {Adam S.} and Mace, {Jess C.} and Ramakrishnan, {Vijay R.} and Alt, {Jeremiah A.} and Smith, {Timothy L.}",

note = "Funding Information: From the Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of California–San Diego (A.S.DC.) San Diego, California, U.S.A.; Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, Department of Otolaryngology–Head and Neck Surgery; Oregon Health and Science University (J.C.M., T.L.S.) Portland, Oregon, U.S.A.; Department of Otolaryngology, University of Colorado (V.R.R.) Aurora, Colorado, U.S.A.; and the Division of Otolaryngology–Head and Neck Surgery, Rhinology–Sinus and Skull Base Surgery Program, Department of Surgery, University of Utah (J.A.A.) Salt Lake City, Utah, U.S.A. Editor{\textquoteright}s Note: This Manuscript was accepted for publication on June 12, 2017. Funding Information: Timothy L. Smith, Jess C. Mace, Vijay R. Ramakrishnan, and Jeremiah A. Alt were supported by a grant for this investigation from the National Institute on Deafness and Other Communication Disorders (NIDCD), one of the National Institutes of Health, Bethesda, MD, U.S.A. (R01 DC005805; PI: TL Smith). Public clinical trial registration (www.clinicaltrials.gov) IDs: NCT01332136 and NCT02720653. This funding organization did not contribute to the design or conduct of this study; collection, management, analysis, or interpretation of the data; preparation, review, approval or decision to submit this manuscript for publication. Adam S. DeConde is a consultant for IntersectENT, (Menlo Park, CA). Adam S. DeConde is a consultant for Stryker Endoscopy (San Jose, CA) and Olympus ENT (Center Valley, PA). Jeremiah A. Alt and Vijay R. Ramakrishnan are consultants for Medtronic (Jacksonville, FL), none of which are affiliated with this investigation. The authors have no other funding, financial relationships, or conflicts of interest to disclose.",

year = "2018",

month = feb,

day = "1",

doi = "10.1002/lary.26788",

language = "English (US)",

volume = "128",

pages = "304--310",

journal = "Laryngoscope",

issn = "0023-852X",

publisher = "John Wiley and Sons Inc.",

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TY - JOUR

T1 - Analysis of factors associated with electing endoscopic sinus surgery

AU - DeConde, Adam S.

AU - Mace, Jess C.

AU - Ramakrishnan, Vijay R.

AU - Alt, Jeremiah A.

AU - Smith, Timothy L.

N1 - Funding Information: From the Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of California–San Diego (A.S.DC.) San Diego, California, U.S.A.; Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, Department of Otolaryngology–Head and Neck Surgery; Oregon Health and Science University (J.C.M., T.L.S.) Portland, Oregon, U.S.A.; Department of Otolaryngology, University of Colorado (V.R.R.) Aurora, Colorado, U.S.A.; and the Division of Otolaryngology–Head and Neck Surgery, Rhinology–Sinus and Skull Base Surgery Program, Department of Surgery, University of Utah (J.A.A.) Salt Lake City, Utah, U.S.A. Editor’s Note: This Manuscript was accepted for publication on June 12, 2017. Funding Information: Timothy L. Smith, Jess C. Mace, Vijay R. Ramakrishnan, and Jeremiah A. Alt were supported by a grant for this investigation from the National Institute on Deafness and Other Communication Disorders (NIDCD), one of the National Institutes of Health, Bethesda, MD, U.S.A. (R01 DC005805; PI: TL Smith). Public clinical trial registration (www.clinicaltrials.gov) IDs: NCT01332136 and NCT02720653. This funding organization did not contribute to the design or conduct of this study; collection, management, analysis, or interpretation of the data; preparation, review, approval or decision to submit this manuscript for publication. Adam S. DeConde is a consultant for IntersectENT, (Menlo Park, CA). Adam S. DeConde is a consultant for Stryker Endoscopy (San Jose, CA) and Olympus ENT (Center Valley, PA). Jeremiah A. Alt and Vijay R. Ramakrishnan are consultants for Medtronic (Jacksonville, FL), none of which are affiliated with this investigation. The authors have no other funding, financial relationships, or conflicts of interest to disclose.

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Objective: Medically refractory chronic rhinosinusitis (CRS) can be managed with appropriate continued medical therapy (CMT) or surgery followed by CMT. Patients who initially elect CMT and do not experience adequate symptom resolution may “cross over” to endoscopic sinus surgery (ESS). Our objective was to identify patient covariates associated with this subset of patients who elect this change in treatment modality. Study Design: Retrospective analysis of a prospective, multi-center cohort of adult patients with CRS enrolled between March 2011 and June 2015 in academic, tertiary referral clinics. Methods: Subjects who initially elected CMT were followed up to 18 months, provided a comprehensive medical history, and completed the 22-item SinoNasal Outcome Test (SNOT-22) at baseline and during 6-month follow-up intervals. Hazard regression modeling was used to identify covariates associated with elective change in treatment modality. Results: One hundred seventy-nine subjects were followed for an average 15.1 (standard deviation ± 4.6) months. Subjects who elected ESS (55 of 179) had significantly worse average endoscopy scores and reported worse SNOT-22 sleep dysfunction scores at baseline (P ≤ 0.026). For each single increasing (worsening) point of Lund-Kennedy endoscopy score, the hazard ratio (HR) of crossover increased by ∼6%. Similarly, for every point of worsening in baseline SNOT-22 total score, the hazard of treatment crossover increased by ∼2%. After covariate adjustment, only baseline SNOT-22 sleep dysfunction scores were associated with an increased risk of treatment crossover (HR = 1.07; 95% confidence interval: 1.02–1.11; P = 0.003). Conclusion: Baseline total SNOT-22 and endoscopy scores are associated with treatment crossover, but reported sleep dysfunction is the only significant independent predictor of treatment crossover. Level of Evidence: 2c. Laryngoscope, 128:304–310, 2018.

AB - Objective: Medically refractory chronic rhinosinusitis (CRS) can be managed with appropriate continued medical therapy (CMT) or surgery followed by CMT. Patients who initially elect CMT and do not experience adequate symptom resolution may “cross over” to endoscopic sinus surgery (ESS). Our objective was to identify patient covariates associated with this subset of patients who elect this change in treatment modality. Study Design: Retrospective analysis of a prospective, multi-center cohort of adult patients with CRS enrolled between March 2011 and June 2015 in academic, tertiary referral clinics. Methods: Subjects who initially elected CMT were followed up to 18 months, provided a comprehensive medical history, and completed the 22-item SinoNasal Outcome Test (SNOT-22) at baseline and during 6-month follow-up intervals. Hazard regression modeling was used to identify covariates associated with elective change in treatment modality. Results: One hundred seventy-nine subjects were followed for an average 15.1 (standard deviation ± 4.6) months. Subjects who elected ESS (55 of 179) had significantly worse average endoscopy scores and reported worse SNOT-22 sleep dysfunction scores at baseline (P ≤ 0.026). For each single increasing (worsening) point of Lund-Kennedy endoscopy score, the hazard ratio (HR) of crossover increased by ∼6%. Similarly, for every point of worsening in baseline SNOT-22 total score, the hazard of treatment crossover increased by ∼2%. After covariate adjustment, only baseline SNOT-22 sleep dysfunction scores were associated with an increased risk of treatment crossover (HR = 1.07; 95% confidence interval: 1.02–1.11; P = 0.003). Conclusion: Baseline total SNOT-22 and endoscopy scores are associated with treatment crossover, but reported sleep dysfunction is the only significant independent predictor of treatment crossover. Level of Evidence: 2c. Laryngoscope, 128:304–310, 2018.

KW - Sinusitis

KW - chronic disease

KW - endoscopy

KW - outcome assessment (health care)

KW - therapeutics

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