Appropriateness criteria predict outcomes for sinus surgery and may aid in future patient selection

Daniel M. Beswick, Jess C. Mace, Zachary M. Soler, Noel F. Ayoub, Luke Rudmik, Adam S. DeConde, Timothy Smith

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: Appropriateness criteria to determine surgical candidacy for chronic rhinosinusitis (CRS) have recently been described. This study stratified patients who underwent endoscopic sinus surgery (ESS) according to these new appropriateness criteria and evaluated postoperative improvements among appropriateness categories. Methods: Adult patients with uncomplicated CRS electing ESS were prospectively enrolled in a multi-institutional cohort study between March 2011 and June 2015 to assess outcomes. Subsequently, appropriateness criteria that consider preoperative medical therapy, 22-item SinoNasal Outcome Test (SNOT-22) scores, and Lund-Mackay computed tomography scores were retrospectively applied. Results: A total of 92.6% (436 of 471) were categorized as “appropriate” ESS candidates, 3.8% (18 of 471) as “uncertain,” and 3.6% (17 of 471) as “inappropriate.” Among uncertain patients, two-thirds (12 of 18) had identifiable reasons for undergoing ESS, most commonly oral corticosteroid intolerance (n = 6). Postoperative follow-up was available for 79% (n = 372). Clinically significant SNOT-22 improvements occurred in both appropriate and uncertain groups (all P < 0.050) but not among the inappropriate group. The inappropriate group reported less mean improvement in SNOT-22 total score compared to appropriate (P = 0.008) and uncertain (P = 0.006) groups. Conclusion: The vast majority of patients (∼93%) who underwent ESS in a multi-institutional research program were identified as appropriate candidates for surgical intervention, as defined by current appropriateness criteria. Valid considerations frequently exist for offering ESS to patients categorized as uncertain. Appropriate and uncertain candidates report similar, clinically significant SNOT-22 improvements following surgery. Patients classified as inappropriate reported significantly less improvement following ESS. Surgical appropriateness criteria may assist in predicting outcomes of ESS. Level of Evidence: 2b. Laryngoscope, 2448–2454, 2018.

Original languageEnglish (US)
Pages (from-to)2448-2454
Number of pages7
JournalLaryngoscope
Volume128
Issue number11
DOIs
StatePublished - Nov 1 2018

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Patient Selection
Laryngoscopes
Adrenal Cortex Hormones
Cohort Studies
Tomography
Research

Keywords

  • chronic disease
  • paranasal sinuses
  • quality of life
  • Sinusitis
  • standards

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Beswick, D. M., Mace, J. C., Soler, Z. M., Ayoub, N. F., Rudmik, L., DeConde, A. S., & Smith, T. (2018). Appropriateness criteria predict outcomes for sinus surgery and may aid in future patient selection. Laryngoscope, 128(11), 2448-2454. https://doi.org/10.1002/lary.27227

Appropriateness criteria predict outcomes for sinus surgery and may aid in future patient selection. / Beswick, Daniel M.; Mace, Jess C.; Soler, Zachary M.; Ayoub, Noel F.; Rudmik, Luke; DeConde, Adam S.; Smith, Timothy.

In: Laryngoscope, Vol. 128, No. 11, 01.11.2018, p. 2448-2454.

Research output: Contribution to journalArticle

Beswick, DM, Mace, JC, Soler, ZM, Ayoub, NF, Rudmik, L, DeConde, AS & Smith, T 2018, 'Appropriateness criteria predict outcomes for sinus surgery and may aid in future patient selection', Laryngoscope, vol. 128, no. 11, pp. 2448-2454. https://doi.org/10.1002/lary.27227
Beswick DM, Mace JC, Soler ZM, Ayoub NF, Rudmik L, DeConde AS et al. Appropriateness criteria predict outcomes for sinus surgery and may aid in future patient selection. Laryngoscope. 2018 Nov 1;128(11):2448-2454. https://doi.org/10.1002/lary.27227
Beswick, Daniel M. ; Mace, Jess C. ; Soler, Zachary M. ; Ayoub, Noel F. ; Rudmik, Luke ; DeConde, Adam S. ; Smith, Timothy. / Appropriateness criteria predict outcomes for sinus surgery and may aid in future patient selection. In: Laryngoscope. 2018 ; Vol. 128, No. 11. pp. 2448-2454.
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abstract = "Objectives: Appropriateness criteria to determine surgical candidacy for chronic rhinosinusitis (CRS) have recently been described. This study stratified patients who underwent endoscopic sinus surgery (ESS) according to these new appropriateness criteria and evaluated postoperative improvements among appropriateness categories. Methods: Adult patients with uncomplicated CRS electing ESS were prospectively enrolled in a multi-institutional cohort study between March 2011 and June 2015 to assess outcomes. Subsequently, appropriateness criteria that consider preoperative medical therapy, 22-item SinoNasal Outcome Test (SNOT-22) scores, and Lund-Mackay computed tomography scores were retrospectively applied. Results: A total of 92.6{\%} (436 of 471) were categorized as “appropriate” ESS candidates, 3.8{\%} (18 of 471) as “uncertain,” and 3.6{\%} (17 of 471) as “inappropriate.” Among uncertain patients, two-thirds (12 of 18) had identifiable reasons for undergoing ESS, most commonly oral corticosteroid intolerance (n = 6). Postoperative follow-up was available for 79{\%} (n = 372). Clinically significant SNOT-22 improvements occurred in both appropriate and uncertain groups (all P < 0.050) but not among the inappropriate group. The inappropriate group reported less mean improvement in SNOT-22 total score compared to appropriate (P = 0.008) and uncertain (P = 0.006) groups. Conclusion: The vast majority of patients (∼93{\%}) who underwent ESS in a multi-institutional research program were identified as appropriate candidates for surgical intervention, as defined by current appropriateness criteria. Valid considerations frequently exist for offering ESS to patients categorized as uncertain. Appropriate and uncertain candidates report similar, clinically significant SNOT-22 improvements following surgery. Patients classified as inappropriate reported significantly less improvement following ESS. Surgical appropriateness criteria may assist in predicting outcomes of ESS. Level of Evidence: 2b. Laryngoscope, 2448–2454, 2018.",
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