Determinants of outcomes of sinus surgery: A multi-institutional prospective cohort study

Timothy Smith, Jamie R. Litvack, Peter H. Hwang, Todd A. Loehrl, Jess C. Mace, Karen J. Fong, Kenneth E. James

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Abstract

Objectives: 1) To measure the proportion of patients with chronic rhinosinusitis (CRS) who experience clinically significant improvement after endoscopic sinus surgery (ESS) in a prospective, multi-institutional fashion. 2) To identify preoperative characteristics that predict clinically significant improvement in quality of life (QOL) after ESS. Study Design: Prospective, multi-institutional cohort study. Setting: Academic tertiary care centers. Subjects and Methods: A total of 302 patients with CRS from three centers were enrolled between July 2004 and December 2008 and followed for an average of 17.4 months postoperatively. Preoperative patient characteristics, CT scan, endoscopy score, and pre- and postoperative quality of life (QOL) data were collected. Univariate and multivariate analyses were performed. Results: Patients improved an average of 15.8 percent (18.9 points) on the Rhinosinusitis Disability Index and 21.2 percent (21.2 points) on the Chronic Sinusitis Survey (both P <0.001). Patients significantly improved on all eight Medical Outcomes Study Short Form-36 (SF-36) subscales (all P <0.001). Among patients with poor baseline QOL, 71.7 percent of patients experienced clinically significant improvement on the RSDI and 76.1 percent on the CSS. Patients undergoing primary surgery were 2.1 times more likely to improve on the RSDI (95% confidence interval [CI], 1.2, 3.4; P = 0.006) and 1.8 times more likely to improve on the CSS (95% CI, 1.1, 3.1; P = 0.020) compared with patients undergoing revision surgery. Conclusion: In this prospective, multi-institutional study, most patients experienced clinically significant improvement across multiple QOL outcomes after ESS. Specific patient characteristics provided prognostic value with regard to outcomes.

Original languageEnglish (US)
Pages (from-to)55-63
Number of pages9
JournalOtolaryngology - Head and Neck Surgery
Volume142
Issue number1
DOIs
StatePublished - Jan 2010

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Cohort Studies
Prospective Studies
Quality of Life
Confidence Intervals
Sinusitis
Reoperation
Tertiary Care Centers
Endoscopy
Multivariate Analysis
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Surgery

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Determinants of outcomes of sinus surgery : A multi-institutional prospective cohort study. / Smith, Timothy; Litvack, Jamie R.; Hwang, Peter H.; Loehrl, Todd A.; Mace, Jess C.; Fong, Karen J.; James, Kenneth E.

In: Otolaryngology - Head and Neck Surgery, Vol. 142, No. 1, 01.2010, p. 55-63.

Research output: Contribution to journalArticle

Smith, Timothy ; Litvack, Jamie R. ; Hwang, Peter H. ; Loehrl, Todd A. ; Mace, Jess C. ; Fong, Karen J. ; James, Kenneth E. / Determinants of outcomes of sinus surgery : A multi-institutional prospective cohort study. In: Otolaryngology - Head and Neck Surgery. 2010 ; Vol. 142, No. 1. pp. 55-63.
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abstract = "Objectives: 1) To measure the proportion of patients with chronic rhinosinusitis (CRS) who experience clinically significant improvement after endoscopic sinus surgery (ESS) in a prospective, multi-institutional fashion. 2) To identify preoperative characteristics that predict clinically significant improvement in quality of life (QOL) after ESS. Study Design: Prospective, multi-institutional cohort study. Setting: Academic tertiary care centers. Subjects and Methods: A total of 302 patients with CRS from three centers were enrolled between July 2004 and December 2008 and followed for an average of 17.4 months postoperatively. Preoperative patient characteristics, CT scan, endoscopy score, and pre- and postoperative quality of life (QOL) data were collected. Univariate and multivariate analyses were performed. Results: Patients improved an average of 15.8 percent (18.9 points) on the Rhinosinusitis Disability Index and 21.2 percent (21.2 points) on the Chronic Sinusitis Survey (both P <0.001). Patients significantly improved on all eight Medical Outcomes Study Short Form-36 (SF-36) subscales (all P <0.001). Among patients with poor baseline QOL, 71.7 percent of patients experienced clinically significant improvement on the RSDI and 76.1 percent on the CSS. Patients undergoing primary surgery were 2.1 times more likely to improve on the RSDI (95{\%} confidence interval [CI], 1.2, 3.4; P = 0.006) and 1.8 times more likely to improve on the CSS (95{\%} CI, 1.1, 3.1; P = 0.020) compared with patients undergoing revision surgery. Conclusion: In this prospective, multi-institutional study, most patients experienced clinically significant improvement across multiple QOL outcomes after ESS. Specific patient characteristics provided prognostic value with regard to outcomes.",
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