Does Delaying Endoscopic Sinus Surgery Adversely Impact Quality-of-Life Outcomes?

Jeremiah A. Alt, Richard R. Orlandi, Jess C. Mace, Zachary M. Soler, Timothy Smith

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

Objectives: There is little consensus regarding the prognostic value of symptom duration in predicting clinical disease severity or quality-of-life (QOL) outcomes in patients with chronic rhinosinusitis (CRS). Our objectives were to: 1) determine if patients with longer symptom duration have worse preoperative disease severity and/or QOL, and 2) determine if delayed surgical intervention influences outcomes of endoscopic sinus surgery (ESS). Methods: Patients diagnosed with CRS were prospectively enrolled into a multicenter cohort study and observed 14.7 (standard deviaton {SD} ± 4.8) months on average following primary ESS. Preoperative symptom duration was stratified into short-term (< 12 months), middle-term (12–60 months), and long-term (> 60 months). Disease severity was assessed using endoscopy and computed tomography. Disease-specific QOL was measured with the 22-item Sinonasal Outcome Test (SNOT-22) and Rhinosinusitis Disability Index. Adjusted bivariate and multivariate associations between symptom duration, disease severity, and QOL scores were evaluated. Results: One hundred and thirteen patients met inclusion criteria with 35 patients lost to postoperative follow-up. No significant differences in preoperative disease severity or QOL scores were reported between symptom duration subgroups. Participants in the long-term symptom subgroup reported significantly greater mean postoperative improvement on SNOT-22 total scores (n = 28; −36.3[± 22.2]) compared to both short-term (n = 27; −23.4[SD ± 11.3]; P = 0.039) and middle-term (n = 23; −23.5[SD ± 20.1]; P = 0.050) subgroups. Postoperative QOL improvements in the long-term symptom subgroup remained significantly greater (P ≤ 0.036) after multivariate adjustment. Conclusions: Symptom duration was not associated with mean preoperative disease severity or QOL. Patients with long-term symptom duration reported the greatest mean postoperative QOL improvement, suggesting that delayed surgical intervention may not reduce QOL improvements following ESS. Level of Evidence: 2c. Laryngoscope, 2018.

Original languageEnglish (US)
JournalLaryngoscope
DOIs
StateAccepted/In press - Jan 1 2018

Keywords

  • chronic disease
  • patient-reported outcome measures
  • Quality of life
  • sinusitis
  • symptom assessment

ASJC Scopus subject areas

  • Otorhinolaryngology

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