Using preoperative SNOT-22 score to inform patient decision for Endoscopic sinus surgery

Objectives/Hypothesis The purpose of this study is to improve patient understanding of surgical outcomes while they make a preference-sensitive decision regarding electing endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). Study Design Prospective observational cohort study. Methods Patients with CRS who elected ESS were prospectively enrolled into a multi-institutional, observational cohort study. Patients' were categorized into 10 preoperative Sino-Nasal Outcome Test (SNOT-22) groups based on 10-point increments beginning with a score of 10 and ending at 110. The proportion of patients achieving a SNOT-22 minimal clinically important difference (MCID) (9 points) and the percentage of relative improvement (%) for each preoperative SNOT-22 group were calculated. A subgroup analysis based on polyp status was performed. Results A total of 327 patients were included in this study. Patients with a SNOT-22 score between 10 and 19 had the lowest chance of achieving an MCID (37.5%) and received a relative mean worsening of their quality of life (QoL) after ESS (+18.8%). Patients with a SNOT-22 score greater than 30 obtained a greater than 75% chance of achieving an MCID, and there was a relative improvement of 45% in QoL (all < -44.9%) after ESS. Outcomes from the polyp status subgroup analysis were similar to the findings from the overall cohort. Conclusion Outcomes from this study suggest that patients with a preoperative SNOT-22 score higher than 30 points receive a greater than 75% chance of achieving an MCID and on average obtain a 45% relative improvement in their QoL after ESS. Patients with SNOT-22 score of less than 20 did not experience improved QoL from ESS. Level of Evidence 2b.