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Appropriateness criteria predict outcomes for sinus surgery and may aid in future patient selection
Author(s) -
Beswick Daniel M.,
Mace Jess C.,
Soler Zachary M.,
Ayoub Noel F.,
Rudmik Luke,
DeConde Adam S.,
Smith Timothy L.
Publication year - 2018
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.27227
Subject(s) - medicine , chronic rhinosinusitis , cohort , endoscopic sinus surgery , appropriateness criteria , surgery , radiology
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