Premium
Does Delaying Endoscopic Sinus Surgery Adversely Impact Quality‐of‐Life Outcomes?
Author(s) -
Alt Jeremiah A.,
Orlandi Richard R.,
Mace Jess C.,
Soler Zachary M.,
Smith Timothy L.
Publication year - 2019
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.27473
Subject(s) - medicine , quality of life (healthcare) , chronic rhinosinusitis , cohort , disease , multivariate analysis , cohort study , surgery , nursing
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 , 129:303–311, 2019