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Appropriateness criteria predict outcomes for sinus surgery and may aid in future patient selection

Beswick, Daniel M. ; Mace, Jess C. ; Soler, Zachary M. ; Ayoub, Noel F. ; Rudmik, Luke ; DeConde, Adam S. ; Smith, Timothy L.

The Laryngoscope, 2018-11, Vol.128 (11), p.2448-2454 [Periódico revisado por pares]

United States: Wiley Subscription Services, Inc

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  • Título:
    Appropriateness criteria predict outcomes for sinus surgery and may aid in future patient selection
  • Autor: Beswick, Daniel M. ; Mace, Jess C. ; Soler, Zachary M. ; Ayoub, Noel F. ; Rudmik, Luke ; DeConde, Adam S. ; Smith, Timothy L.
  • Assuntos: Chronic Disease ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; paranasal sinuses ; Patient Selection ; Predictive Value of Tests ; Prospective Studies ; quality of life ; Rhinitis - diagnostic imaging ; Rhinitis - surgery ; Sinusitis ; Sinusitis - diagnostic imaging ; Sinusitis - surgery ; Surgery ; Tomography, X-Ray Computed ; Treatment Outcome
  • É parte de: The Laryngoscope, 2018-11, Vol.128 (11), p.2448-2454
  • Notas: and
    j.c.m.
    ID# NCT02720653 and NCT01332136. The NIDCD did not contribute to the design or conduct of this study; preparation, review, approval or decision to submit this manuscript for publication. The authors have no other funding, financial relationships, or conflicts of interest to disclose.
    z.m.s.
    Public clinical trial registration
    ,
    t.l.s
    were supported by a grant for this investigation from the National Institute on Deafness and Other Communication Disorders (NIDCD), one of the National Institutes of Health (NIH), Bethesda, MD., USA (R01 DC005805; PIs
    www.clinicaltrials.gov
    ObjectType-Article-1
    SourceType-Scholarly Journals-1
    ObjectType-Feature-2
    content type line 23
  • Descrição: 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
  • Editor: United States: Wiley Subscription Services, Inc
  • Idioma: Inglês
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