Determinants of Outcomes of Sinus Surgery: A Multi‐Institutional Prospective Cohort Study

Abstract

OBJECTIVES-1. To measure the proportion of patients with chronic rhinosinusitis (CRS) who experience clinically significant improvement after endoscopic sinus surgery (ESS) in a prospective, multi-institutional fashion. 2. To identify preoperative characteristics which predict clinically significant improvement in quality of life (QOL) after ESS. STUDY DESIGN-Prospective, multi-institutional cohort study SETTING-Academic tertiary care centers SUBJECTS & METHODS-302patients with CRS from three centers were enrolled between July 2004 and December 2008 and followed for an average of 17.4 months postoperatively. Preoperative patient characteristics, computed tomography (CT) scan, endoscopy score and pre-and postoperative quality of life (QOL) were collected. Univariate and multivariate analyses were performed.

Burden of Illness: A Systematic Review of Depression in Chronic Rhinosinusitis

“…20 Nine studies used a validated questionnaire to screen for depression, 9,11,[13][14][15][16][17][18][19] and four studies relied on a previous physician diagnosis. 7,8,10,12 There were four studies that used physician-diagnosed depression (n ϭ 631 patients). 7,8,10,12 All of these studies relied on patient report or medical record confirmation of other non-otolaryngologist physicians to make the diagnosis of depression.…”

Role of Depression in Outcomes of Endoscopic Sinus Surgery

“…More recently, we examined depression in a multi-institutional study and found that it did not predict post-operative QOL, but again, this depended on selfreport which can under-or overestimate the actual prevalence. 2 To address the limitations associated with self-reported depression, patients completed screening with an objective depression screening instrument. Patients with depression presented with worse disease-specific and general health-related QOL before surgery but experienced similar degrees of improvement postoperatively.…”

“…1,2 Major depressive disorder affects 13 to 14 million Americans yearly, is a leading cause of disability in the population between 15 and 44 years old, and is estimated to cost $83 billion annually. 3,4 The prevalence of depression has been estimated to be between 5.4% and 8.9% in the general population, but is much more common in patients with chronic disease and has been estimated to be in the range of 14%-36%.…”

“…14 Several authors have reported worse disease-specific quality of life (QOL) in CRS patients with depression, whereas others have reported similar disease-specific symptoms to other patients. 1,2,[11][12][13] Some have reported similar outcomes after surgical treatment for depressed and non-depressed patients whereas others report depression as a negative predictor of postoperative QOL outcomes. 1,2,[11][12][13] Given the discrepancy between studies, frequent use of self-reported depression in these studies, and intermittent use of prospective data, we set out to examine the role of depression in surgical treatment of patients with CRS in a prospective fashion with objective measures of both depression and outcomes of care.…”

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

“…[71][72][73][74] However, there is conflicting evidence on the ability of CT severity to predict QoL gains postintervention, with some studies showing correlations 71,75 but more studies showing that CT stage is not an independent predictor of outcome. 71,76,77 Among currently available radiographic scoring systems, there is simply binary data; eg, presence or absence of inflammation. However, there is likely missing information in this scheme.…”