Early versus Delayed Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis: Impact on Health Care Utilization

Abstract

Objectives: Using a patient cohort with chronic rhinosinusitis (CRS) refractory to medical management, evaluate the impact of early versus delayed endoscopic sinus surgery (ESS) in terms of postoperative health care utilization. Methods: The MarketScan CCAE database was queried. Patients with ESS in 2010 and complete medical history from 2004 to 2012 were identified. Diagnoses of CRS or polyposis prior to 2005 as well as ESS prior to 2010 were exclusion criteria. Patients were characterized by time interval of first CRS diagnosis to ESS and grouped as follows: (1) <1 year (N = 888); (2) 1-2 years (N = 267); (3) 2-3 years (N = 300); (4) 3-4 years (N = 414); and (5) 4-5 years (N = 649). Outpatient visits/procedures and prescriptions associated with CRS were analyzed for all groups at the following time points: year immediately preoperative, year 1 postoperative, and year 2 postoperative. Results: Patients in all groups showed significant decline in health care utilization following surgery. Groups 1 and 2 had significantly fewer health care needs pre- and postoperatively compared to Group 5. Specifically, Group 1 had an average of 3.45 visits (95% confidence interval [CI]: 3.31-3.58) and 2.92 filled prescriptions (95% CI: 2.71-3.14) preoperatively versus Group 5 (visits: 4.57 (95% CI: 4.37-4.78); prescriptions: 4.69 (95% CI: 4.33-5.05)). At year 2 postoperative, Group 1 had 0.92 visits (95% CI: 0.74-1.10) and 0.82 prescriptions (95% CI: 0.67-0.96) versus Group 5, with 1.78 visits (95% CI: 1.45-2.11) and 2.06 prescriptions (95% CI: 1.73-2.39). Conclusions: Patients treated surgically early in the diagnosis of CRS have lower health care needs than patients treated after many years of failed medical management.