Wait times for endoscopic sinus surgery influence patient-reported outcome measures in patients with chronic rhinosinusitis who fulfill appropriateness criteria.

Abstract

Previous studies on the impact of wait times for endoscopic sinus surgery (ESS) in medically recalcitrant chronic rhinosinusitis (rCRS) have not examined its influence on the 5 distinct symptoms domains of the 22-item Sino-Nasal Outcome Test (SNOT-22), and have not applied evidence-based surgical indications. Our primary study objective was to investigate the impact of ESS wait times on postoperative SNOT-22 global and symptom domain scores in patients with rCRS deemed "appropriate" surgical candidates. This was a retrospective analysis of adult patients with rCRS undergoing ESS, categorized as "appropriate" surgical candidates. Primary outcome measure was change in SNOT-22 global/symptom domain score (preoperative - 6-month postoperative). Correlational analyses were performed between wait time and change in SNOT-22 global and symptom domain scores. For significant negative correlations, the threshold wait time to generate a worsening in health-related quality-of-life (HRQoL) equivalent to the mean clinically important difference (MCID) was calculated. A total of 104 patients with a mean ± standard deviation (SD) wait time of 310.8 ± 155.9 days were analyzed. Postoperative SNOT-22 global and symptom domain scores significantly improved postoperatively. Wait time for ESS was negatively correlated with change in SNOT-22 global, rhinologic, extranasal rhinologic, and ear/facial domain scores (p < 0.05), and a wait time threshold of 287, 452, 421, and 381 days corresponded to a decrease equivalent to the MCID, respectively. We identified less improvement in HRQoL after ESS with increasing surgical wait time. Moreover, prolonged wait times may result in less improvement in disease-specific symptoms, but do not appear to worsen psychological or sleep dysfunction.