EQ-5D-derived health utility values in patients undergoing surgery for chronic rhinosinusitis

The impact of surgical trainee participation on sinus surgery outcomes

OBJECTIVES/HYPOTHESIS

To determine the effect of otolaryngology trainee participation on clinical outcomes in patients who undergo endoscopic sinus surgery (ESS) for chronic rhinosinusitis.

STUDY DESIGN

Secondary analysis of prospectively collected data.

METHODS

Patients enrolled in a sinus surgery outcomes study between May 2011 and March 2013 were stratified into two groups--those who were operated on by an attending alone and those operated on by an attending with a trainee present (resident, fellow, or both). Patients completed quality of life (QOL) surveys including the Chronic Sinusitis Survey (CSS), 22-item Sino-Nasal Outcome Test (SNOT-22), and EuroQol 5-dimension survey preoperatively and 1 year postoperatively. Operative time, estimated blood loss (EBL), complication rates, and survey scores were compared between groups.

RESULTS

The study population consisted of 452 patients. The attending alone (n = 119) and trainee (n = 333) groups were statistically comparable in terms of patient demographics, disease severity, and extent of surgery. Mean operative time was significantly shorter in the attending-alone group (80.0 vs. 90.6 minutes, P < .01). Mean EBL (105 mL attending vs. 117 mL trainee, P = .39) and complication rates (3.3% attending vs. 0.6% trainee, P = .07) were similar between groups. Observed changes in QOL measures following ESS were comparable between groups, although absolute improvement in the SNOT-22 scores (19.0 attending vs. 24.5 trainee, P = .05) did show a trend toward greater improvement in the trainee group.

CONCLUSIONS

Trainee participation in ESS is associated with prolongation in surgical time; however, such participation was not found to adversely affect patient safety or clinical outcomes.

LEVEL OF EVIDENCE

2b.

Health utility outcomes in patients undergoing medical management for chronic rhinosinusitis: a prospective multiinstitutional study

BACKGROUND

A health utility value represents an individual's preference for living in a specific health state and is used in cost-utility analyses. This study investigates the impact of continuing medical therapy on health utility outcomes in patients with chronic rhinosinusitis (CRS).

METHODS

The Medical Outcomes Study Short Form-6D (SF-6D) questionnaire was administered to patients prospectively enrolled in a longitudinal study examining treatment outcomes for CRS. Patients were prescribed robust, initial medical therapy and then elected to continue with medical therapy (n = 40) or undergo endoscopic sinus surgery (ESS), followed by medical therapy (n = 152). Patients observed through treatment crossover to ESS were also evaluated (n = 20). Health utility values (SF-6D) were generated at baseline, 6-months, and 12-months follow-up for both cohorts and evaluated using repeated measures analysis of variance (ANOVA).

RESULTS

Treatment crossover patients were found to have a significantly higher prevalence of previous sinus surgery compared to medical management (χ(2) = 6.91; p = 0.009) and surgical intervention (χ(2) = 8.11; p = 0.004) subgroups. Mean baseline utility value for the medical therapy cohort was significantly better compared to the ESS cohort (mean ± standard deviation; 0.76 ± 0.12 vs 0.70 ± 0.15; p = 0.023). Significant improvement in health utility was reported in the ESS cohort (F(2) = 37.69; p < 0.001), whereas values remained stable, without significant improvement, in both the medical therapy cohort (F(2) = 0.03; p = 0.967) and treatment crossover cohort (F(2) = 2.36; p = 0.115).

CONCLUSION

Patients electing continued medical management report better baseline health utility compared to patients electing ESS. Patients electing ESS show significant improvement in health utility, whereas those electing continued medical management demonstrate stable health utility over 12 months.

Cognitive function in chronic rhinosinusitis: a controlled clinical study

BACKGROUND

Cognitive dysfunction in patients with chronic rhinosinusitis (CRS) has previously received little attention. Cognitive data generally includes only subjective measures and lack appropriate controls when cognition is considered. The purpose of this study was to characterize dimensions of cognitive function that are affected in patients with CRS compared to a control sample using subjective and objective measures of cognitive function.

METHODS

Patients fulfilling diagnostic criteria for CRS and non-CRS controls were recruited from the same clinical reference population. Patient-reported cognitive dysfunction was assessed using the Cognitive Failures Questionnaire (CFQ) and fatigue via the Fatigue Severity Scale (FSS). Objective cognitive function was assessed using a battery of tests from the Automated Neuropsychological Assessment Metrics (ANAM) computerized platform.

RESULTS

A total of 100 subjects were enrolled, including 50 patients with active CRS and 50 control subjects. Patients with CRS scored significantly worse in subjective cognition as measured by total CFQ scores (38.3 ± 16.5 vs 30.9 ± 12.5; p = 0.009) and the FSS (4.2 ± 1.6 vs 3.0 ± 1.5; p = 0.001). Patients with CRS were also found to have worse simple reaction time scores compared to controls without CRS (162.4 ± 56.2 vs 193.0 ± 44.6; p = 0.003). These differences persisted regardless of polyp status. Performance differences for FSS and SRT measures remained significant after controlling for age, gender, race/ethnicity, education, allergic rhinitis, asthma, obstructive sleep apnea, depression, and antihistamine usage.

CONCLUSION

Patients with CRS report significantly more cognitive dysfunction and fatigue on validated instruments and had worse reaction times on computerized testing. Further study is necessary to determine whether available treatments impact these measures.