Preoperative concerns of patients undergoing endoscopic sinus surgery

There is no sinus without "us": A randomized controlled study assessing the efficacy of shared decision-making in the surgical management of chronic rhinosinusitis

KEY POINTS

CRS patients exhibit little decision conflict in their choice of pursuing surgery. Standard counseling alone appears to suffice once patients express an interest in surgery. Decision aids may increase patient knowledge and improve postoperative care understanding.

Gender-Specific Differences in Preoperative Concerns in Patients Undergoing Endoscopic Sinus Surgery for Chronic Rhinosinusitis

OBJECTIVES

Among patients with chronic rhinosinusitis (CRS), gender differences in epidemiology as well as quality of life have been reported. However, whether gender differences in endoscopic sinus surgery (ESS) preoperative concerns exist is unclear.

METHODS

CRS patients undergoing ESS at 3 tertiary care centers in Los Angeles completed the validated Western Surgical Concern Inventory - ESS assessing ESS preoperative concerns.

RESULTS

Of the 75 patients included, female patients expressed greater concern than male patients in regard to nasal packing, undergoing anesthesia, impact of surgery on daily activities, and pain and discomfort following surgery.

CONCLUSION

This study suggests there are gender differences in ESS preoperative concerns and otolaryngologists should be aware of these possible concerns during preoperative discussions.

Sinus Surgery and Balloon Sinuplasty: What Do Patients Want to Know?

OBJECTIVE

Limited knowledge exists regarding the information patients seek online about sinus procedures. The goals of our study were to identify the most searched online queries regarding functional endoscopic sinus surgery (FESS) and balloon sinuplasty and evaluate the sources to which patients are directed.

STUDY DESIGN

Observational.

SETTING

Online Google Database.

METHODS

Google data were analyzed using the search engine optimization tool Ahrefs. People Also Ask (PAA) questions (extracted from Google searches) helped identify questions for analysis of search query volume. Search results were categorized into specific topics, and the source (eg, academic vs medical practice) of the information was identified. The JAMA benchmark criteria were used to determine the quality of the online resource.

RESULTS

The most searched term (average monthly queries) on Google was "sinus surgery" (13,190), followed by "balloon sinuplasty" (9212). For FESS and balloon sinuplasty, most questions focused on treatment of sinusitis (71.64% vs 79.19%) and preoperative inquiries about sinus issues (11.50% vs 11.35%). Answers to PAA questions for FESS were obtained from academic sources at a higher frequency compared to balloon sinuplasty (26.7% vs 10.3%, P = .016) but a lower frequency from medical practice websites (15.2% vs 29.3%, P = .042). The mean (SD) JAMA scores for FESS and balloon sinuplasty sources were 1.59 (1.46) and 1.40 (1.46), respectively.

CONCLUSION

There is a high volume of online search queries regarding FESS and balloon sinuplasty. The quality of the sources could be improved by addressing authorship, attribution, disclosure, and currency. This information may help otolaryngologists better address patient queries.

The value of endoscopic sinus surgery in chronic rhinosinusitis

OBJECTIVES

Chronic rhinosinusitis (CRS) is a disease with significant impacts at both a societal and personal level. There has been an increase in emphasis on patient-centered care and patient outcomes, with value becoming a commonplace concept in health care systems. This review seeks to better define the value that endoscopic sinus surgery (ESS) provides in the treatment of CRS.

DATA SOURCES

PubMed literature review.

REVIEW METHODS

A review of published literature related to ESS and its effects on CRS patients from multiple perspectives (quality outcomes, patient satisfaction, cost-effectiveness) was integrated and analyzed through the viewpoint of a value equation.

RESULTS

ESS provides long-term quality outcomes in both patient-reported outcome measures (PROMs) as well as in objective metrics for patients refractory to medical therapy. The vast majority undergoing ESS are satisfied both in the short and long-term with their decision to pursue surgery. Treatment of CRS with ESS is generally more cost-effective than continued medical therapy (CMT), especially in refractory patients. Taken together, the combination of improved outcomes as well as patient satisfaction after ESS in relation to the costs of surgery provides significant quantifiable value to CRS patients.

CONCLUSION

ESS clearly provides value in the treatment of CRS. Understanding both quality and outcome metrics along with patient expectations and priorities will assist providers in generating a more personalized and value-based approach to patients with CRS.

LEVEL OF EVIDENCE

5.

Long-term outcomes of endoscopic sinus surgery in the management of adult chronic rhinosinusitis

BACKGROUND

There is a striking lack of long-term, prospective outcomes data for endoscopic sinus surgery (ESS) in chronic rhinosinusitis (CRS) using validated instruments. Our primary objective in this study was to report long-term outcomes (>10 years) after ESS for CRS obtained by prospective data collection.

METHODS

An observational cohort (n = 59) of adult patients with CRS electing ESS was enrolled between 2004 and 2008. Long-term, disease-specific quality-of-life (QOL) outcomes, health utility values (HUV), revision surgery rate, development of asthma, and patient expectations/satisfaction with outcomes of ESS were examined using descriptive statistics and simple fixed-effects linear modeling.

RESULTS

Fifty-nine adult patients were followed for 10.9 years (±13.8 months), on average. Mean QOL significantly improved between baseline and 6 months and remained durable to 10 years. HUV improved to normal. A 17% revision surgery rate within the 10-year follow-up period was observed with a 25% revision rate in CRS with polyposis. New-onset asthma after ESS occurred at a rate of 0.8%/year. Patient satisfaction with ESS outcomes was generally high.

CONCLUSIONS

Ten-year prospective outcomes of ESS for CRS demonstrate that the initial clinically significant improvements in QOL seen 6 months postoperatively are durable over the long term. Over 75% of patients reported clinically significant long-term QOL and HUV improvement. HUV returned to normal. Revision surgery rate was 17% and worse postoperative endoscopy scores within 18 months of initial ESS were associated with higher likelihood of revision surgery. Most patients would pursue ESS again and recommend the procedure to other patients considering this treatment option.

Exploring the psychological morbidity of waiting for sinus surgery using a mixed methods approach

BACKGROUND

Patients with chronic rhinosinusitis (CRS) often have to endure significant wait times for endoscopic sinus surgery (ESS). The pyschiatric impact of placement on a waitlist for ESS has not been explored.

METHODS

Questionnaires measuring CRS symptom severity and health-related anxiety and stress (SNOT-22, HADS, WPAI-GH) were sent to patients diagnosed with CRS and currently on a waitlist for ESS. Fifteen representative waitlisted patients participated in one-on-one semi-structured interviews discussing their experience with their wait for ESS. A deductive thematic analysis was used to interpret the interview data using a quantitative driven mixed methods analysis.

RESULTS

Participants waiting for ESS reported worsening clinical symptomatology during their waiting period. Participants reported waitlist and CRS impact on both work and social aspects of their lives. The HADS scale showed no overall significant level of depression or anxiety in the HADS screening questionnaire. The qualitative data describe the effects of the symptom burden of CRS.

CONCLUSIONS

Patients waitlisted for ESS did not demonstrate any significant level of psychiatric distress, however variability exists. The qualitative arm of this study elucidates how patients cope with their wait.

Patient knowledge and expectations in endoscopic sinus surgery

BACKGROUND

The potential for patient misconceptions about endoscopic sinus surgery (ESS) has implications for the informed consent process. An understanding of patients' baseline knowledge and sources of information regarding ESS would improve surgeons' ability to counsel patients preoperatively and provide effective educational materials.

METHODS

A prospective patient survey was performed at 2 independent tertiary care medical centers. Patients who were offered ESS as part of routine rhinology care were queried about expectations, knowledge, and sources of information regarding ESS before preoperative counseling.

RESULTS

Of the 30 patients who completed the survey, 70% of patients reported doing research on ESS before the visit. The most common sources of information were friends and family (40%), YouTube (30.0%), and WebMD (26.7%). The most important factors researched included risks (95%), benefits (85%), and recovery related issues (70%). Patients in the younger group used healthcare and physician rating websites whereas none of the patients older than the median age of 44 years reported using them (33.3% vs 0%, p = 0.028). The older group more often relied upon healthcare providers than the younger group (71.5% vs 18.8%, p = 0.011). A range of responses were noted regarding early postoperative symptoms and recovery time.

CONCLUSION

This study identified a varied understanding of ESS including significant misconceptions about risks, anesthesia, and need for ongoing therapy, among others. Patients obtain their information from a variety of sources including peers, other doctors, and the Internet. Awareness of the gaps in patient knowledge and the sources of information will improve preoperative counseling.