Medical therapy vs surgery for chronic rhinosinusitis: a prospective, multi-institutional study

被引:65
|
作者
Smith, Timothy L. [1 ]
Kern, Robert C. [2 ]
Palmer, James N. [3 ]
Schlosser, Rodney J. [4 ]
Chandra, Rakesh K. [2 ]
Chiu, Alexander G. [5 ]
Conley, David [2 ]
Mace, Jess C. [1 ]
Fu, Rongwei F. [6 ]
Stankiewicz, James A. [7 ]
机构
[1] Oregon Hlth & Sci Univ, Dept Otolaryngol Head & Neck Surg, Div Rhinol & Sinus Surg, Oregon Sinus Ctr, Portland, OR 97239 USA
[2] Northwestern Univ, Dept Otolaryngol Head & Neck Surg, Sinus & Allergy Ctr, Chicago, IL 60611 USA
[3] Hosp Univ Penn, Dept Otolaryngol Head & Neck Surg, Div Rhinol, Philadelphia, PA 19104 USA
[4] Med Univ S Carolina, Dept Otolaryngol Head & Neck Surg, Div Rhinol & Sinus Surg, Charleston, SC 29425 USA
[5] Univ Arizona, Div Otolaryngol, Tucson, AZ USA
[6] Oregon Hlth & Sci Univ, Dept Emergency Med, Dept Publ Hlth & Prevent Med, Portland, OR 97201 USA
[7] Loyola Univ, Chicago, IL 60611 USA
关键词
assessment; endoscopy; outcomes; sinusitis; surgery; therapy; QUALITY-OF-LIFE; ENDOSCOPIC SINUS SURGERY; OUTCOMES;
D O I
10.1002/alr.20063
中图分类号
R76 [耳鼻咽喉科学];
学科分类号
100213 ;
摘要
Background: Evidence evaluating the comparative effectiveness of various treatments for chronic rhinosinusitis (CRS) is insufficient. This study evaluates outcomes in patients who failed initial medical management and elect a subsequent treatment option, either continued medical management or endoscopic sinus surgery (ESS) coupled with continued medical management. Methods: Adult subjects were prospectively enrolled into a nonrandomized, multi-institutional cohort. Baseline characteristics and objective clinical findings were collected. Primary outcome measures included 2 disease-specific quality-of-life (QOL) instruments: the Rhinosinusitis Disability Index (RSDI) and Chronic Sinusitis Survey (CSS). Bivariate and multivariate analyses compared QOL improvement by treatment type, as well as differences in antibiotic and oral steroid utilization and work/school productivity. Results: Subjects (n = 180) were enrolled between March 2009 and April 2010. Patients electing medical management (n = 55) reported significantly better baseline QOL on 1 instrument relative to surgery patients (CSS symptom [p = 0.019] and total scores [p = 0.010]). Surgical patients (n = 75) reported significantly more improvement than medically managed patients (RSDI, p = 0.015; CSS, p < 0.001). Surgical patients reported significantly fewer oral antibiotics (p = 0.002), oral steroids (p = 0.042), and missed days of work/school (p < 0.001) following ESS. After adjustment, more frequent improvement was found within the surgical cohort as measured by the RSDI physical (78.7% vs 56.4%; odds ratio [OR], 3.36; 95% confidence interval [CI], 1.15-9.87; p = 0.027), CSS symptom (80.6% vs 57.4%; OR, 2.65; 95% CI, 1.06-6.66; p = 0.038), medication (49.3% vs 29.6%; OR, 2.33; 95% CI, 0.96-5.64; p = 0.060), and total scores (76.4% vs 53.7%; OR, 2.20; 95% CI, 0.865.59; p = 0.099). Conclusion: Patients electing ESS experienced significantly higher levels of improvement in several outcomes. Further investigation with a larger cohort is warranted as treatment selection bias may confound the magnitude of improvement experienced with each treatment. (C) 2011 ARS-AAOA, LLC.
引用
收藏
页码:235 / 241
页数:7
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