Precision medicine: why surgeons deviate from "appropriateness criteria" in the management of chronic rhinosinusitis and effects on outcomes

International Forum of Allergy & Rhinology
Andrew ThambooZara M Patel

Abstract

In uncomplicated chronic rhinosinusitis (CRS), a consensus regarding appropriate medical therapy (AMT) before surgical intervention has been published in the form of "appropriateness criteria" for endoscopic sinus surgery (ESS). We sought to determine why tertiary surgeons may deviate from the suggested criteria and evaluated whether those deviations result in change in outcomes. Patients with uncomplicated CRS were prospectively enrolled over the course of 1 year. The 22-item Sino-Nasal Outcomes Test (SNOT-22), a general health outcome out of 100, and a physician form, indicating management pathway and decision making, was completed at each visit over a 6-month follow-up period. A descriptive analysis was used to quantify reasons for veering from the "appropriateness criteria," and repeated linear regression modeling was used to measure whether compliance impacted SNOT-22, general health, and Lund-Kennedy (LK) scores over the period of study. One hundred fifty-five patients were enrolled. Sixty-eight percent followed the appropriate management pathway based on their presentation and the suggested criteria. Disparate reasons were documented for deviation in the other 32%, and, despite establishing several predictive categories,...Continue Reading

References

Dec 11, 1985·International Journal of Technology Assessment in Health Care·R H BrookR E Park
Oct 2, 2009·Clinical Otolaryngology : Official Journal of ENT-UK ; Official Journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery·C HopkinsJ P Browne
Aug 17, 2011·Annals of Internal Medicine·Sriram VaidyanathanBrian Lipworth
Mar 14, 2012·The Laryngoscope·Luke RudmikZachary M Soler
Apr 4, 2015·Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery·Richard M RosenfeldMaureen D Corrigan
Feb 18, 2016·International Forum of Allergy & Rhinology·Richard R OrlandiPeter H Hwang

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Citations

Dec 5, 2018·International Forum of Allergy & Rhinology·David W Kennedy
Mar 15, 2020·American Journal of Rhinology & Allergy·Arifeen S RahmanCarol H Yan
Nov 26, 2020·International Forum of Allergy & Rhinology·Richard R OrlandiBing Zhou

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