Early versus delayed endoscopic sinus surgery in patients with chronic rhinosinusitis: impact on health care utilization

Abstract

Objective: To evaluate the impact of early versus delayed endoscopic sinus surgery (ESS) in terms of postoperative health care utilization, using a patient cohort with chronic rhinosinusitis (CRS).

Study design: Retrospective administrative database analysis.

Setting: US-based primary and secondary sites of care.

Subjects and methods: CRS patients with ESS in 2010-with no other ESS before 2010 and with complete medical history from 2004 to 2012-were identified within the MarketScan database. Patients were characterized by time interval of first sinusitis or nasal polyposis diagnosis to ESS and grouped as following: group 1, <1 year (n=818); group 2, 1 to <2 years (n=247); group 3, 2 to <3 years (n=274); group 4, 3 to <4 years (n=364); group 5, 4 to <5 years (n=595); and group 6, ≥5 years (n=535). Outpatient visits/procedures and prescriptions associated with sinusitis and/or nasal polyps were analyzed for 1 year preoperatively and 2 years postoperatively. Subanalyses were conducted on separate cohorts with or without asthma or polyps, within each group.

Results: Patients in group 1 had significantly fewer visits and prescriptions than patients in group 6 (postoperative visits: group 1, 4.45 [95% CI, 4.06-4.84]; group 6, 6.70 [95% CI, 6.10-7.30; prescriptions: group 1, 4.54 [95% CI, 4.12-4.96]; group 6, 7.61 [95% CI, 6.92-8.31]). Gradual increases in utilization were observed from groups 1 to 6. Subanalysis of patients with and without asthma or polyps showed similar findings.

Conclusion: Early intervention after diagnoses of CRS, with or without asthma or polyps, is associated with lower health care utilization than intervention after many years of medical management.

Keywords: administrative database; chronic rhinosinusitis; endoscopic sinus surgery; long-term follow-up study; observational research; time to surgery.