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. 2017 Sep 1;143(9):891-898.
doi: 10.1001/jamaoto.2017.0752.

Evaluating Surgeon-Specific Performance for Endoscopic Sinus Surgery

Luke Rudmik  1 , Yuan Xu  2 , Jeremiah A Alt  3 , Adam Deconde  4 , Timothy L Smith  5 , Rodney J Schlosser  6 , Hude Quan  2 , Zachary M Soler  6
Affiliations

Evaluating Surgeon-Specific Performance for Endoscopic Sinus Surgery

Luke Rudmik et al. JAMA Otolaryngol Head Neck Surg. .

Abstract

Importance: Several identified factors have raised questions concerning the quality of care for endoscopic sinus surgery (ESS), including the presence of large geographic variation in the rates and extent of surgery, poorly defined indications, and lack of ESS-specific quality metrics. Combined with the risk of major complications, ESS represents a high-value target for quality improvement.

Objective: To evaluate differences in surgeon-specific performance for ESS using a risk-adjusted, 5-year ESS revision rate as a quality metric.

Design, setting, and participants: This retrospective study used a population-based administrative database to study adults (≥18 years of age) with chronic rhinosinusitis (CRS) who underwent primary ESS in Alberta, Canada, between March 1, 2007, and March 1, 2010. The study period ended in 2015 to provide 5 years of follow-up.

Interventions: Endoscopic sinus surgery for CRS.

Main outcomes and measures: Primary outcomes were the 5-year observed and risk-adjusted ESS revision rate. Logistic regression was used to develop a risk adjustment model for the primary outcome.

Results: A total of 43 individual surgeons performed primary ESS in 2168 patients with CRS. Within 5 years after the primary ESS procedure, 239 patients underwent revision ESS, and the mean crude 5-year ESS revision rate was 10.6% (range, 2.4%-28.6%). After applying the risk adjustment model and 95% CI to each surgeon, 7 surgeons (16%) had lower-than-expected performance and 2 surgeons (5%) had higher-than-expected performance. Three variables had significant associations with surgeon-specific, 5-year ESS revision rates: presence of nasal polyps (odds ratio [OR], 2.07; 95% CI, 1.59-2.70), more annual systemic corticosteroid courses (OR, 1.33; 95% CI, 1.19-1.48), and concurrent septoplasty (OR, 0.70; 95% CI, 0.55-0.89).

Conclusions and relevance: Evaluating surgeon-specific performance for ESS may provide information to assist in quality improvement. Although most surgeons had comparable risk-adjusted, 5-year ESS revision rates, 16% of surgeons had lower-than-expected performance, indicating a potential to improve quality of care. Future studies are needed to evaluate more surgeon-specific variables and validate a risk adjustment model to provide appropriate feedback for quality improvement.

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Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Rudmik reported serving on the scientific advisory board for BioInspire and 480 Biomedical. Dr Alt reported serving as a consultant for Medtronic, Spirox, and GlycoMira Therapeutics. Dr Deconde reported serving as a consultant for IntersectENT and Stryker Endoscopy. Dr Schlosser reported serving as a consultant for Olympus, Medtronic, and Arrinex and receiving grant support from Intersect and Entellus. Dr Soler reported serving as a consultant for Olympus Inc and 480 Biomedical Inc. No other disclosures were reported.

Figures

Figure.
Figure.. Adjusted 5-Year, Surgeon-Specific Endoscopic Sinus Surgery Revision Rates for Chronic Rhinosinusitis
Overall crude revision rates were 10.6% for both the observed and risk-adjusted revisions (vertical dashed lines). Error bars indicate 95% CIs.
See this image and copyright information in PMC

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