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. 2020 Feb;130(2):297-302.
doi: 10.1002/lary.28036. Epub 2019 May 17.

Socioeconomic and demographic determinants of postoperative outcome after endoscopic sinus surgery

Sarek A Shen  1 , Aria Jafari  2 , Jesse R Qualliotine  2 , Adam S DeConde  2
Affiliations

Socioeconomic and demographic determinants of postoperative outcome after endoscopic sinus surgery

Sarek A Shen et al. Laryngoscope. 2020 Feb.

Abstract

Objectives/hypothesis: Socioeconomic and demographic factors have a significant impact on healthcare utilization and surgical outcomes. The effect of these variables on baseline symptom severity and quality of life (QOL) after endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) is not well established. Our goal was to investigate the association of sociodemographic factors on QOL before and after ESS, as reflected by the 22-item Sino-Nasal Outcome Test (SNOT-22) score.

Study design: Retrospective case series.

Methods: From October 2016 to August 2018, 244 patients with chronic rhinosinusitis who underwent ESS were included. Socioeconomic and demographic data, surgical characteristics, and baseline and postoperative SNOT-22 scores were recorded. Univariate and multivariate regression were performed to identify determinants of baseline symptom severity and improvement following ESS.

Results: Nonwhite patients reported worse baseline symptoms severity (SNOT-22, 52.06 vs. 43.76, P = .021) compared to white patients, yet lower CRS symptoms at follow-up (SNOT-22, 23.38 vs. 28.63, P = .035). Relative improvement was higher in nonwhite patients as well (41.2% vs. 36.5%, Mann-Whitney U = 1,747, P = .015). In an adjusted multivariate logistic regression model, below-median income ($71,805 [California]) was associated with worse baseline symptom severity (β = 7.72; 95% confidence interval [CI]: 1.10, 14.26). Nonmarried patients (β = 6.78; 95% CI: 2.22, 13.48) and white patients (β = 8.45; 95% CI: 0.40, 13.97) had worse QOL at follow-up.

Conclusions: Nonwhite patients and those with below-median income present with more severe CRS symptoms at baseline. However, a greater degree of absolute and relative QOL improvement was found in nonwhite and married patients following ESS. Improved understanding of the significance of socioeconomic and demographic factors and attention to cultural differences/marital status could have a substantial impact on ESS outcomes.

Level of evidence: 4 Laryngoscope, 130:297-302, 2020.

Keywords: Endoscopic sinus surgery; access to care; demographic; heath disparities; outcome; quality of life; socioeconomic.

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References

BIBLIOGRAPHY

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