Radiographic disease severity in chronic rhinosinusitis patients and health care utilization

Laryngoscope Investigative Otolaryngology

article

Mitesh P. Mehta MD¹  Kevin Hur MD²  Caroline P. E. Price BA¹  Stephanie Shintani-Smith MD, MS¹  Kevin C. Welch MD¹  David B. Conley MD¹  Robert C. Kern MD¹  Bruce K. Tan MD, MS¹ 

[1] Department of Otolaryngology—Head and Neck Surgery, Northwestern University Feinberg School of Medicine;Department of Otolaryngology—Head and Neck Surgery, University of Southern California

关键词: chronic rhinosinusitis;    health care utilization;    Lund-Mackay score;    radiographic disease severity;    SNOT-22;   

DOI  :  10.1002/lio2.663

学科分类：环境科学（综合）

来源: Wiley

【 摘 要 】

Objectives Chronic rhinosinusitis (CRS) affects approximately 12% of the population and leads to increased health care utilization and indirect costs exceeding $20 billion annually in the United States. The Lund-Mackay score (LMS) measures radiographic disease severity for CRS but poorly correlates with symptom scores. The association between LMS and health care utilization in CRS patients has not yet been investigated. The study aimed to assess the association between health care utilization and CRS radiographic severity using LMS. Methods CRS patients enrolled in a clinical registry were evaluated. Nasal endoscopy findings and LMS were recorded for patients with sinus CT imaging. Patient symptom scores, demographic characteristics, and health care utilization measures were collected. The relationship between these factors and LMS was examined. Results A total of 556 patients met inclusion criteria. Mean age was 45.3 years, 53.4% were male, and 41.7% had nasal polyps. There was no difference in sex, smoking history, 22-item Sino-nasal Outcome Test scores, or past medical history factors between patients with high (≥8, n = 410) and low (<8, n = 146) LMS. Among high LMS patients, 73.7% underwent endoscopic sinus surgery (ESS) compared to 55.5% with low LMS ( P  < .01), and a greater percentage of patients had nasal polyps (49.3% vs 20.5%, P  < .01). On multivariable logistic regression, high LMS patients used fewer antibiotic courses (OR: 0.68 [0.51-0.91]), but were more likely to be managed with ESS (OR: 2.28 [1.41-3.73]), and have nasal polyps (OR: 2.11 [1.16-3.93]) compared to low LMS patients. There was no significant difference in the number of steroid courses, over the counter pill use, provider visits, work/school days missed, or symptom duration between the two LMS groups. Conclusion CRS patients with severe radiographic disease are more likely to have nasal polyps, undergo ESS, and take fewer antibiotic courses. However, there is no association between radiographic disease severity and other measures of health care utilization. Level of Evidence 2b, individual retrospective cohort study.

【 授权许可】

CC BY|CC BY-NC-ND