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Predictive factors of a beneficial quality of life outcome in patients undergoing primary sinonasal surgery: a population-based prospective cohort study

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

To assess predictive factors of a beneficial quality of life (QoL) outcome after primary sinonasal surgery.

Methods

A population-based prospective cohort study among 160 adult patients undergoing primary sinonasal surgery (76 septoplasties, SP; 84 endoscopic sinus surgeries, ESS) was conducted. We collected QoL data using the Sinonasal Outcome Test-22 (SNOT-22) before and after surgery. A beneficial QoL outcome was defined as a SNOT-22 score change ≥ 9 points 12 months after surgery. Various demographic, clinical and symptom-related factors predicting a beneficial QoL outcome were sought using binary logistic regression analysis.

Results

The mean age of the patients was 39 years (range 18–61) and 82 (51%) were males. The SNOT-22 score change varied markedly after SP (range − 17 to + 80) and ESS (range − 20 to + 58), but on average it improved (median + 15 after SP and + 16 after ESS). 41 patients (64%) achieved beneficial QoL outcome after SP and 46 (66%) after ESS. In a multivariate analysis, poor QoL before surgery (preoperative SNOT-22 ≥ 20 points) predicted a beneficial QoL outcome after SP and ESS (adjusted odds ratio 10; 95% confidence interval 1.6–64 and 12; 2.5–55, respectively) and a senior surgeon operating after SP (9.9; 1.5–67). On receiver operating characteristic curve analysis, the integer threshold value for the preoperative SNOT-22 score that gave the highest sensitivity (74%) and specificity (70%) was 30.

Conclusions

QoL change after primary SP and ESS varies. A preoperative SNOT-22 score of at least 30 best predicted a beneficial QoL outcome after both procedures.

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References

  1. Siegel NS, Gliklich RE, Taghizadeh F et al (2000) Outcomes of septoplasty. Otolaryngol Head Neck Surg 122(2):228–232

    Article  CAS  PubMed  Google Scholar 

  2. Alakarppa AI, Koskenkorva TJ, Koivunen PT et al (2016) Quality of life before and after sinonasal surgery: a population-based matched cohort study. Eur Arch Otorhinolaryngol. https://doi.org/10.1007/s00405-016-4272-2

    PubMed  Google Scholar 

  3. Smith TL, Mendolia-Loffredo S, Loehrl TA et al (2005) Predictive factors and outcomes in endoscopic sinus surgery for chronic rhinosinusitis. Laryngoscope 115(12):2199–2205

    Article  PubMed  Google Scholar 

  4. Hytonen ML, Lilja M, Makitie AA et al (2012) Does septoplasty enhance the quality of life in patients?. Eur Arch Otorhinolaryngol 269. https://doi.org/10.1007/s00405-012-1931-9

  5. Zhang Z, Linkin DR, Finkelman BS et al (2011) Asthma and biofilm-forming bacteria are independently associated with revision sinus surgeries for chronic rhinosinusitis. J Allergy Clin Immunol 128(1):221–223. https://doi.org/10.1016/j.jaci.2011.02.022

    Article  PubMed  Google Scholar 

  6. Litvack JR, Griest S, James KE et al (2007) Endoscopic and quality-of-life outcomes after revision endoscopic sinus surgery. Laryngoscope 117(12):2233–2238. https://doi.org/10.1097/MLG.0b013e31814539e8

    Article  PubMed  Google Scholar 

  7. Watelet JB, Annicq B, Van Cauwenberge P et al (2004) Objective outcome after functional endoscopic sinus surgery: Prediction factors. Laryngoscope 114(6):1092–1097. https://doi.org/10.1097/00005537-200406000-00025

    Article  CAS  PubMed  Google Scholar 

  8. Smith TL, Litvack JR, Hwang PH et al (2010) Determinants of outcomes of sinus surgery: a multi-institutional prospective cohort study. Otolaryngol Head Neck Surg 142(1):55–63. https://doi.org/10.1016/j.otohns.2009.10.009

    Article  PubMed  PubMed Central  Google Scholar 

  9. Katotomichelakis M, Simopoulos E, Tripsianis G et al (2014) Predictors of quality of life outcomes in chronic rhinosinusitis after sinus surgery. Eur Arch Otorhinolaryngol 271(4):733–741. https://doi.org/10.1007/s00405-013-2626-6

    Article  PubMed  Google Scholar 

  10. Steele TO, Mace JC, Smith TL (2015) Does comorbid anxiety predict quality of life outcomes in patients with chronic rhinosinusitis following endoscopic sinus surgery? Int Forum Allergy Rhinol 5(9):829–838. https://doi.org/10.1002/alr.21543

    Article  PubMed  PubMed Central  Google Scholar 

  11. Fokkens WJ, Lund VJ, Mullol J et al (2012) European position paper on rhinosinusitis and nasal polyps 2012. Rhinol Suppl 23(23):3 (p preceding table of contents, 1–298)

    PubMed  Google Scholar 

  12. Blomgren K, Alho OP, Ertama L et al (2005) Acute sinusitis: Finnish clinical practice guidelines. Scand J Infect Dis 37(4):245–250

    PubMed  Google Scholar 

  13. Hopkins C, Gillett S, Slack R et al (2009) Psychometric validity of the 22-item Sinonasal Outcome Test. Clin Otolaryngol 34(5):447–454. https://doi.org/10.1111/j.1749-4486.2009.01995.x

    Article  CAS  PubMed  Google Scholar 

  14. Morley AD, Sharp HR (2006) A review of sinonasal outcome scoring systems—which is best? Clin Otolaryngol 31(2):103–109. https://doi.org/10.1111/j.1749-4486.2006.01155.x

    Article  CAS  PubMed  Google Scholar 

  15. Dietz de Loos DA, Segboer CL, Gevorgyan A et al (2013) Disease-specific quality-of-life questionnaires in rhinitis and rhinosinusitis: review and evaluation. Curr Allergy Asthma Rep 13(2):162–170. https://doi.org/10.1007/s11882-012-0334-8

    Article  PubMed  Google Scholar 

  16. Buckland JR, Thomas S, Harries PG (2003) Can the Sino-nasal Outcome test (SNOT-22) be used as a reliable outcome measure for successful septal surgery? Clin Otolaryngol Allied Sci 28(1):43–47

    Article  CAS  PubMed  Google Scholar 

  17. Poirrier AL, Ahluwalia S, Goodson A et al (2013) Is the Sino-Nasal Outcome test-22 a suitable evaluation for septorhinoplasty? Laryngoscope 123(1):76–81. https://doi.org/10.1002/lary.23615 [doi]

    Article  PubMed  Google Scholar 

  18. Wild D, Grove A, Martin M et al (2005) Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: report of the ISPOR task force for translation and cultural adaptation. Value Health 8(2):94–104. https://doi.org/10.1111/j.1524-4733.2005.04054.x

    Article  PubMed  Google Scholar 

  19. Stammberger H, Posawetz W (1990) Functional endoscopic sinus surgery. Concept, indications and results of the Messerklinger technique. Eur Arch Otorhinolaryngol 247(2):63–76

    Article  CAS  PubMed  Google Scholar 

  20. Chowdhury NI, Mace JC, Bodner TE et al (2017) Investigating the minimal clinically important difference for SNOT-22 symptom domains in surgically managed chronic rhinosinusitis. Int Forum Allergy Rhinol. https://doi.org/10.1002/alr.22028

    Google Scholar 

  21. Akobeng AK (2007) Understanding diagnostic tests 3: receiver operating characteristic curves. Acta Paediatr 96(5):644–647

    Article  PubMed  Google Scholar 

  22. Hopkins C, Rudmik L, Lund VJ (2015) The predictive value of the preoperative Sinonasal Outcome Test-22 score in patients undergoing endoscopic sinus surgery for chronic rhinosinusitis. Laryngoscope 125(8):1779–1784. https://doi.org/10.1002/lary.25318

    Article  PubMed  Google Scholar 

  23. Hong SD, Lee NJ, Cho HJ et al (2015) Predictive factors of subjective outcomes after septoplasty with and without turbinoplasty: can individual perceptual differences of the air passage be a main factor? Int Forum Allergy Rhinol 5(7):616–621. https://doi.org/10.1002/alr.21508

    Article  PubMed  Google Scholar 

  24. Rudmik L, Soler ZM, Mace JC et al (2014) Using preoperative SNOT-22 score to inform patient decision for endoscopic sinus surgery. Laryngoscope. https://doi.org/10.1002/lary.25108

    Google Scholar 

  25. Bliven BD, Kaufman SE, Spertus JA (2001) Electronic collection of health-related quality of life data: validity, time benefits, and patient preference. Qual Life Res 10(1):15–22

    Article  CAS  PubMed  Google Scholar 

  26. Gwaltney CJ, Shields AL, Shiffman S (2008) Equivalence of electronic and paper-and-pencil administration of patient-reported outcome measures: a meta-analytic review. Value Health 11(2):322–333. https://doi.org/10.1111/j.1524-4733.2007.00231.x

    Article  PubMed  Google Scholar 

  27. Hopkins C, Slack R, Lund V et al (2009) Long-term outcomes from the English national comparative audit of surgery for nasal polyposis and chronic rhinosinusitis. Laryngoscope 119(12):2459–2465. https://doi.org/10.1002/lary.20653

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Otorhinolaryngology and Head and Neck Surgery, Oulu University Hospital, OYS, P.O. Box 21, 90029, Oulu, Finland

    Antti I. Alakärppä, Timo J. Koskenkorva, Petri T. Koivunen & Olli-Pekka Alho

  2. PEDEGO Research Unit, University of Oulu, Oulu, Finland

    Antti I. Alakärppä, Timo J. Koskenkorva, Petri T. Koivunen & Olli-Pekka Alho

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  1. Antti I. Alakärppä
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  2. Timo J. Koskenkorva
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  3. Petri T. Koivunen
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  4. Olli-Pekka Alho
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Correspondence to Antti I. Alakärppä.

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Alakärppä, A.I., Koskenkorva, T.J., Koivunen, P.T. et al. Predictive factors of a beneficial quality of life outcome in patients undergoing primary sinonasal surgery: a population-based prospective cohort study. Eur Arch Otorhinolaryngol 275, 1139–1147 (2018). https://doi.org/10.1007/s00405-018-4918-3

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  • DOI: https://doi.org/10.1007/s00405-018-4918-3

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