Ethan Newton1, Arif Janjua2, Ernest Lai3, Guiping Liu3, Trafford Crump4, Jason M Sutherland3. 1. Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada. 2. Rhinology and Skull Base Surgery, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada. 3. Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada. 4. Department of Surgery, University of Calgary, Calgary, AB, Canada.
Abstract
BACKGROUND: In many developed countries, wait times for elective surgery are increasing. Among these elective surgeries is endoscopic sinus surgery (ESS) performed for treatment of chronic rhinosinusitis (CRS). Little is known about the impact of wait times on patients' surgical outcomes. The purpose of this study was to evaluate the association between patients' wait times and postoperative patient-reported outcomes. METHODS: This study was based on a prospectively recruited longitudinal cohort of patients booked for ESS for the treatment of medically-refractory CRS in Vancouver, Canada. Patients were recruited between September 2012 and December 2016. All participants completed the Sino-Nasal Outcome Test (SNOT-22) preoperatively and 6 months postoperatively. The primary outcome measure was participants' change in SNOT-22 score. A regression model measured the association between patient-reported outcome, wait time, and potential confounders. RESULTS: The study included 150 participants. The mean surgical wait time was 32 weeks. The mean preoperative SNOT-22 score was 40.0. The improvement in SNOT-22 scores following ESS was 18 points. Regression analysis found no association between wait time for ESS and the change in SNOT-22 scores after surgery (p = 0.42). Only preoperative SNOT-22 score correlated with outcome scores. CONCLUSION: There was no association between the gains in health-related quality of life and the length of time participants waited for surgery. The largest gains in health were concentrated among participants with the highest symptom burden, irrespective of wait time. This result suggests that it may be safe to triage patients based on symptom severity as an approach to maximizing the population's overall health.
BACKGROUND: In many developed countries, wait times for elective surgery are increasing. Among these elective surgeries is endoscopic sinus surgery (ESS) performed for treatment of chronic rhinosinusitis (CRS). Little is known about the impact of wait times on patients' surgical outcomes. The purpose of this study was to evaluate the association between patients' wait times and postoperative patient-reported outcomes. METHODS: This study was based on a prospectively recruited longitudinal cohort of patients booked for ESS for the treatment of medically-refractory CRS in Vancouver, Canada. Patients were recruited between September 2012 and December 2016. All participants completed the Sino-Nasal Outcome Test (SNOT-22) preoperatively and 6 months postoperatively. The primary outcome measure was participants' change in SNOT-22 score. A regression model measured the association between patient-reported outcome, wait time, and potential confounders. RESULTS: The study included 150 participants. The mean surgical wait time was 32 weeks. The mean preoperative SNOT-22 score was 40.0. The improvement in SNOT-22 scores following ESS was 18 points. Regression analysis found no association between wait time for ESS and the change in SNOT-22 scores after surgery (p = 0.42). Only preoperative SNOT-22 score correlated with outcome scores. CONCLUSION: There was no association between the gains in health-related quality of life and the length of time participants waited for surgery. The largest gains in health were concentrated among participants with the highest symptom burden, irrespective of wait time. This result suggests that it may be safe to triage patients based on symptom severity as an approach to maximizing the population's overall health.