Functional endoscopic sinus surgery: do ratings of appropriateness predict patient outcomes?

Sinus surgery appropriateness ratings were recently developed by Value Health Sciences in cooperation with AAO-HNS. The goal of this study was to assess the relationships among three ratings of sinus surgery appropriateness (Appropriate, Inappropriate, or Equivocal) and symptom response. The enrolled population included 49 patients who completed the Smo-Nasal Outcome Test-20 (SNOT-20) presurgery and 6 months postsurgery. The SNOT-20 is a patient-based measure of sinusitis-related health status and quality of life. Overall, the mean percent difference (delta %) between pre- and postsurgery SNOT scores was 38%, a statistically and clinically significant improvement. However, there was no relationship between the appropriateness rating for the surgery and the delta % SNOT score (i = 1.83, p-value = 0.171); 20 patients with an Equivocal rating demonstrated the greatest delta % (49%), 20 patients with an Appropriate rating showed the least delta % (26%), and 9 patients with an Inappropriate rating had an intermediate delta % (39%). Furthermore, those patients having an Appropriate rating at the time of surgery reported a greater persistence of bothersome symptoms at 6 months (p-value = 0.02) then patients in either the Equivocal or Inappropriate rating. These results suggest that appropriateness ratings may not predict which patients will obtain the greatest symptom improvement from sinus surgery.