The predictive value of the preoperative Sinonasal Outcome Test-22 score in patients undergoing endoscopic sinus surgery for chronic rhinosinusitis.

OBJECTIVES/HYPOTHESIS: With the aim of facilitating preference-sensitive decision making regarding elective endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS), we set out to evaluate the predictive value of the 22-item Sinonasal Outcome Test (SNOT-22) patient-reported outcome measure and to compare outcomes of a UK cohort with a similar United States/Canadian-based study.

STUDY DESIGN

Prospective observational cohort study,

METHODS

Patients electing ESS in 87 UK hospitals were enrolled. The primary outcome was change in SNOT-22 score 3 months after surgery. Patients were categorized according to baseline SNOT-22 score, and the proportion of patients achieving a SNOT-22 minimal clinically important difference (MCID) of 8.9 was calculated, as well as the percentage change in SNOT-22 score.

RESULTS

A total of 2,263 patients were included within this study. There was an average 40% reduction in SNOT-22 scores following surgery, and 66% of patients overall achieved the MCID. The proportion of patients achieving the MCID increased significantly with increasing baseline SNOT-22. Patients with a preoperative score of <20 failed to achieve a mean improvement greater than the MCID. Patients with a score of >30 had a greater than 70% chance of achieving the MCID. CRS patients with polyps had greater improvement than patients with CRS without polyps. The predictive value of the SNOT-22 is similar in the UK cohort, although overall patients did not benefit from surgery as much as their North American counterparts.

CONCLUSIONS

Medically recalcitrant patients with CRS considering surgery should make decisions guided by their preoperative quality-of-life impairment, as measured by the SNOT-22.

LEVEL OF EVIDENCE

2b