Smith Timothy L, Mace Jess C, Rudmik Luke, Schlosser Rodney J, Hwang Peter H, Alt Jeremiah A, Soler Zachary M
Oregon Sinus Center, Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon.
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
Laryngoscope. 2017 Jan;127(1):14-21. doi: 10.1002/lary.26095. Epub 2016 Jun 14.
OBJECTIVES/HYPOTHESIS: The objective of this investigation was to evaluate endoscopic sinus surgery (ESS) outcomes for chronic rhinosinusitis (CRS) between medical centers to determine if differences in quality-of-life outcomes were detectable. In addition, we sought to identify significant, independent cofactors toward the development of an ESS-specific risk-adjustment model so that ESS outcomes may be appropriately compared between institutions and healthcare providers.
Prospective, multicenter, observational cohort.
Study participants electing ESS for CRS were enrolled and randomly selected in equal numbers from three academic clinical practices in North America between April 2011 and May 2015. The magnitude of average 6-month postoperative improvement in patient-related outcome measures (PROMs) was compared between enrollment sites using multivariate linear regression modeling.
A total of 228 participants met inclusion criteria and were included for final analyses (n = 76 per site). The prevalence of septal deviation/septoplasty and oral corticosteroid-dependent conditions was significantly different between enrollment sites (P ≤ 0.004). Each enrollment site generated significant within-subject improvement across all PROMs after ESS (P < 0.001); however, average unadjusted magnitudes of improvement were significantly different between sites for the primary outcome measure. After controlling for baseline PROMs, septal deviation, steroid-dependent conditions, and medication use variables, enrollment site was no longer associated with significant outcome differences (P = 0.535).
Comparison of surgeon outcomes of ESS is feasible and must take into account a number of baseline patient characteristics. Further studies will be critical toward developing an ESS-specific risk-adjustment model and enabling a robust comparison of surgeon outcomes.
2c. Laryngoscope, 127:14-21, 2017.
目的/假设：本研究的目的是评估各医疗中心慢性鼻窦炎（CRS）的鼻内镜鼻窦手术（ESS）结果，以确定生活质量结果的差异是否可检测。此外，我们试图确定ESS特异性风险调整模型建立过程中的显著独立辅助因素，以便在不同机构和医疗服务提供者之间对ESS结果进行适当比较。
前瞻性、多中心、观察性队列研究。
2011年4月至2015年5月期间，从北美三个学术临床机构中随机选择数量相等的、选择ESS治疗CRS的研究参与者。使用多元线性回归模型比较各入组地点术后6个月患者相关结局指标（PROMs）的平均改善程度。
共有228名参与者符合纳入标准并纳入最终分析（每个地点76名）。入组地点之间鼻中隔偏曲/鼻中隔成形术和口服糖皮质激素依赖情况的患病率有显著差异（P≤0.004）。ESS后，每个入组地点在所有PROMs上均产生了显著的受试者内改善（P<0.001）；然而，主要结局指标的平均未调整改善幅度在各地点之间存在显著差异。在控制了基线PROMs、鼻中隔偏曲、类固醇依赖情况和药物使用变量后，入组地点与显著的结局差异不再相关（P=0.535）。
比较ESS的外科医生手术结果是可行的，且必须考虑一些患者基线特征。进一步的研究对于开发ESS特异性风险调整模型以及实现对外科医生手术结果的有力比较至关重要。
2c。《喉镜》，2017年，第127卷，第14 - 21页。
