Chowdhury Naweed I, Mace Jess C, Smith Timothy L, Rudmik Luke
Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, Oregon Health and Science University, Portland, Oregon, U.S.A.
Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Calgary, Calgary, Alberta, Canada.
Laryngoscope. 2018 Jan;128(1):23-30. doi: 10.1002/lary.26723. Epub 2017 Jun 10.
OBJECTIVES/HYPOTHESIS: Previous studies have shown declines in productivity due to chronic rhinosinusitis (CRS) are correlated with disease-specific quality-of-life (QOL) measures. However, it is unclear which symptom domains contribute primarily to productivity loss. This investigation sought to assess the association between CRS-specific QOL subdomain impairment and productivity loss.
Prospective, multi-institutional, observational cohort study.
There were 198 patients with refractory CRS enrolled between August 2012 and June 2015. Baseline QOL measures were obtained across five subdomains of the 22-item SinoNasal Outcome Test (SNOT-22). Lost productivity time was determined from patient-reported measures of annual absenteeism, presenteeism, and lost leisure time, and then monetized using annual daily wage rates from the 2012 US National Census and 2013 Department of Labor statistics.
Productivity losses correlated with impairments in both SNOT-22 psychological dysfunction (Spearman correlation coefficient [Rs] = 0.428, P < .001), and sleep dysfunction domain scores (Rs = 0.355, P < .001). Higher SNOT-22 total scores also significantly correlated with increased monetized productivity losses (Rs = 0.366, P < .001). The mean annual productivity cost was $11,820/patient, whereas patients with comorbid immunodeficiency ($23,285/patient), tobacco use ($23,195/patient), and steroid dependency ($18,910/patient) reported higher than average annual productivity costs. Multivariate linear regression found maximum annual productivity costs in adjusted psychological ($13,300/patient, P < .001) and sleep dysfunction ($9,275/patient, P < .001) domains.
Impairments in sleep and psychological SNOT-22 domains correlate with productivity losses. Patients with comorbid immunodeficiency, smoking, and steroid dependency had higher than average productivity losses. Targeted management of psychological and sleep dysfunction in combination with standard symptom control may improve patient-centered care and reduce the annual economic burden of CRS.
2c. Laryngoscope, 128:23-30, 2018.
目的/假设：既往研究表明，慢性鼻-鼻窦炎（CRS）导致的生产力下降与疾病特异性生活质量（QOL）指标相关。然而，尚不清楚哪些症状领域是导致生产力损失的主要原因。本研究旨在评估CRS特异性QOL子领域损害与生产力损失之间的关联。
前瞻性、多机构、观察性队列研究。
2012年8月至2015年6月期间纳入了198例难治性CRS患者。通过22项鼻鼻窦结局测试（SNOT-22）的五个子领域获取基线QOL指标。生产力损失时间由患者报告的年度缺勤、出勤时低效工作以及休闲时间损失情况确定，然后使用2012年美国国家人口普查和2013年劳工部统计数据中的年度日工资率进行货币化计算。
生产力损失与SNOT-22心理功能障碍（斯皮尔曼相关系数[Rs]=0.428，P<.001）以及睡眠功能障碍领域得分（Rs=0.355，P<.001）均相关。SNOT-22总分越高也与货币化生产力损失增加显著相关（Rs=0.366，P<.001）。平均年度生产力成本为每位患者11,820美元，而合并免疫缺陷（每位患者23,285美元）、吸烟（每位患者23,195美元）和类固醇依赖（每位患者18,910美元）的患者报告的年度生产力成本高于平均水平。多变量线性回归发现，调整后的心理功能障碍（每位患者13,300美元，P<.001）和睡眠功能障碍（每位患者9,275美元，P<.001）领域的年度生产力成本最高。
睡眠和心理SNOT-22领域的损害与生产力损失相关。合并免疫缺陷、吸烟和类固醇依赖的患者生产力损失高于平均水平。针对性地管理心理和睡眠功能障碍并结合标准症状控制，可能会改善以患者为中心的护理，并减轻CRS的年度经济负担。
2c。《喉镜》，2018年，第128卷，第23 - 30页。
