Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, VA.
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada.
Int Forum Allergy Rhinol. 2019 Jun;9(6):593-600. doi: 10.1002/alr.22309. Epub 2019 Feb 12.
Sinonasal symptoms and poor quality of life (QOL) prompt chronic rhinosinusitis (CRS) patients to undergo sinus surgery (ESS). However, little is known regarding the symptoms most important to patients and how these impact expectations and postoperative satisfaction.
A prospective, multi-institutional cohort study of 100 CRS patients undergoing ESS completed a novel adaptation of the 22-item Sino-Nasal Outcome Test (SNOT-22) wherein they rated how important it was for specific symptoms to improve after surgery, along with preoperative expectations and postoperative satisfaction. The primary satisfaction measure was whether a patient would choose to undergo endoscopic sinus surgery (ESS) again. A multivariate, logistic regression model was built using demographics, objective measures, and the adapted SNOT-22 data. Spearman correlation analysis was also performed.
Nasal obstruction was rated as "extremely" or "very" important by 93% of patients, followed by smell/taste, thick nasal discharge, need to blow nose, postnasal discharge, and sleep symptoms (range, 61-72%). Symptoms like sadness and embarrassment were not considered important by preoperative patients (≤28%). In multivariate logistic regression, postoperative satisfaction depended on preoperative expectations being met and ESS improving their most important symptoms (odds rato, 19.6-27.5; p < 0.005). Postoperative satisfaction was not correlated with achieving a minimal clinically important difference, but it was correlated with magnitude of change in SNOT-22 (r = 0.35; p < 0.05).
Nasal, smell, and sleep-related symptoms were consdidered most important by this cohort. Meeting of preoperative expectations, improvement of the most important symptoms, and the magnitude of change in the SNOT-22 may drive postoperative satisfaction.
鼻-鼻窦症状和生活质量（QOL）较差促使慢性鼻-鼻窦炎（CRS）患者接受鼻窦手术（ESS）。然而，患者最重要的症状以及这些症状如何影响预期和术后满意度的了解甚少。
对 100 例接受 ESS 的 CRS 患者进行前瞻性、多机构队列研究，他们对 22 项鼻-鼻窦结局测试（SNOT-22）的一项新改编进行评分，评估特定症状在手术后改善的重要程度，以及术前预期和术后满意度。主要满意度测量指标是患者是否会选择再次接受内镜鼻窦手术（ESS）。使用人口统计学、客观测量值和改编的 SNOT-22 数据构建多变量逻辑回归模型。还进行了 Spearman 相关性分析。
93%的患者认为鼻塞非常或非常重要，其次是嗅觉/味觉、浓稠的鼻涕、需要擤鼻子、后鼻滴注和睡眠症状（范围为 61-72%）。像悲伤和尴尬这样的症状在术前患者中并不被认为是重要的（≤28%）。在多变量逻辑回归中，术后满意度取决于术前期望的满足程度和 ESS 是否改善他们最重要的症状（优势比，19.6-27.5；p<0.005）。术后满意度与达到最小临床重要差异无关，但与 SNOT-22 的变化幅度相关（r=0.35；p<0.05）。
本队列认为鼻腔、嗅觉和睡眠相关症状最重要。满足术前期望、改善最重要的症状以及 SNOT-22 的变化幅度可能会推动术后满意度。
