Ference Elisabeth H, Reddy Sheila R, Tieu Ryan, Gokhale Sohum, Park Siyeon, LeCocq Jason
Caruso Department of Otolaryngology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.
Partnership for Health Analytic Research, LLC, Beverly Hills, California, USA.
OTO Open. 2020 Sep 1;4(3):2473974X20950727. doi: 10.1177/2473974X20950727. eCollection 2020 Jul-Sep.
To investigate the clinical and health care burden of chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) in the United States.
Retrospective, cross-sectional design with analyses of patient visits from 2 databases.
National Ambulatory Medical Care Survey (NAMCS, 2012-2016) and State Ambulatory Surgery and Services Databases (SASD, 2012-2015) in available states.
In each analysis, we identified patients (≥18 years old) with a diagnosis of CRSwNP (: 471.x; : J33.x) in the visit record during the study period. CRS patients without polyps (CRSsNP: : 473.x, : J32.x; without CRSwNP codes) were identified for comparison. In the SASD, we focused on visits involving relevant sinus procedures. Outcomes included comorbidities, diagnostic testing, and prescribed medication (NAMCS) and surgery visit characteristics (SASD).
We identified 2272 NAMCS records from physician offices (183 CRSwNP, 2089 CRSsNP). Most visits were for patients aged <65 years (78.8%, 80.6%) and privately insured (67.7%, 61.5%); CRSwNP visits had a male majority (56.3%, 35.4%). CRSwNP vs CRSsNP visits more often reported asthma (40.2%, 10.3%), allergic rhinitis (14.0%, 8.7%), and congestion (22.0%, 21.1%), with the use of glucocorticoids (21.0%, 17.7%) and nasal allergy medication (26.2%, 10.2%). In the SASD, 427,306 surgery visits were identified (71,195 CRSwNP, 356,111 CRSsNP); demographics were similar to NAMCS. CRSwNP surgeries involved more sinus types (59.3%, 41.4%). Surgeries were mostly elective (>99%) and completed quickly (<2 hours), without perioperative complications (>99%), followed by routine discharge (>91%); follow-up visits were common (14.9%, 13.9%).
CRSwNP compared to CRSsNP patients have a distinct clinical experience, with moderately higher medication need and more extensive surgery.
调查美国伴鼻息肉的慢性鼻 - 鼻窦炎（CRSwNP）的临床和医疗负担。
采用回顾性横断面设计，对来自2个数据库的患者就诊情况进行分析。
现有州的国家门诊医疗调查（NAMCS，2012 - 2016年）和州门诊手术与服务数据库（SASD，2012 - 2015年）。
在每次分析中，我们在研究期间的就诊记录中确定诊断为CRSwNP（国际疾病分类编码：471.x；J33.x）的患者（≥18岁）。确定无息肉的慢性鼻 - 鼻窦炎患者（CRSsNP：国际疾病分类编码：473.x，J32.x；无CRSwNP编码）进行比较。在SASD中，我们重点关注涉及相关鼻窦手术的就诊情况。结局包括合并症、诊断性检查和处方药物（NAMCS）以及手术就诊特征（SASD）。
我们从医生办公室确定了2272条NAMCS记录（183例CRSwNP，2089例CRSsNP）。大多数就诊患者年龄<65岁（78.8%，80.6%）且为私人保险（67.7%，61.5%）；CRSwNP就诊患者中男性居多（56.3%，35.4%）。与CRSsNP就诊相比，CRSwNP就诊更常报告哮喘（40.2%，10.3%）、过敏性鼻炎（14.0%，8.7%）和鼻塞（22.0%，21.1%），使用糖皮质激素（21.0%，17.7%）和鼻用抗过敏药物（26.2%，10.2%）。在SASD中，确定了427,306次手术就诊（71,195例CRSwNP，356,111例CRSsNP）；人口统计学特征与NAMCS相似。CRSwNP手术涉及的鼻窦类型更多（59.3%，41.4%）。手术大多为择期手术（>99%）且完成迅速（<2小时），围手术期并发症发生率低（>99%），随后常规出院（>91%）；随访就诊常见（14.9%，13.9%）。
与CRSsNP患者相比，CRSwNP患者有独特的临床经历，药物需求略高，手术范围更广。
