82% of sinus patients show improvement
82% of sinus patients show improvement
Managers can assess outcomes, prove their value
Sinus surgery alleviates symptoms of 82% of patients and reduces their dependence on medication, according to an outcomes study conducted by researchers at the Massachusetts Eye and Ear Infirmary in Boston.1
Patients reported that their general health, such as ability to perform normal daily activities, also improved within six months of sinus surgery, but to a lesser degree, researchers said.
"We wanted to see if we were making a difference in general functioning and well-being," says Richard E. Gliklich, MD, assistant professor at Harvard Medical School in Boston and director of the Clinical Outcomes Research Unit of the Massachusetts Eye and Ear Infirmary. "Most people undergo [sinus surgery] for quality-of-life reasons.
"This population isn't at the same level [of general health] as the U.S. population even after surgery," Gliklich says. "But they are getting significant improvements."
Gliklich and his colleague Ralph Metson, MD, studied 108 patients who had ethmoid sinus surgery. The patients filled out a sinus-specific questionnaire and a general health status survey (SF36) preoperatively and three and six months postoperatively.2 Gliklich also administered questionnaires to 52 patients who received only medical therapy. (For more information on the SF-36 and SF-12 general health surveys, see SDS, December 1995, p. 137.)
Setting reasonable expectations
Surgical patients reported a greater improvement in symptoms than the medical group, although Gliklich cautioned that the comparison is limited because the two groups were not demographically or clinically matched.
Such outcomes information about improvement in quality of life after surgery can be valuable in pre-op education for patients considering or scheduling sinus surgery, Gliklich says.
"I tell patients they have a greater than 80% chance of improving their sinus-related symptoms, but improvement is not a cure," he says. "This information is very useful because it sets up very reasonable expectations."
Sharing outcomes with managed care
Same-day surgery managers also may use outcomes information in discussions with managed care to highlight the importance of sinus surgery, Gliklich says. For example, a previous study showed that chronic sinusitis had a greater impact on general health than other serious illnesses, such as angina, back pain, and congestive heart failure.3
That finding is even more dramatic in light of the age of sinusitis sufferers, whose average age is 42, Gliklich says.
Gliklich says he doesn't know why sinus surgery patients don't report as much improvement in general health as they do in sinus symptoms. "The question is whether that may be lagging behind the sinusitis parameters," he says. "Or it may be sinusitis has more systemic aspects to it that aren't well understood."
In a yet-unpublished study, Gliklich also found that sinus surgery reduces patients' annual medication costs from $1,200-$1,500 to $700-$750.
Gliklich plans to follow up on the outcomes study with patient questionnaires one year after surgery. "We're hoping they will show further improvement," he says.
Gliklich also is opening up his outcomes assessment tools to other physicians, hospitals, and same-day surgery programs. The price for registration and analysis has not been determined, he says.
Ultimately, the outcomes studies will include information on return to work and improvement in daily functioning -- information that is vital to patients and payers, Gliklich says.
References
1. Gliklich RE, and Metson R. The effect of sinus surgery on quality of life. Presented at the annual meeting of the American Academy of Otolaryngology-Head and Neck Surgery. New Orleans; Sept. 17, 1995.
2. McHorney CA, Ware JE, Lu JFR, et al. The MOS 36-item short form health survey (SF-36) III: Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care 1994; 32(4):40-66.
3. Gliklich RE and Metson R. The health impact of chronic sinusitis in patients seeking otolaryngologic care. Otolaryngol Head Neck Surg 1995; 113:104-109. *
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