Wait times for endoscopic sinus surgery influence patient-reported outcome measures in patients with chronic rhinosinusitis who fulfill appropriateness criteria

Background: Previous studies on the impact of wait times for endoscopic sinus surgery (ESS) in medically recalcitrant chronic rhinosinusitis (rCRS) have not examined its influence on the 5 distinct symptoms domains of the 22-item Sino-Nasal Outcome Test (SNOT-22), and have not applied evidence-based surgical indications. Our primary study objective was to investigate the impact of ESS wait times on postoperative SNOT-22 global and symptom domain scores in patients with rCRS deemed "appropriate" surgical candidates.

Methods: This was a retrospective analysis of adult patients with rCRS undergoing ESS, categorized as "appropriate" surgical candidates. Primary outcome measure was change in SNOT-22 global/symptom domain score (preoperative - 6-month postoperative). Correlational analyses were performed between wait time and change in SNOT-22 global and symptom domain scores. For significant negative correlations, the threshold wait time to generate a worsening in health-related quality-of-life (HRQoL) equivalent to the mean clinically important difference (MCID) was calculated.

Results: A total of 104 patients with a mean ± standard deviation (SD) wait time of 310.8 ± 155.9 days were analyzed. Postoperative SNOT-22 global and symptom domain scores significantly improved postoperatively. Wait time for ESS was negatively correlated with change in SNOT-22 global, rhinologic, extranasal rhinologic, and ear/facial domain scores (p < 0.05), and a wait time threshold of 287, 452, 421, and 381 days corresponded to a decrease equivalent to the MCID, respectively.

Conclusion: We identified less improvement in HRQoL after ESS with increasing surgical wait time. Moreover, prolonged wait times may result in less improvement in disease-specific symptoms, but do not appear to worsen psychological or sleep dysfunction.