Endoscopic sinus surgery provides effective relief as observed by health care use pre- and postoperatively

Objective: To analyze the impact of endoscopic sinus surgery (ESS) on overall health care utilization for the treatment of chronic rhinosinusitis (CRS).

Study design: Retrospective administrative database analysis.

Setting: All US-based primary and secondary sites of care.

Subjects and methods: A cohort of patients with ESS (Current Procedural Terminology codes 31254-31288) in 2008 and at least 5 years of continuous medical and drug plan enrollment were included (n = 9105). Inpatient and outpatient medical history (including prescriptions) was analyzed from weeks -104 to +104 postoperatively.

Results: Health care utilization was constant up to -6 months preoperatively, at a per-patient per-week (PPPW) average of $11.75 (prescriptions, $2.44 [95% confidence interval (CI), $2.32-$2.56]; inpatient care, $ 0.82 [95% CI, $ 0.43-$1.20]; outpatient care, $8.49 [95% CI, $7.90-$9.08]). At -26 weeks preoperatively, a continuous increase from baseline levels was observed up to week -3, reaching an average PPPW of $95.37 (prescriptions, $13.74 [95% CI, $12.51-$14.96]; inpatient care, $2.73 [95% CI, $1.76-$3.70]; and outpatient care, $78.90 [95% CI, 73.65-$84.14]). From week -3 to surgery, outpatient events and prescriptions increased significantly, suggesting a decision to operate and costs associated with preoperative management. Postoperatively, costs declined rapidly, reaching baseline levels by 13 weeks postoperatively. Adverse events were reported in 388 patients (2.94% cases of hemorrhage, 0.14% cases of cerebrospinal fluid leak, 0.58% cases of orbital complications), and 572 (6.28%) patients had revision surgery.

Conclusion: Patients with CRS incur ongoing, baseline levels of health care utilization. Preoperatively, CRS-related health care needs are more than 8-fold greater than those at baseline. Following ESS, health care needs declined rapidly and reached baseline levels within 13 weeks postoperatively.