Systematic review of change in bodily pain after sinus surgery

Department of Medicine, Georgetown University Hospital, Washington, DC 20016, USA.
Otolaryngology Head and Neck Surgery (Impact Factor: 1.72). 01/2009; 139(6):759-65. DOI: 10.1016/j.otohns.2008.09.020
Source: PubMed

ABSTRACT To determine whether bodily pain is increased in patients with chronic rhinosinusitis (CRS) and if bodily pain improves following endoscopic sinus surgery (ESS).
All studies reporting results of more than 10 adult patients analyzing the response of bodily pain to ESS were retrieved by searching MEDLINE, EMBASE, Web of Science, Cochrane databases, and additional web-based sources (from January 1, 1980, to May 1, 2008); by examining bibliographies of retrieved articles; and by contacting investigators in the field.
Of 279 ESS symptom outcome studies, only studies measuring results using the 36-Item Short Form Health Survey (SF-36) quality-of-life survey instrument measured bodily pain. Eleven observational ESS studies (1019 patients) reported mean preoperative SF-36 bodily pain scores at 0.89 SD below general population norms (24% more severe bodily pain than general population norms) and significantly below norms for a population 25 years older. Using a repeated-measures design, nine of 11 studies noted significant improvement in SF-36 bodily pain domain scores following ESS, with a moderate-sized combined effect of 0.55 (95% confidence interval, 0.45-0.64; I(2) = 44%) using the fixed-effects model. This pooled effect corresponded to a mean improvement of 11.8 U on the SF-36 bodily pain domain scale.
Bodily pain is increased in patients with CRS awaiting ESS, exceeding the normative bodily pain scores of a general normative population 25 years older. Using within-subject comparisons, a clinically and statistically significant improvement in bodily pain is noted after ESS, an improvement similar to that previously described for fatigue.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives/HypothesisTo describe the role and applicability of the EuroQol 5-Dimension, 5-Level (EQ-5D-5L) questionnaire for the assessment of general health-related quality of life in patients with chronic rhinosinusitis. Study DesignProspective cohort study. Methods The EQ-5D-5L was administered to 462 patients with refractory chronic rhinosinusitis before and 3 months after sinus surgery. Preoperative and postoperative scores across each of five health dimensions were analyzed and the results compared to those obtained from two widely used chronic rhinosinusitis outcomes instruments: the Chronic Sinusitis Survey (CSS) and SinoNasal Outcomes Test-22 (SNOT-22). ResultsThree hundred and fifty patients completed the five questions and visual analog scale (VAS) of the EQ-5D at baseline and at 3 months for a response rate of 75.8%. There were no incomplete questionnaires. The frequency of patients reporting problems in the EQ-5D domains of pain/discomfort, anxiety/depression, and usual activities decreased following sinus surgery (74.3% vs. 34.4%, 48.6% vs. 31.4%, and 30.6% vs. 19.4%, respectively; all P<0.001). The domains of mobility and self-care did not demonstrate statistically significant change. EQ-5D VAS (standard deviation) improved from 73.4 (16.9) before surgery to 82.0 (14.4) after surgery (P<0.001). Preoperative VAS correlated with SNOT-22 scores (Pearson coefficient of 0.50; P<0.01). Postoperative change in VAS and SNOT-22 scores demonstrated moderate correlation (Pearson coefficient of 0.36, P<0.01). Conclusion The EQ-5D is a general health measure with sensitivity to clinical change in rhinosinusitis that support its use for monitoring patient outcomes. The limited response burden and ability to directly calculate health utility make it an attractive tool for rhinosinusitis outcomes research. Level of Evidence2c. Laryngoscope, 125:7-15, 2015
    The Laryngoscope 01/2015; 125(1). DOI:10.1002/lary.24715 · 2.03 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Disease-specific reductions in patient productivity can lead to substantial economic losses to society. The purpose of this study was to: 1) define the annual productivity cost for a patient with refractory chronic rhinosinusitis (CRS) and 2) evaluate the relationship between degree of productivity cost and CRS-specific characteristics. Prospective, multi-institutional, observational cohort study. The human capital approach was used to define productivity costs. Annual absenteeism, presenteeism, and lost leisure time was quantified to define annual lost productive time (LPT). LPT was monetized using the annual daily wage rates obtained from the 2012 U.S. National Census and the 2013 U.S. Department of Labor statistics. A total of 55 patients with refractory CRS were enrolled. The mean work days lost related to absenteeism and presenteeism were 24.6 and 38.8 days per year, respectively. A total of 21.2 household days were lost per year related to daily sinus care requirements. The overall annual productivity cost was $10,077.07 per patient with refractory CRS. Productivity costs increased with worsening disease-specific QoL (r = 0.440; p = 0.001). Results from this study have demonstrated that the annual productivity cost associated with refractory CRS is $10,077.07 per patient. This substantial cost to society provides a strong incentive to optimize current treatment protocols and continue evaluating novel clinical interventions to reduce this cost. N/A. Laryngoscope, 2014.
    The Laryngoscope 09/2014; 124(9). DOI:10.1002/lary.24630 · 2.03 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    Pharmacoepidemiology and Drug Safety 04/2014; 3(2):1-5. DOI:10.4172/2167-1052.1000148 · 3.17 Impact Factor

Full-text (2 Sources)

Available from
Mar 4, 2015