title: Determinants of outcomes of sinus surgery: a multi-institutional prospective cohort study.
abstract: OBJECTIVE
  1) To measure the proportion of patients with chronic rhinosinusitis (CRS) who experience clinically significant improvement after endoscopic sinus surgery (ESS) in a prospective, multi-institutional fashion. 2) To identify preoperative characteristics that predict clinically significant improvement in quality of life (QOL) after ESS.
  
  
  METHODS
  Prospective, multi-institutional cohort study.
  
  
  METHODS
  Academic tertiary care centers.
  
  
  METHODS
  A total of 302 patients with CRS from three centers were enrolled between July 2004 and December 2008 and followed for an average of 17.4 months postoperatively. Preoperative patient characteristics, CT scan, endoscopy score, and pre- and postoperative quality of life (QOL) data were collected. Univariate and multivariate analyses were performed.
  
  
  RESULTS
  Patients improved an average of 15.8 percent (18.9 points) on the Rhinosinusitis Disability Index and 21.2 percent (21.2 points) on the Chronic Sinusitis Survey (both P < 0.001). Patients significantly improved on all eight Medical Outcomes Study Short Form-36 (SF-36) subscales (all P < 0.001). Among patients with poor baseline QOL, 71.7 percent of patients experienced clinically significant improvement on the RSDI and 76.1 percent on the CSS. Patients undergoing primary surgery were 2.1 times more likely to improve on the RSDI (95% confidence interval [CI], 1.2, 3.4; P = 0.006) and 1.8 times more likely to improve on the CSS (95% CI, 1.1, 3.1; P = 0.020) compared with patients undergoing revision surgery.
  
  
  CONCLUSIONS
  In this prospective, multi-institutional study, most patients experienced clinically significant improvement across multiple QOL outcomes after ESS. Specific patient characteristics provided prognostic value with regard to outcomes.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Smith
authors.forename: Jamie R
authors.initials: JR
authors.lastname: Litvack
authors.forename: Peter H
authors.initials: PH
authors.lastname: Hwang
authors.forename: Todd A
authors.initials: TA
authors.lastname: Loehrl
authors.forename: Jess C
authors.initials: JC
authors.lastname: Mace
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Fong
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: James
mesh_terms: D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures; D011446:Prospective Studies; D011788:Quality of Life; D012220:Rhinitis / Q000601:surgery*; D012852:Sinusitis / Q000601:surgery*; D016896:Treatment Outcome