title: The European positional paper on rhinosinusitis and nasal polyps: has the introduction of guidance on the management of sinus disease affected uptake of surgery and acute admissions for sinusitis?
abstract: Rhinosinusitis is a common condition with adults experiencing 2-5 episodes per year. The European Positional Paper on Rhinosinusitis and Nasal Polyps (EP3OS) published in 2005 and updated in 2007 provided evidence-based guidelines on the management of sinus disease promoting a conservative approach to treatment. This study examines the effect of EP3OS on sinus surgery uptake and acute admissions for sinusitis in England and Wales. A retrospective study using the national electronic health databases of England (Hospital Episodes Statistics, HES online) and Wales (Patient Episodes Database of Wales, PEDW) was undertaken from 2000 to 2010 using the OPCS-4 codes E12-E17 (sinus surgery) and ICD10 code J01 (acute admission for sinusitis). Data were analysed for effect following the introduction of the EP3OS in 2005 using linear regression and Chi squared analysis. 116,370 sinus procedures and 10,916 acute admissions for sinusitis were made during the study period. No significant decrease in sinus surgery procedures occurred following the introduction of the EP3OS as may have been expected (p > 0.05), although subgroup analysis suggested a significant increase in Wales (p < 0.05). In addition, significant increases in acute admissions for sinusitis were observed following the introduction of EP3OS (p < 0.05). However, subgroup analysis suggested this was not the case in Wales (p > 0.05). The EP3OS appears to have had little impact on the rates of sinus surgery but more conservative approaches to managing of sinus disease may have led to an increase in acute admissions. Further research is required to investigate whether changes in practice were adopted.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University Hospital of Wales, Cardiff, CF14 4XW, UK. bencosway@doctors.org.uk
authors.forename: Ben
authors.initials: B
authors.lastname: Cosway
authors.forename: Alun
authors.initials: A
authors.lastname: Tomkinson
authors.forename: David
authors.initials: D
authors.lastname: Owens
mesh_terms: D004739:England; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D009298:Nasal Polyps / Q000628:therapy*; D013517:Otorhinolaryngologic Surgical Procedures / Q000706:statistics & numerical data* / Q000639:trends; D010256:Paranasal Sinuses / Q000601:surgery; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012220:Rhinitis / Q000628:therapy*; D012852:Sinusitis / Q000628:therapy*; D014852:Wales