title: Endoscopic sinus surgery provides effective relief as observed by health care use pre- and postoperatively.
abstract: OBJECTIVE
  To analyze the impact of endoscopic sinus surgery (ESS) on overall health care utilization for the treatment of chronic rhinosinusitis (CRS).
  
  
  METHODS
  Retrospective administrative database analysis.
  
  
  METHODS
  All US-based primary and secondary sites of care.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors: The Cleveland Clinic, Cleveland, Ohio, USA.
authors: Michael S
authors: MS
authors: Benninger
authors: Chantal E
authors: CE
authors: Holy
mesh_terms: D000328:Adult; D004724:Endoscopy / Q000191:economics* / Q000379:methods*; D005260:Female; D005102:Health Expenditures; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D012086:Reoperation / Q000191:economics; D012189:Retrospective Studies; D012220:Rhinitis / Q000191:economics* / Q000601:surgery*; D012852:Sinusitis / Q000191:economics* / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States
keywords: administrative database; chronic rhinosinusitis; endoscopic sinus surgery; long-term follow-up study; observational research