title: Early versus delayed endoscopic sinus surgery in patients with chronic rhinosinusitis: impact on health care utilization.
abstract: OBJECTIVE
  To evaluate the impact of early versus delayed endoscopic sinus surgery (ESS) in terms of postoperative health care utilization, using a patient cohort with chronic rhinosinusitis (CRS).
  
  
  METHODS
  Retrospective administrative database analysis.
  
  
  METHODS
  US-based primary and secondary sites of care.
  
  
  METHODS
  CRS patients with ESS in 2010-with no other ESS before 2010 and with complete medical history from 2004 to 2012-were identified within the MarketScan database. Patients were characterized by time interval of first sinusitis or nasal polyposis diagnosis to ESS and grouped as following: group 1, <1 year (n=818); group 2, 1 to <2 years (n=247); group 3, 2 to <3 years (n=274); group 4, 3 to <4 years (n=364); group 5, 4 to <5 years (n=595); and group 6, ≥5 years (n=535). Outpatient visits/procedures and prescriptions associated with sinusitis and/or nasal polyps were analyzed for 1 year preoperatively and 2 years postoperatively. Subanalyses were conducted on separate cohorts with or without asthma or polyps, within each group.
  
  
  RESULTS
  Patients in group 1 had significantly fewer visits and prescriptions than patients in group 6 (postoperative visits: group 1, 4.45 [95% CI, 4.06-4.84]; group 6, 6.70 [95% CI, 6.10-7.30; prescriptions: group 1, 4.54 [95% CI, 4.12-4.96]; group 6, 7.61 [95% CI, 6.92-8.31]). Gradual increases in utilization were observed from groups 1 to 6. Subanalysis of patients with and without asthma or polyps showed similar findings.
  
  
  CONCLUSIONS
  Early intervention after diagnoses of CRS, with or without asthma or polyps, is associated with lower health care utilization than intervention after many years of medical management.
authors.affiliation: Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA benninm@ccf.org.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Benninger
authors.affiliation: Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Raj
authors.initials: R
authors.lastname: Sindwani
authors.affiliation: Acclarent Inc, Menlo Park, California, USA.
authors.forename: Chantal E
authors.initials: CE
authors.lastname: Holy
authors.affiliation: ENT Department, Guy's Hospital, London, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Hopkins
mesh_terms: D000328:Adult; D002908:Chronic Disease; D016208:Databases, Factual; D004724:Endoscopy / Q000191:economics / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000191:economics / Q000379:methods*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012220:Rhinitis / Q000191:economics / Q000601:surgery*; D012852:Sinusitis / Q000191:economics / Q000601:surgery*; D013997:Time Factors; D014481:United States
keywords: administrative database; chronic rhinosinusitis; endoscopic sinus surgery; long-term follow-up study; observational research; time to surgery