The Utility of Preoperative Phone Calls for Endoscopic Sinus Surgery Procedures

2021 ◽  
pp. 194589242110205
Author(s):  
Sabina Dang ◽  
Mallory McKeon ◽  
Varun Menon ◽  
Rakesh Chandra ◽  
Marc L. Bennett
Keyword(s):  
Patient Education ◽  
Surgical Outcomes ◽  
Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Phone Call ◽  
Phone Calls ◽  
Two Samples ◽  
Patient Reported ◽  
Chi Squared ◽  
Call Volume

Objective Perioperative patient education improves patient satisfaction, surgical outcomes, and can reduce postoperative call volume. Here, we investigate whether the use of standardized preoperative phone calls elicits similar results in patients undergoing endoscopic sinus surgery (ESS). Methods Patients undergoing ESS at a tertiary rhinology center were identified prospectively through the electronic medical record (EMR). In the intervention cohort, a standardized preoperative educational phone call was performed. A postoperative survey was utilized to collect self-assessment of satisfaction and understanding in all patients. Postoperative call rates were obtained from the EMR. Wilcoxon rank sum and chi-squared analyses were conducted to compare results. Demographics of the otology and rhinology cohorts were compared with a Mann Whitney U-test. Results Data from 43 cases and 58 controls were collected. Patients receiving the intervention were similar to controls with regard to patient-reported understanding (case:9.1 ± 1.1 vs control:9.0 ± 1.4, p = 0.801) and satisfaction (case:9.4 ± 1.1 vs 8.9 ± 1.4, p = 0.155). Both cases and controls called the clinic regarding surgical outcomes more often than for postoperative medications or administrative concerns. Independent of receiving the intervention, patients that did not call clinic postoperatively had significantly better understanding of their procedures (call:8.6 ± 1.6 vs no-call:9.5 ± 1.0, p < 0.015) and satisfaction with their experience (call:8.8 ± 1.4 vs no-call:9.5 ± 1.1, p < 0.028). Patient age may contribute to lack of impact in the rhinology cohort, as compared to the otology group, but socioeconomic status does not seem to differentiate the two samples. Conclusion Though shown in other settings, a significant impact of educational phone calls prior to surgery was not observed in this sample. Patient education calls prior to endoscopic sinus surgery were not associated with changes in postoperative call volume to the clinic. Patient understanding and satisfaction may be related to other factors, such as patient selection or demographics. Future studies may target such patients prior to ESS.

scholarly journals Pattern of symptom improvement following endoscopic sinus surgery for chronic rhinosinusitis

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Salma S. Al Sharhan ◽  
Mohammed H. Al Bar ◽  
Shahad Y. Assiri ◽  
Assayl R. AlOtiabi ◽  
Deemah M. Bin-Nooh ◽  
...  
Keyword(s):  
Surgical Outcomes ◽  
Endoscopic Sinus Surgery ◽  
T Test ◽  
Sinus Surgery ◽  
Symptom Improvement ◽  
P Value ◽  
Psychological Dysfunction ◽  
Significant Difference ◽  
The Mean ◽  
Snot 22

Abstract Background Chronic rhinosinusitis (CRS) is a common inflammation of the nose and the paranasal sinuses. Intractable CRS cases are generally treated with endoscopic sinus surgery (ESS). Although the effect of ESS on CRS symptoms has been studied, the pattern of symptom improvement after ESS for CRS is yet to be investigated. The aim of this study was to determine the magnitude and sequence of symptom improvement after ESS for CRS, and to assess the possible preoperative factors that predict surgical outcomes in CRS patients. Methods This was a longitudinal prospective study of 68 patients who had CRS (with or without nasal polyps). The patients underwent ESS at King Fahd Hospital of the University, Al Khobar, Saudi Arabia. The Sino-nasal Outcome Test-22 (SNOT-22) questionnaire was used for assessment at four time points during the study: pre-ESS, 1-week post-ESS, 4 weeks post-ESS, and 6 months post-ESS. Results The difference between the mean scores recorded for the five SNOT-22 domains pre-ESS and 6 months post-ESS were as follows: rhinologic symptoms (t-test = 7.22, p-value =  < 0.001); extra-nasal rhinologic symptoms (t-test = 4.87, p-value =  < 0.001); ear/facial symptoms (t-test = 6.34, p-value =  < 0.001); psychological dysfunction (t-test = 1.99, p-value = 0.049); and sleep dysfunction (t-test = 5.58, p-value =  < 0.001). There was a significant difference between the mean scores recorded for the five domains pre-ESS and 6 months post-ESS. Rhinologic symptoms had the largest effect size (d = 1.12), whereas psychological dysfunction had the least effect size (d = 0.24). The only statistically significant difference in the SNOT-22 mean scores recorded 4 weeks post-ESS was observed between allergic and non-allergic patients (t = − 2.16, df = 66, p = 0.035). Conclusion Understanding the pattern of symptom improvement following ESS for CRS will facilitate patient counselling and aid the optimization of the current treatment protocols to maximize surgical outcomes and quality of life. Level of evidence Prospective observational.

scholarly journals What is the optimal outcome after endoscopic sinus surgery in the treatment of chronic rhinosinusitis? A consultation of Canadian experts

2021 ◽  
Vol 50 (1) ◽  
Author(s):  
Nadim Saydy ◽  
Sami P. Moubayed ◽  
Marie Bussières ◽  
Arif Janjua ◽  
Shaun Kilty ◽  
...  
Keyword(s):  
Chronic Rhinosinusitis ◽  
Endoscopic Sinus Surgery ◽  
Patient Reported Outcome ◽  
Sinus Surgery ◽  
Structured Interviews ◽  
Subjective Data ◽  
Operative Outcomes ◽  
Patient Reported ◽  
Definition Of Success ◽  
Reported Data

Abstract Objectives Many experts feel that in the absence of well-defined goals for success, they have an easier time identifying failure. As success ought to not be defined only by absence of failure, we aimed to define optimal outcomes for endoscopic sinus surgery (ESS) in chronic rhinosinusitis (CRS) by obtaining expert surgeon perspectives. Methods A total of 12 surgeons participated in this targeted consultation. Face to face semi-structured interviews were performed with expert surgeons in the field of CRS and ESS. General impressions and personal definitions of acceptable operative success and optimal operative outcomes were compiled and summarized. Results According to an expert survey, patients’ main objectives are an improvement in their chief complain, a general improvement in quality of life (QoL), and a better overall symptomatic control. The most important aspects of endoscopy for defining a successful intervention were an adequate mucus circulation, a healthy mucosa, minimal edema, and patency of all explored cavities or ostia. In the assessment of surgical outcomes, it was determined that both objective and patient reported data must be carefully examined, with more attention given to subjective outcomes. Conclusions According to data gathered from a Canadian expert consultation, a definition of success must be based on both subjective data and nasal endoscopy. We propose to define an acceptable outcome as either a subjective improvement of at least the minimal clinically improvement difference of a validated patient reported outcome questionnaire, along with a satisfactory endoscopic result (1) or a complete subjective resolution with a sub-optimal endoscopy (2). Graphical abstract

Implementing Digital Technology to Transitioning a Clinical Trial to a Registry – TAILOR-PCI Digital Study: Methods/Study Design (Preprint)

2021 ◽  
Author(s):  
Robert Avram ◽  
Derek So ◽  
Erin Iturriaga ◽  
Julia Byrne ◽  
Ryan Lennon ◽  
...  
Keyword(s):  
Clinical Trial ◽  
The United States ◽  
Completion Rate ◽  
Phone Call ◽  
Consent Rate ◽  
Digital Platform ◽  
Phone Calls ◽  
Patient Reported ◽  
Research Platform

BACKGROUND TAILOR-PCI was the largest cardiovascular genotype-based randomized clinical trial (RCT) investigating whether CYP2C19 genotype-guided selection of oral P2Y12 inhibitor therapy improved ischemic outcomes after percutaneous coronary intervention (PCI). The TAILOR-PCI Digital Registry was a novel proof-of-concept study that evaluated the feasibility of extending the main RCT follow-up period using a remote digital platform. OBJECTIVE To describe patients onboarding, engagement and results of a digital registry after enrollment in a RCT. METHODS In this intervention study, previously enrolled TAILOR-PCI patients in the United States and Canada within 24 months of randomization were invited by letters containing a URL to the TAILOR-PCI Digital Registry website (http://tailorpci.eurekaplatform.org), instructing them to download the study app. Patients previously enrolled in the TAILOR-PCI study, with a smartphone, were eligible to join the Digital Registry. Those who did not respond to the letter were contacted by phone to survey reasons for non-participation and were invited again to join the study. A direct-to-patient digital research platform (the Eureka Research Platform) was used to onboard, consent and enrol patients in the Digital Registry. Patients were asked to complete health-related surveys and provide follow-up data digitally. Consent rate to the Digital Registry, duration of participation in the Digital Registry and monthly activity completion rate. The hypothesis being tested was formulated before data collection began. RESULTS After the parent trial was completed, letters were mailed to 907 eligible patients (representing 19% of total enrolled in the RCT) across 24 sites, who were within 15.6 ± 5.2 months after randomization leading to 290 unique individuals visits to the Digital Registry website. Among those invited, 110 patients (12%) consented: 45 (41%) after the letter, 37 (34%) after the 1st phone call and 28 (25%) after a 2nd call. Of the 862 who didn’t consent after the letter, 453 patients (53%) did not respond to repeated phone calls and among the 409 patients who responded, 171 (41%) declined participation stating lack of time, 128 (31%), due to lack of smartphone and 47 (11%) due to difficulty understanding what was expected of them in the study. Patients who consented were older, had less diabetes or tobacco use; a greater proportion had bachelor's degrees or higher and were more computer literate than those who did not consent. The average completion rate of the 920 available monthly electronic visits was 64.9±7.6% without a decrease in this rate throughout the study duration. There were no differences between randomization arms in any patient reported outcomes using the digital platform. CONCLUSIONS Extended follow-up after enrollment in a RCT using a digital registry is technically feasible but was limited due to inability to contact most eligible patients, lack of time or access to a smartphone. Among those enrolled, most patients completed required electronic visits. Enhanced recruitment methods, such as introduction of the digital study at the time of RCT consent, provision of smartphone and robust study support for onboarding, should be explored further. CLINICALTRIAL TAILOR-PCI (Clinicaltrials.gov: NCT01742117)

Hyaluronic acid for post sinus surgery care: systematic review and meta-analysis

2017 ◽  
Vol 131 (S1) ◽  
pp. S2-S11 ◽  
Author(s):  
E Fong ◽  
M Garcia ◽  
C M Woods ◽  
E Ooi
Keyword(s):  
Systematic Review ◽  
Hyaluronic Acid ◽  
Endoscopic Sinus Surgery ◽  
Meta Analysis ◽  
Adhesion Formation ◽  
Sinus Surgery ◽  
Current Evidence ◽  
Secondary Outcome ◽  
Control Group ◽  
Patient Reported

AbstractBackground:Wound healing after endoscopic sinus surgery may result in adhesion formation. Hyaluronic acid may prevent synechiae development. A systematic review was performed to evaluate the current evidence on the clinical efficacy of hyaluronic acid applied to the nasal cavity after sinus surgery.Methods:Studies using hyaluronic acid as an adjunct treatment following endoscopic sinus surgery for chronic rhinosinusitis were identified. The primary outcome was adhesion formation rates. A meta-analysis was performed on adhesion event frequency. Secondary outcome measures included other endoscopic findings and patient-reported outcomes.Results:Thirteen studies (501 patients) met the selection criteria. A meta-analysis of adhesion formation frequency on endoscopy demonstrated a lower risk ratio in the hyaluronic acid intervention group (42 out of 283 cases) compared to the control group (81 out of 282) of 0.52 (95 per cent confidence interval = 0.37–0.72). Hyaluronic acid use was not associated with any significant adverse events.Conclusion:Hyaluronic acid appears to be clinically safe and well tolerated, and may be useful in the early stages after sinus surgery to limit adhesion rate. Further research, including larger randomised controlled trials, is required to evaluate patient- and clinician-reported outcomes of hyaluronic acid post sinus surgery.

Readability assessment of internet-based patient education materials related to endoscopic sinus surgery

2012 ◽  
Vol 122 (8) ◽  
pp. 1649-1654 ◽  
Author(s):  
Deepa V. Cherla ◽  
Saurin Sanghvi ◽  
Osamah J. Choudhry ◽  
James K. Liu ◽  
Jean Anderson Eloy
Keyword(s):  
Patient Education ◽  
Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Readability Assessment

scholarly journals Effectiveness of endoscopic sinus surgery and aspirin therapy in the management of aspirin-exacerbated respiratory disease

2021 ◽  
Vol 42 (2) ◽  
pp. 136-141
Author(s):  
Auddie M. Sweis ◽  
Tran B. Locke ◽  
Kevin I. Ig-Izevbekhai ◽  
Theodore C. Lin ◽  
Ankur Kumar ◽  
...  
Keyword(s):  
Respiratory Disease ◽  
Endoscopic Sinus Surgery ◽  
Test Score ◽  
Aspirin Therapy ◽  
Sinus Surgery ◽  
Secondary Outcome ◽  
Persistent Symptoms ◽  
Aspirin Exacerbated Respiratory Disease ◽  
Patient Reported ◽  
The Mean

Background: Aspirin therapy and/or type 2 (T2) biologics are used in the management of aspirin-exacerbated respiratory disease (AERD). Objective: To identify the number of patients with AERD who tolerated aspirin therapy, yet due to persistent symptoms, incorporated T2 biologic management. Methods: A retrospective review was performed between July 2016 and June 2019. Patients with AERD and who underwent endoscopic sinus surgery (ESS), aspirin desensitization (AD), and at least 6 months of aspirin therapy (ATAD) after AD, and who remained biologic-naive up through this timepoint were included in the study. Introduction of a T2 biologic while on ATAD was the primary outcome. The secondary outcome was a change in a validated patient-reported outcome measure for chronic rhinosinusitis score between the postoperative predesensitization timepoint, and the 6-month postdesensitization timepoint, presented as means and compared by using the Student's t-test. Results: A total of 103 patients met inclusion criteria. Two patients (1.9%) ultimately supplemented ATAD with a T2 biologic. The mean outcomes measure test score after 6 months of ATAD for patients who received biologics was 40.5 versus 15 in those who did not receive biologics (p = 0.02). The mean differences between the postoperative predesensitization test score and the 6-month postdesensitization test score for patients who went on to receive biologics was an increase of 13 versus a decrease of 10 for those patients who did not receive biologics (p = 0.12). Conclusion: ESS, coupled with AD and ATAD, was successful in the long-term management of the majority of the patients with AERD, which rarely required the incorporation of T2 biologics. Patient questionnaires, such as outcomes measure test score, may identify aspirin therapy failures and help guide the practitioner in deciding when to introduce T2 biologics into the patient's treatment regimen.

scholarly journals Impact of Biofilms on Quality of Life of Rhinosinusitis Patients after Endoscopic Sinus Surgery

2012 ◽  
Vol 5 (3) ◽  
pp. 95-102
Author(s):  
Neelima Gupta ◽  
PP Singh ◽  
Lakshmi Vaid ◽  
Manish Arya ◽  
Rumpa Saha
Keyword(s):  
Quality Of Life ◽  
Surgical Outcomes ◽  
Endoscopic Sinus Surgery ◽  
Active Role ◽  
Sinus Surgery ◽  
Treatment Modalities ◽  
Mucosal Inflammation ◽  
Persistent Symptoms ◽  
Positive Bacterial Culture

ABSTRACT Introduction The chronic and recalcitrant nature of rhinosinusitis has been known from many years. Many reasons for this have been implicated and biofilms have now been established as one of the cause for its recurrent and persistent nature. Little literature and studies exist confirming this effect. This study presents analysis of sinonasal mucosal samples and correlates presence of biofilms with surgical outcomes. Materials and methods An analysis of mucosal samples collected during endoscopic sinus surgery from 40 patients of chronic rhinosinusitis (CRS) was done. Preoperative symptoms, endoscopic and radiological scores were documented and mucosal samples collected intraoperatively were sent for biofilm detection. Biofilm detection was performed using microtiter plate method. Postoperatively patients were followed up for minimum of 3 months with endoscopic evaluation and presence of ongoing symptoms was also recorded. Results Thirteen patients out of 40 patients showed positive bacterial culture. Eight out of 13, i.e. 61.53% bacteria produced biofilms and five out of 13, i.e. 38.46% bacteria did not produce biofilms. Patients with biofilms had significantly worse preoperative and postoperative symptom and endoscopic scores. Thus, presence of biofilms was related to poor outcomes. Conclusion This study showed that the presence of biofilms was correlated with higher symptom scores and poorer surgical outcomes. Also, more recurrences were found in patients with positive biofilms. This strengthens the belief that biofilms may play an active role in persisting mucosal inflammation and persistent symptoms in some patients of CRS. Treatment modalities aiming removal of biofilms may be important in management of CRS. How to cite this article Vaid L, Arya M, Gupta N, Singh PP, Saha R. Impact of Biofilms on Quality of Life of Rhinosinusitis Patients after Endoscopic Sinus Surgery. Clin Rhinol An Int J 2012;5(3):95-102.

scholarly journals Real-Time Operative Coding for Endoscopic Sinonasal Procedures: Quality Improvement in Practice

Sinusitis ◽  
2021 ◽  
Vol 5 (1) ◽  
pp. 32-44
Author(s):  
Bassem Mettias ◽  
Joshua D. Whittaker ◽  
Yujay Ramakrishnan
Keyword(s):  
Quality Improvement ◽  
Endoscopic Sinus Surgery ◽  
Human Error ◽  
Financial Impact ◽  
Sinus Surgery ◽  
Clinical Coding ◽  
Tertiary Centre ◽  
Chi Squared ◽  
The Impact ◽  
Control Firm

Objective: investigate the impact of an intraoperative coding sticker (ICS) on the accuracy of coding in endoscopic sinonasal procedures. Methods: this was a two-cycle audit evaluating the accuracy (and financial impact) of intraoperative coding of sinonasal procedures at a single tertiary centre. An ICS was introduced following consultation with the coding department. The accuracy of coding was measured before (cycle 1) and after (cycle 2) the ICS was introduced to a pilot firm and compared to a control firm. The ICS was used in 35% of the pilot firm cases. Results: the accuracy of clinical coding for endoscopic sinus surgery was 60% in the first cycle. Switching to the ICS has improved the accuracy in that firm from 50% in first cycle to 70% in the second cycle (p = 0.936; Chi-squared test). The median reimbursement for endoscopic sinus surgery was equal in both cycles of £1493.00 per patient. However, inaccurate coding resulted in £109.92 excess tariff payment in first cycle and £130.96 deficiency in the second cycle. Users of ICS reported it to be easy to use for clinicians, staff and clinical coders, whilst minimizing human error. Conclusions: The integration of the ICS improves the coding in sinonasal procedures and offers low-fidelity option alternative to live coding on the computer. The accuracy was not statistically significant in the study possibly due to the low number of observations. This can allow a precise coding standard with reliable service remuneration.

scholarly journals Effects of functional endoscopic sinus surgery on chronic rhinosinusitis resistant to medication

2014 ◽  
Vol 128 (11) ◽  
pp. 976-980 ◽  
Author(s):  
H Li ◽  
X Zhang ◽  
Y Song ◽  
T Wang ◽  
G Tan
Keyword(s):  
Chronic Rhinosinusitis ◽  
Endoscopic Sinus Surgery ◽  
Conservative Therapy ◽  
Therapy Group ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Therapeutic Effects ◽  
Post Surgery ◽  
Surgery Group ◽  
Patient Reported

AbstractObjective:To evaluate the therapeutic effects of functional endoscopic sinus surgery in patients with chronic rhinosinusitis who were unresponsive to medical treatment.Methods:A total of 232 patients were divided into 2 groups: a functional endoscopic sinus surgery group (n = 162) and a conservative therapy group (n = 70). Efficacy was assessed in terms of Lund–Kennedy endoscopy scores and Sino-Nasal Outcome Test 20 symptom scores.Results:In the functional endoscopic sinus surgery group, Lund–Kennedy and Sino-Nasal Outcome Test 20 scores were significantly lower at 3, 6 and 12 months post-surgery compared with baseline scores. In the conservative therapy group, both sets of scores were significantly lower at 3 months, but not at 12 months. In this latter group, the Lund–Kennedy scores decreased only slightly and the Sino-Nasal Outcome Test 20 scores significantly decreased at six months compared with initial scores, indicating disparity between the subjective and objective measures. Patient-reported symptom improvement was better in the functional endoscopic sinus surgery group than in the medication group at 12 months (p < 0.001).Conclusion:These findings suggest that functional endoscopic sinus surgery has better efficacy over a longer period compared with conservative therapy.

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