Indications for Sinus Surgery: How Appropriate Are the Guidelines?

Sinusitis is the most commonly reported chronic disorder in America. More than 75,000 sinus surgical procedures were performed in 1993. Evaluating the appropriateness of procedures is a major focus of health care reform. The American Academy of Otolaryngology‐Head and Neck Surgery (AAO‐HNS) collabor...

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Bibliographic Details
Published in:The Laryngoscope 1998-03, Vol.108 (3), p.332-338
Main Authors: Piccirillo, Jay F., Thawley, Stanley E., Haiduk, Andrea, Kramper, Maggie, Wallace, Mark, Hartman, James M.
Format: Article
Language:English
Subjects:
Adult
Biological and medical sciences
Chronic Disease
Female
Guideline Adherence
Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics
Humans
Male
Medical sciences
Middle Aged
Paranasal Sinuses - surgery
Practice Guidelines as Topic
Prospective Studies
Sinusitis - surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the upper aerodigestive tract
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Summary:Sinusitis is the most commonly reported chronic disorder in America. More than 75,000 sinus surgical procedures were performed in 1993. Evaluating the appropriateness of procedures is a major focus of health care reform. The American Academy of Otolaryngology‐Head and Neck Surgery (AAO‐HNS) collaborated with Value Health Sciences, Inc. (VHS) to develop guidelines for the use of sinus surgery. The clinical utility of these guidelines is presented. Patients undergoing sinus surgery at Barnes Hospital in St. Louis, Missouri, between November 1994 and July 1995 were eligible. Relevant patient information was used to prospectively rate surgery on the nine‐point VHS appropriateness scale (1 to 3, inappropriate; 4 to 6, equivocal; 7 to 9, appropriate). Of 55 patients, 37 (67%) had chronic sinusitis, 10 (18%) recurrent sinusitis, five (9%) chronic sinusitis with nasal polyps, and three (6%) sinusitis with moderate to severe asthma; 27 (49%) had previous sinus surgery. Appropriateness ratings ranged from 1 to 9, with nine (16%) procedures rated as inappropriate, 22 (40%) uncertain, and 24 (44%) appropriate. There were no significant differences in the ratings of appropriateness between the group of patients who had undergone previous sinus surgery and the group of patients who had not. Overall, the guidelines were easily applied and clinically pertinent.
ISSN:0023-852X
1531-4995
DOI:10.1097/00005537-199803000-00005