This study observed very high geographic variation in the rates of ESS across the province of Alberta. Given the negative impact of unwarranted surgical variation on quality of care, outcomes from this study indicate a need to further evaluate the delivery of care for ESS in Canada to improve overall health system performance.

Although the incidence and prevalence rates of diagnosed CRS were lower compared with earlier published estimates obtained from population-based survey analysis, outcomes from this study may more accurately reflect the disease burden of CRS to the health care system. Given that the prevalence of CRS within a single province is expected to be uniformly distributed, the large geographic variation in diagnosed CRS indicates a potential gap in quality of care and justifies further investigation into the reasons for the variation.

Topical intranasal steroid therapy continues to be underutilized for patients with CRS. Given the negative impact of low-quality medical care, outcomes from this study indicate a need to further evaluate factors leading to the underutilization of a recommended treatment in patients with CRS to improve overall health system performance.

This study has validated several coding algorithms; based on the results a case definition of ≥2 physician claims of CRS (ICD-9 of 471.x or 473.x) within 2 years provides an optimal level of validity. Future studies will need to validate this administrative case definition from different health system perspectives and using larger retrospective chart reviews from multiple providers.