Chronic rhinosinusitis identification in administrative databases and health surveys: A systematic review

Macdonald, Kristian I.; Kilty, Shaun; Walraven, Carl van

doi:10.1002/lary.25804

Cited by 10 publications

(11 citation statements)

References 35 publications

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“…In the group of 21,395 that had ESS and septoplasty on same day, 94% had maxillary, 82.1% had ethmoid surgery, 38.8% had frontal surgery, and 28.5% had sphenoid surgery. In those patients having septoplasty on same day, 16.6% had only one sinus operated on, 39.1% had two sinuses operated on, 24.6% had three sinuses operated on, and 18.7% had all four of the sinuses operated on. The patient population that had ESS and no septoplasty had 76.1% that underwent maxillary surgery, 66.6% of the patients undergoing ethmoid surgery, 35% had frontal surgery, and 28.1% had sphenoid surgery.…”

Section: Resultsmentioning

confidence: 99%

“…This strategy would naturally tend to overestimate patients with CRS. This may account for the significant differential in the prevalence statistics quoted in the literature . In turn, this influences the cost attributed to CRS on a broad basis and possibly lead to significant overestimation of the cost burden of this disease.…”

Section: Discussionmentioning

confidence: 99%

“…This may account for the significant differential in the prevalence statistics quoted in the literature. [14][15][16] In turn, this influences the cost attributed to CRS on a broad basis and possibly lead to significant overestimation of the cost burden of this disease. Our data confirms the female predominance in both the commercial population and the Medicare population for both ARS and CRS.…”

Section: Discussionmentioning

confidence: 99%

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A pathway to value‐based care of chronic rhinosinusitis using a claims database

Denneny

Cyr

Witsell

et al. 2018

Laryngoscope Investig Oto

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Objective To construct a comprehensive picture of the typical chronic rhinosinusitis (CRS) patient in the United States including the demographics, comorbidities, and geographic prevalence. The study will also identify the diagnostic and treatment regimens, their cost, and pattern of use for both medically and surgically managed patients. Study Design Historical cohort study utilizing private and public payer databases. Methods Medical claims data from the Truven Health MarketScan Research Databases from the years 2010 to 2012 for patients with acute rhinosinusitis (ARS) and CRS 18 and older were analyzed. Results There were 54 million unique patients in the databases from 2010 to 2012. Approximately 8 million had at least one diagnosis of ARS and 298,337 had a diagnosis of CRS. Females represented 63.7% of patients with ARS and 59.4% with CRS. Medicare patients represented 6.7% of the ARS population and 10.2% of the CRS population. The mean cost of a CRS episode for those commercially insured was $1024 and $762 in Medicare. CRS patients underwent diagnostic procedures including diagnostic endoscopy (55.1%), cultures (23.6%), sinus CT scan (82.1%) and MRI (0.2%). Endoscopic sinus surgery (ESS) was performed on 14.4% of those patients with CRS. Change in frequency of medication use from the 6 months prior to ESS to the 6 months post‐ESS yielded a reduction in total costs of 34.2% or $3.9 M. The most commonly operated sinuses (with or without septoplasty on same day as ESS) were the maxillary (94%/76.1%); followed by ethmoid (82.1%/66.6%); frontal (38.8%/35.1%); and sphenoid (28.5%/28.1%). In total, 16.6% had one sinus operated on, 39.1% had two, 24.6% had three, and 18.7% had four sinuses operated on. Conclusions This data paints a much clearer understanding of the current medical and surgical management. This study confirms the previously described “value proposition” for the surgical management of those CRS patients refractory to medical management. Level of Evidence 4

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A pathway to value‐based care of chronic rhinosinusitis using a claims database

Denneny

Cyr

Witsell

et al. 2018

Laryngoscope Investig Oto

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“…Identifying CRS cases by use of office diagnoses by non-otolaryngologists or billing data is frequently inaccurate. 9,10 For example, in a series of 114 cases billed as CRS by primary care or emergency medicine providers, only one patient actually met CRS criteria. 11 Fewer than 10% of patients in this study met the 12-week criteria for symptom duration, no patient had evidence of inflammation on physical examination, nearly 70% of patients who had computed tomography (CT) scans performed had no or only mild CT evidence of sinusitis, and only 7% of narrative assessments described patients as having CRS.…”

Section: Definitionmentioning

confidence: 99%

“…Identifying CRS cases by use of office diagnoses by non‐otolaryngologists or billing data is frequently inaccurate . For example, in a series of 114 cases billed as CRS by primary care or emergency medicine providers, only one patient actually met CRS criteria .…”

Section: Introductionmentioning

confidence: 99%

The role of infection and antibiotics in chronic rhinosinusitis.

Barshak

Durand

2017

Laryngoscope Investig Oto

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ObjectiveTo review the current understanding of the role of infection and antibiotics in chronic rhinosinusitis.Review methodsPubMed literature searchResultsChronic rhinosinusitis (CRS) in adults is an inflammatory condition and the role of infection is unclear. Biofilms are present in both CRS and normal patients so their role in CRS is unknown. Sinus cultures in CRS demonstrate a mixture of aerobic and anaerobic bacteria but may be hard to interpret due to contaminating nasal flora. Staphylococcus aureus is common in CRS patients but also present in 20‐30% of nasal cultures in the normal population; eradicating this organism did not lead to symptom improvement versus placebo in a randomized controlled trial (RCT). In CRS patients who develop an episode of acute rhinosinusitis (ARS), bacteria typical of ARS can generally be cultured and require short‐course treatment. For CRS, topical antibacterial or antifungal agents have shown no benefit over placebo in RCTs, although RCTs of topical antibacterial agents have been small. Oral macrolides and doxycycline, antibiotics with anti‐inflammatory properties, are the only systemic antibiotics that have been evaluated in RCTs. One RCT found 3 weeks of doxycycline beneficial in patients with polyps but follow up was short (<3 months); RCTs of prolonged macrolide therapy have produced mixed results, and most show no benefit after cessation of therapy. Long‐term antibiotic therapy may produce side effects and select increasingly resistant flora. The American Academy of Otolaryngology—Head and Neck Surgery guidelines recommend against treatment of CRS with antifungal agents but do not comment on the role of antibacterial treatment.ConclusionThe role of infection in CRS is unknown, and the only well‐defined role for antibiotics is for treatment of ARS episodes or their infectious complications.Level of EvidenceN/A.

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