When do the risks of repeated courses of corticosteroids exceed the risks of surgery?

Leung, Randy; Dinnie, Keith; Smith, Timothy L.

doi:10.1002/alr.21377

Cited by 47 publications

(42 citation statements)

References 21 publications

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“…Of note, CRSsNP patients were not included in the analysis. 733 Given the potential risks of systemic corticosteroids, clearer evidence addressing the use of corticosteroids in CRSsNP patients is crucial to balance these risks. No published studies exist to determine the benefit of oral corticosteroids alone in CRSsNP, other than 1 study addressing olfaction.…”

Section: Viie3 Crssnp Management: Oral Corticosteroidsmentioning

confidence: 99%

“…Finally, an evidence-based risk analysis of oral corticosteroid use in CRSwNP was performed by Leung et al 733 Using published complications rates, QoL changes, and costs, their analysis simulated the economic impact of adverse events from a Medicare patient perspective, societal perspective, and a universal healthcare perspective. This analysis found that a breakeven threshold favored surgery over medical therapy when CRSwNP patients required oral corticosteroids more than once every 2 years.…”

Section: Viiie3 Crswnp Management: Oral Corticosteroidsmentioning

confidence: 99%

See 1 more Smart Citation

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Orlandi

Kingdom

Hwang

et al. 2016

Int Forum Allergy Rhinol

Self Cite

557

888

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Background:The body of knowledge regarding rhinosinusitis (RS) continues to expand, with rapid growth in number of publications, yet substantial variability in the quality of those presentations. In an effort to both consolidate and critically appraise this information, rhinologic experts from around the world have produced the International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR:RS). Methods:Evidence-based reviews with recommendations (EBRRs) were developed for scores of topics, using previously reported methodology. Where existing evidence was insufficient for an EBRR, an evidence-based review (EBR) was produced. The sections were then synthesized and the entire manuscript was then reviewed by all authors for consensus. Results:The resulting ICAR:RS document addresses multiple topics in RS, including acute RS (ARS), chronic RS (CRS) with and without nasal polyps (CRSwNP and CRSsNP), recurrent acute RS (RARS), acute exacerbation of CRS (AE-CRS), and pediatric RS. Conclusion:As a critical review of the RS literature, ICAR:RS provides a thorough review of pathophysiology and evidence-based recommendations for medical and surgical treatment. It also demonstrates the significant gaps in our understanding of the pathophysiology and optimal management of RS. Too o en the foundation upon which these recommendations are based is comprised of lowerlevel evidence. It is our hope that this summary of the evidence in RS will point out where additional research efforts may be directed. C 2016 ARS-AAOA, LLC. Key Words:rhinosinusitis; chronic rhinosinusitis; acute rhinosinusitis; recurrent acute rhinosinusitis; evidence-based medicine; systematic review; endoscopic sinus surgery List of Abbreviations Used

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Section: Viie3 Crssnp Management: Oral Corticosteroidsmentioning

confidence: 99%

Section: Viiie3 Crswnp Management: Oral Corticosteroidsmentioning

confidence: 99%

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Orlandi

Kingdom

Hwang

et al. 2016

Int Forum Allergy Rhinol

Self Cite

557

888

View full text Add to dashboard Cite

show abstract

“…Some are likely to experience complications of treatment including not only complications of surgery but also complications of ongoing medical management, for example long-term steroid exposure. 27 When we perform such an analysis we find that endoscopic sinus surgery costs less to produce more QALYs than the option of medical management alone. A sensitivity analysis concludes with 95% certainty that endoscopic sinus surgery is the more cost effective option.…”

Section: Lecturementioning

confidence: 96%

THE 2017 13^TH ANNUAL DAVID W. KENNEDY, MD, LECTURE The evolution of outcomes in sinus surgery for chronic rhinosinusitis: past, present, and future

Smith

2017

Int Forum Allergy Rhinol

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“…The analysis favoured surgery over medication when patients needed more than one course of oral steroids every 2 years, once a year if concomitant asthma was present, or twice yearly for patients with Samter's triad [54].…”

Section: Comparative Evidence Between Medical and Surgical Interventionsmentioning

confidence: 99%

Surgical Versus Medical Interventions in CRS and Nasal Polyps: Comparative Evidence Between Medical and Surgical Efficacy

Dessouky

Hopkins

2015

Curr Allergy Asthma Rep

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CRS with nasal polyps (CRSwNP) is a subgroup of CRS, where polyps can be visualised in the middle meatus. In the general population, the prevalence is estimated to lie between 0.2 and 4 %. Up to 15 % of patients with asthma have nasal polyps and up to 45 % of patients with nasal polyps have asthma. The management of CRSwNP involves primary medical management, with surgery normally reserved for recalcitrant cases. Surgical techniques for CRSwNP range from simple polypectomy and endoscopic sinus surgery (ESS) to radical nasalisation with removal of the middle turbinates. We have reviewed the comparative literature regarding medical and surgical interventions in CRSwNP, with emphasis on outcomes, complications, cost-effectiveness and on the timing of surgery. Similar outcomes are reported for medical and surgical management, but there is sufficient evidence to support the role of surgery once symptoms have failed to adequately respond. There is insufficient evidence to define the optimal timing and extent of surgery.

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When do the risks of repeated courses of corticosteroids exceed the risks of surgery?

Abstract: This represents the first rationalized evidence-based analysis for when surgery should be considered in place of repeated courses of oral corticosteroids. This threshold provides a guide for otolaryngologists to use when making clinical decisions with patients.

Cited by 47 publications

References 21 publications

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

THE 2017 13^TH ANNUAL DAVID W. KENNEDY, MD, LECTURE The evolution of outcomes in sinus surgery for chronic rhinosinusitis: past, present, and future

Surgical Versus Medical Interventions in CRS and Nasal Polyps: Comparative Evidence Between Medical and Surgical Efficacy

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When do the risks of repeated courses of corticosteroids exceed the risks of surgery?

Abstract: This represents the first rationalized evidence-based analysis for when surgery should be considered in place of repeated courses of oral corticosteroids. This threshold provides a guide for otolaryngologists to use when making clinical decisions with patients.

Cited by 47 publications

References 21 publications

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

THE 2017 13TH ANNUAL DAVID W. KENNEDY, MD, LECTURE The evolution of outcomes in sinus surgery for chronic rhinosinusitis: past, present, and future

Surgical Versus Medical Interventions in CRS and Nasal Polyps: Comparative Evidence Between Medical and Surgical Efficacy

Contact Info

Product

Resources

About

THE 2017 13^TH ANNUAL DAVID W. KENNEDY, MD, LECTURE The evolution of outcomes in sinus surgery for chronic rhinosinusitis: past, present, and future