2018 Section 5 - Rhinology and Allergic Disorders

Reprinted by permission of JAMA Otolaryngol Head Neck Surg. 2017; 143(9):891-898.

Research

Evaluating Surgeon-Specific Performance for Endoscopic Sinus Surgery JAMA Otolaryngology–Head & Neck Surgery | Original Investigation

Luke Rudmik, MD, MSc; Yuan Xu, PhD; Jeremiah A. Alt, MD, PhD; Adam Deconde, MD; Timothy L. Smith, MD, MPH; Rodney J. Schlosser, MD; Hude Quan, MD, PhD; Zachary M. Soler, MD, MSc

IMPORTANCE Several identified factors have raised questions concerning the quality of care for endoscopic sinus surgery (ESS), including the presence of large geographic variation in the rates and extent of surgery, poorly defined indications, and lack of ESS-specific quality metrics. Combined with the risk of major complications, ESS represents a high-value target for quality improvement.

OBJECTIVE To evaluate differences in surgeon-specific performance for ESS using a risk-adjusted, 5-year ESS revision rate as a quality metric.

DESIGN, SETTING, AND PARTICIPANTS This retrospective study used a population-based administrative database to study adults ( 18 years of age) with chronic rhinosinusitis (CRS) who underwent primary ESS in Alberta, Canada, between March 1, 2007, and March 1, 2010. The study period ended in 2015 to provide 5 years of follow-up.

INTERVENTIONS Endoscopic sinus surgery for CRS.

MAIN OUTCOMES AND MEASURES Primary outcomes were the 5-year observed and risk-adjusted ESS revision rate. Logistic regression was used to develop a risk adjustment model for the primary outcome. RESULTS A total of 43 individual surgeons performed primary ESS in 2168 patients with CRS. Within 5 years after the primary ESS procedure, 239 patients underwent revision ESS, and the mean crude 5-year ESS revision rate was 10.6% (range, 2.4%-28.6%). After applying the risk adjustment model and 95% CI to each surgeon, 7 surgeons (16%) had lower-than-expected performance and 2 surgeons (5%) had higher-than-expected performance. Three variables had significant associations with surgeon-specific, 5-year ESS revision rates: presence of nasal polyps (odds ratio [OR], 2.07; 95% CI, 1.59-2.70), more annual systemic corticosteroid courses (OR, 1.33; 95% CI, 1.19-1.48), and concurrent septoplasty (OR, 0.70; 95% CI, 0.55-0.89). CONCLUSIONS AND RELEVANCE Evaluating surgeon-specific performance for ESS may provide information to assist in quality improvement. Although most surgeons had comparable risk-adjusted, 5-year ESS revision rates, 16% of surgeons had lower-than-expected performance, indicating a potential to improve quality of care. Future studies are needed to evaluate more surgeon-specific variables and validate a risk adjustment model to provide appropriate feedback for quality improvement.

Author Affiliations: Author affiliations are listed at the end of this article. Corresponding Author: Luke Rudmik, MD, MSc, Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Calgary, 1820 Richmond Rd SW, Calgary, AB T2T 5C7, Canada ( lukerudmik@gmail.com ).

JAMA Otolaryngol Head Neck Surg . 2017;143(9):891-898. doi: 10.1001/jamaoto.2017.0752 Published online June 22, 2017.

© 2017 American Medical Association. All rights reserved.

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