2018 Section 5 - Rhinology and Allergic Disorders

Research Original Investigation

Evaluating Surgeon-Specific Performance for Endoscopic Sinus Surgery

Figure. Adjusted 5-Year, Surgeon-Specific Endoscopic Sinus Surgery Revision Rates for Chronic Rhinosinusitis

Observed revision rate A

Risk-adjusted revision rate B

Surgeon No.

Mean Rate (95% CI)

Surgeon No.

Mean Rate (95% CI)

22 42 34 14 41 26 30 17 20 43 13 39 38 37 16 23 40 28 12 33 31 21 2 6 3

29.4 (14.1-44.7) 25.0 (3.8-46.2) 25.0 (6.0-44.0) 25.0 (13.7-36.3) 23.5 (3.4-43.7) 22.2 (6.5-37.9) 20.8 (4.6-37.1) 20.8 (9.3-32.3) 20.5 (7.8-33.2) 18.8 (0.0-37.9) 16.9 (7.8-26.0) 16.7 (0.0-33.9) 15.8 (0.0-32.2) 15.8 (0.0-32.2) 14.8 (9.3-20.3) 13.6 (7.2-20) 13.2 (7.5-18.9) 12.5 (3.1-21.9) 12.1 (1.0-23.3) 11.8 (0.0-27.1) 11.1 (0.0-23) 10.3 (3.1-17.5) 10.0 (0.0-23.1) 9.1 (0.0-21.1) 8.8 (0.0-18.4) 8.4 (2.5-14.4) 8.4 (4.2-12.6) 7.4 (0.0-17.3) 6.9 (1.1-12.8) 6.9 (1.1-12.8) 6.7 (0.0-15.6) 6.7 (1.0-12.3) 6.3 (1.8-10.8) 6.0 (0.0-12.6) 5.4 (0.3-10.6) 5.3 (0.0-15.3) 5.3 (0.0-15.3) 4.5 (0.0-13.2) 3.8 (0.0-11.2) 3.6 (0.0-10.4)

22 42 34 14 40 26 30 17 20 43 13 37 36 16 23 41 39 28 12 33 31 21 2 6 3

24.1 (15.2-32.9) 27.8 (11.9-43.6) 24.1 (11.2-37.0) 17.7 (11.3-24.2) 28.6 (12.5-44.6) 22.7 (11.6-33.9) 20.6 (8.7-32.4) 23.0 (14.1-31.9) 19.5 (10.4-28.6) 24.7 (7.2-42.3) 15.7 (8.7-22.6) 19.6 (4.1-35.1) 20.8 (4.9-36.7) 11.1 (7.2-15.0) 13.4 (7.9-19.0) 11.4 (6.8-16.0) 11.4 (3.5-19.3) 11.3 (1.6-21.0) 13.8 (0.0- 29.6) 11.9 (0.0-26.2) 12.4 (0.3-24.6) 10.8 (3.4-18.2) 12.1 (0.0-26.6) 12.7 (0.0-28.0) 10.8 (0.0-22.1) 10.1 (3.0-17.3) 11.2 (5.8-16.6) 7.6 (0.0-19.0) 8.2 (0.5-16.0) 9.5 (0.0-22.7) 6.1 (0.0-12.5) 7.1 (0.0-14.2) 8.2 (1.7-14.8) 7.5 (0.0-17.0) 7.8 (0.0-24.8) 4.7 (0.0-11.1) 6.1 (0.0-21.0) 5.6 (0.0-19.9) 4.8 (0.0-18.0) 4.8 (0.0-18.1) 3.1 (0.0-9.0) 2.2 (0.0-10.7) 1.8 (0.0-9.8)

7 1

7 1

27 11 10 24

27 11 24 10

8 5

8 5

15

15 38

9

36 35 32 29 25

9

35 32 29 25

4

2.6 (0.0-5.6) 2.4 (0.0-7.2) 2.3 (0.0- 6.8)

4

19 18

19 18

0

30 40 Observed Revision Rate, % 10 20

50

0

30 40 Risk-Adjusted Revision Rate, % 10 20

50

Overall crude revision rates were 10.6% for both the observed and risk-adjusted revisions (vertical dashed lines). Error bars indicate 95% CIs.

quality improvement is a highly complex process that in- volves multiple stakeholders, evaluating the performance of surgeons and providing feedback in real time represent a promising strategy. 4 Although othermedical and surgical spe- cialties have started registries focused on performance measurement, 10,36-38 research focused on evaluating the performance of surgeons duringmanagement of CRS has been limited. A variety of metrics can reasonably be examined when looking at surgeon-specific outcomes formanagement of CRS. This study examined the ESS revision rate, but other poten- tialmetrics includedegreeof quality-of-life improvement,work productivity, need for subsequent medications and physi- cian visits, cost of surgical treatment, or prevention of CRS

there are other variables that need to be accounted for in the risk-adjustment model before surgeon performance can be evaluated using revision rate as a quality metric. In theory, with expanding research into the pathophysi- ology and clinical outcomes for CRS combined with im- proved surgical technology, the quality of care for this chronic disease shouldhave increasedduring the past 3 decades. How- ever, despite substantial advances in themanagement of CRS, persistent gaps still exist in the quality of care for CRS, such as large practice variation, 19,20,32,33 delayed access to ESS, 34,35 and postoperative complications that require hospital care. 25 As we continue to search for ways to improve howwe deliver care for CRS, it is important to begin evaluating the role that surgeons play in this quality-improvement puzzle. Although

JAMA Otolaryngology–Head & Neck Surgery September 2017 Volume 143, Number 9 (Reprinted)

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