2018 Section 5 - Rhinology and Allergic Disorders

Original Investigation Research

Evaluating Surgeon-Specific Performance for Endoscopic Sinus Surgery

adjusted, 5-year ESS revision rates, 16%of surgeons had lower- than-expected performance, indicating a potential to improve quality of care. The presence of nasal polyps and more prior systemic corticosteroid courses were associated with in- creased risk of undergoing ESS revision, whereas concurrent septoplasty was associated with a reduced risk of ESS revi- sion. Future studies need to evaluate more surgeon-specific variables and validate a risk-adjustment model to provide ap- propriate feedback for quality improvement.

surgery performed by another surgeon. These and other is- sues will need to be addressed before implementation of com- paring surgeon performance for ESS.

Conclusions This study evaluated differences in surgeon-specific perfor- mance for ESS. Althoughmost surgeons had comparable risk-

ARTICLE INFORMATION Accepted for Publication: April 17, 2017.

cancer surgery: improving quality and reducing costs. J Am Coll Surg. 2016;222(1):19-29, e12. 12 . Graham B, Green A, James M, Katz J, Swiontkowski M. Measuring patient satisfaction in orthopaedic surgery. J Bone Joint Surg Am . 2015;97 (1):80-84 . 13 . Shahian DM, He X, Jacobs JP, et al. The Society of Thoracic Surgeons composite measure of individual surgeon performance for adult cardiac surgery: a report of the Society of Thoracic Surgeons Quality Measurement Task Force. Ann Thorac Surg . 2015;100(4):1315-1324 . 14 . Rudmik L, Mace J, Soler ZM, Smith TL. Long-term utility outcomes in patients undergoing endoscopic sinus surgery. Laryngoscope . 2014;124 (1):19-23 . 15 . Soler ZM, Wittenberg E, Schlosser RJ, Mace JC, Smith TL. Health state utility values in patients undergoing endoscopic sinus surgery. Laryngoscope . 2011;121(12):2672-2678 . 16 . Patel ZM, Thamboo A, Rudmik L, Nayak JV, Smith TL, Hwang PH. Surgical therapy vs continued medical therapy for medically refractory chronic rhinosinusitis: a systematic review and meta-analysis. Int Forum Allergy Rhinol . 2017;7(2): 119-127 . 17 . Bhattacharyya N. Ambulatory sinus and nasal surgery in the United States: demographics and perioperative outcomes. Laryngoscope . 2010;120 (3):635-638 . 18 . Wier LM, Steiner CA, Owens PL. Surgeries in Hospital-Owned Outpatient Facilities: Agency for Healthcare Research and Quality. http://www.hcup -us.ahrq.gov/reports/statbriefs/sb188-Surgeries -Hospital-Outpatient-Facilities-2012.pdf . Published February 2015. Accessed May 8, 2017. 19 . Rudmik L, Bird C, Dean S, Dort JC, Schorn R, Kukec E. Geographic variation of endoscopic sinus surgery in Canada: an Alberta-based small area variation analysis. Otolaryngol Head Neck Surg . 2015;153(5):865-874 . 20 . Rudmik L, Holy CE, Smith TL. Geographic variation of endoscopic sinus surgery in the United States. Laryngoscope . 2015;125(8):1772-1778 . 21 . Venkatraman G, Likosky DS, Morrison D, Zhou W, Finlayson SR, Goodman DC. Small area variation in endoscopic sinus surgery rates among the Medicare population. Arch Otolaryngol Head Neck Surg . 2011;137(3):253-257 . 22 . UK Commissioning Guide. Rhinosinusitis. https: //www.rcseng.ac.uk/library-and-publications /college-publications/docs/rhinosinusitis -commissioning-guide/ . Accessed May 11, 2017. 23 . Dautremont JF, Rudmik L. When are we operating for chronic rhinosinusitis? a systematic review of maximal medical therapy protocols prior

Innovator in Community Health Sciences of Canada Award (Dr Rudmik). Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication. Additional Contributions: We thank the MSI Foundation and Petro-Canada Young Innovator in Community Health Sciences of Canada Award for the grants to support this project. REFERENCES 1 . Duclos A, Carty MJ. Value of health care delivery. JAMA . 2011;306(3):267 . 2 . Kaplan RS, Porter ME. How to solve the cost crisis in health care. Harv Bus Rev . 2011;89(9):46-52, 54, 56-61 passim . 3 . Vila PM, Schneider JS, Piccirillo JF, Lieu JE. Understanding quality measures in otolaryngology–head and neck surgery. JAMA Otolaryngol Head Neck Surg . 2016;142(1):86-90 . 4 . Blumenthal D. Better health care: a way forward. JAMA . 2016;315(13):1333-1334 . 5 . Dimick JB, Weeks WB, Karia RJ, Das S, Campbell DA Jr. Who pays for poor surgical quality? building a business case for quality improvement. J Am Coll Surg . 2006;202(6):933-937 . 6 . Smith TL, Mace JC, Rudmik L, et al. Comparing surgeon outcomes in endoscopic sinus surgery for chronic rhinosinusitis. Laryngoscope . 2017;127(1): 14-21 . 7 . Kiernan F, Rahman F. Measuring surgical performance: a risky game? Surgeon . 2015;13(4): 213-217 . 8 . Maruthappu M, El-Harasis MA, Nagendran M, et al. Systematic review of methodological quality of individual performance measurement in surgery. Br J Surg . 2014;101(12):1491-1498 . 9 . Cassel CK, Conway PH, Delbanco SF, Jha AK, Saunders RS, Lee TH. Getting more performance from performance measurement. N Engl J Med . 2014;371(23):2145-2147 . 10 . Bhatt DL, Drozda JP Jr, Shahian DM, et al; ACC/AHA Task Force on Performance Measures. ACC/AHA/STS statement on the future of registries and the performance measurement enterprise: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Society of Thoracic Surgeons. Ann Thorac Surg . 2015;100(5): 1926-1941 . 11 . Govaert JA, van Dijk WA, Fiocco M, et al. Nationwide outcomes measurement in colorectal

Published Online: June 22, 2017. doi: 10.1001/jamaoto.2017.0752

Author Affiliations: Division of Otolaryngology– Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada (Rudmik); Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada (Xu, Quan); Division of Otolaryngology– Head and Neck Surgery, Rhinology–Sinus and Skull Base Surgery Program, Department of Surgery, University of Utah, Salt Lake City (Alt); Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California, San Diego (Deconde); Division of Rhinology and Sinus/ Skull Base Surgery, Oregon Sinus Center, Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland (Smith); Division of Rhinology and Sinus Surgery, Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston (Schlosser, Soler). Author Contributions: Drs Rudmik and Xu had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Rudmik, Xu, Alt, DeConde, Quan. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: Rudmik, Alt, DeConde, Smith, Schlosser. Critical revision of the manuscript for important intellectual content: Rudmik, Xu, Alt, DeConde, Smith, Quan, Soler. Statistical analysis: Rudmik, Xu, Quan. Obtained funding: Rudmik. Administrative, technical, or material support: Alt, DeConde, Smith, Soler. Study supervision: Rudmik, Alt, DeConde, Smith, Schlosser, Quan. Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Rudmik reported serving on the scientific advisory board for BioInspire and 480 Biomedical. Dr Alt reported serving as a consultant for Medtronic, Spirox, and GlycoMira Therapeutics. Dr Deconde reported serving as a consultant for IntersectENT and Stryker Endoscopy. Dr Schlosser reported serving as a consultant for Olympus, Medtronic, and Arrinex and receiving grant support from Intersect and Entellus. Dr Soler reported serving as a consultant for Olympus Inc and 480 Biomedical Inc. No other disclosures were reported. Funding/Support: This study was supported by an MSI Foundation Grant and a Petro-Canada Young

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

jamaotolaryngology.com

© 2017 American Medical Association. All rights reserved.

125