Does Surgery Work? Study Sniffs Out an Answer

Surgeons, of course, hope their handiwork helps patients. But how can they be sure? That question inspired Cedars-Sinai to launch an innovative study that used patient surveys to quantify the outcomes of surgery for sinus inflammation, or rhinosinusitis. The data was reassuring.

"We can now say that if you have endoscopic sinus surgery at Cedars-Sinai, you have an 87 percent chance of feeling better a year later," said Martin Hopp, MD, PhD, director of Otolaryngology and medical director of the Cedars-Sinai Sinus Center.

Rhinosinusitis involves an inflammation of the mucous membranes of the nose and nearby sinuses that can become chronic. Symptoms may include headaches, nasal stuffiness, pressure-like pain and fatigue. Physicians at the Sinus Center were among the first to adopt endoscopic techniques, which are less invasive than traditional open surgery, to treat this condition.

The research project involved 18 physicians and the nearly 600 patients they treated at the Sinus Center from 2010 to 2015. In surveys taken before their surgery and at several intervals for a year afterward, patients ranked 22 sino-nasal symptoms by severity, physical problems, functional limitations and emotional consequences. At year's end, 87 percent of patients reported reduced symptoms, with 2 percent about the same and the remainder reporting worsening symptoms.

The Cedars-Sinai Sinus Center of Excellence Quality Assurance and the Office of Continuing Medical Education (CME) collaborated on the study, which has been accepted for presentation at the prestigious 2016 World Congress on Continuing Professional Development, March 17-19 in San Diego. The congress brings together practitioners and researchers to focus on improving the continuing medical education and professional development of health professionals.

An important goal of Cedars-Sinai's quality-assurance project was to educate the participating physicians about rhinosinusitis and relevant surgical techniques. A total of 40 hours of CME training was offered over five years. The physicians also reviewed the patient survey results at these sessions. The study found that half the physicians attended at least 14 hours of the training.

"The data suggests the value of combining long-term, focused education with an internal quality improvement initiative," the researchers concluded. In future studies, Hopp said the hopes to learn whether the surgical outcomes will vary from year to year or according to the season of the year in which the operation was performed.

The Cedars-Sinai Sinus Center offers two types of endoscopic nasal surgery. Image-guided surgery involves inserting a magnifying endoscope tube, with a light and camera at the end, into the nose. This instrument guides the surgeon in clearing away polyps or other obstructions or removing small bones to enlarge the opening to the sinus. In balloon sinuplasty, the surgeon inserts a guide-wire catheter equipped with a tiny balloon through the nostril. Once it arrives in the blocked sinus passageway, the balloon is inflated to widen the sinus passageway.

Endoscopic surgery can reduce scarring, recovery time and pain for patients as compared with open surgery.