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Original Investigation
June 22, 2017

Evaluating Surgeon-Specific Performance for Endoscopic Sinus Surgery

Author Affiliations
  • 1Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
  • 2Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
  • 3Division of Otolaryngology–Head and Neck Surgery, Rhinology–Sinus and Skull Base Surgery Program, Department of Surgery, University of Utah, Salt Lake City
  • 4Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California, San Diego
  • 5Division of Rhinology and Sinus/Skull Base Surgery, Oregon Sinus Center, Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland
  • 6Division of Rhinology and Sinus Surgery, Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
JAMA Otolaryngol Head Neck Surg. Published online June 22, 2017. doi:10.1001/jamaoto.2017.0752
Key Points

Question  When using a risk-adjusted, 5-year surgery revision rate as a surrogate marker for performance, are there differences in surgeon-specific performance for endoscopic sinus surgery?

Findings  After evaluating 43 surgeons within the province of Alberta, Canada, there were differences in surgeon-specific performance for endoscopic sinus surgery. Three variables demonstrated significant associations with 5-year endoscopic sinus surgery revision rate: presence of nasal polyps, more annual systemic corticosteroid courses, and concurrent septoplasty.

Meaning  Evaluating surgeon-specific performance for endoscopic sinus surgery may provide information to assist in quality improvement. Given the findings from this study, the surgeon-specific, risk-adjusted, 5-year endoscopic sinus surgery revision rate may represent a quality metric to assess surgical performance during management of chronic rhinosinusitis.

Abstract

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.

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