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Rudmik L, Xu Y, Alt JA, et al. Evaluating Surgeon-Specific Performance for Endoscopic Sinus Surgery. JAMA Otolaryngol Head Neck Surg. 2017;143(9):891–898. doi:10.1001/jamaoto.2017.0752
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?
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.
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.
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.
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.
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.
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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