PDF(Pubmed)
Abstract：
BACKGROUND: Surgery is often indicated in the treatment of medically recalcitrant chronic rhinosinusitis (CRS). There is conflicting evidence on the impact of timeliness of sinus surgery on the degree of perceived symptom improvement in CRS.
OBJECTIVE: The goal of this study was to systematically evaluate the available literature on the relationship between patient wait times for endoscopic sinus surgery (ESS) and postoperative changes in patient-reported outcome measures.
METHODS: Ovid, MEDLINE, CINAHL, and Cochrane Library of Systematic Reviews between January 2000 and September 1, 2023, were searched. A total of 931 studies were independently screened by 2 reviewers. Two studies were included in the meta-analysis, while 4 others were included in a narrative review.
RESULTS: Two studies consisting of 1606 patients were included in the meta-analysis. A mean difference in 22-Item Sino-Nasal Outcome Test (SNOT-22) of -0.3 (95% CI = -3.9 to 3.3, I2 = 89%, P < .01 was observed between \"long\" and \"short\" groups, while a mean difference in SNOT-22 of -0.1 (95% CI = -2.5 to 2.3, I2 = 80%, P = .03) was observed between \"long\" and \"mid\" groups. Patients who receive surgery earlier on their disease process (ie, earlier from the time of diagnosis to eventual surgery) appear to require less access to healthcare resources including prescription medications, thus suggesting better disease control.
CONCLUSIONS: There is conflicting evidence to conclude whether timing of ESS affects disease-specific measures in patients with CRS. Patients who receive surgery earlier appear to have lower demands on healthcare utilization including visits and prescription use. Our study suggests there is a need for increased access to surgical specialists who manage patients with CRS, and better understanding by primary care specialists in how to manage CRS when specialist access is not available.
OBJECTIVE: The goal of this study was to systematically evaluate the available literature on the relationship between patient wait times for endoscopic sinus surgery (ESS) and postoperative changes in patient-reported outcome measures.
METHODS: Ovid, MEDLINE, CINAHL, and Cochrane Library of Systematic Reviews between January 2000 and September 1, 2023, were searched. A total of 931 studies were independently screened by 2 reviewers. Two studies were included in the meta-analysis, while 4 others were included in a narrative review.
RESULTS: Two studies consisting of 1606 patients were included in the meta-analysis. A mean difference in 22-Item Sino-Nasal Outcome Test (SNOT-22) of -0.3 (95% CI = -3.9 to 3.3, I2 = 89%, P < .01 was observed between \"long\" and \"short\" groups, while a mean difference in SNOT-22 of -0.1 (95% CI = -2.5 to 2.3, I2 = 80%, P = .03) was observed between \"long\" and \"mid\" groups. Patients who receive surgery earlier on their disease process (ie, earlier from the time of diagnosis to eventual surgery) appear to require less access to healthcare resources including prescription medications, thus suggesting better disease control.
CONCLUSIONS: There is conflicting evidence to conclude whether timing of ESS affects disease-specific measures in patients with CRS. Patients who receive surgery earlier appear to have lower demands on healthcare utilization including visits and prescription use. Our study suggests there is a need for increased access to surgical specialists who manage patients with CRS, and better understanding by primary care specialists in how to manage CRS when specialist access is not available.
摘要：
背景：在治疗顽固性慢性鼻窦炎（CRS）时，通常需要手术治疗。关于鼻窦手术的及时性对CRS感知症状改善程度的影响存在矛盾的证据。
目的：本研究的目的是系统评估现有文献中关于患者鼻内镜手术（ESS）等待时间与患者报告结果指标的术后变化之间的关系。
方法：奥维德，MEDLINE,CINAHL,搜索了2000年1月至2023年9月1日之间的Cochrane系统评论图书馆。共有931项研究由2名评审员独立筛选。两项研究被纳入荟萃分析，而另外4人被纳入叙述性审查。
结果：两项由1606名患者组成的研究被纳入荟萃分析。22项鼻中结果测试（SNOT-22）的平均差为-0.3（95％CI=-3.9至3.3，I2=89％，在“长”组和“短”组之间观察到P<.01，而SNOT-22的平均差为-0.1(95%CI=-2.5至2.3，I2=80%，P=.03）在“长”和“中”组之间观察到。在疾病过程中较早接受手术的患者（即，从诊断到最终手术的早期)似乎需要更少的医疗资源，包括处方药，因此建议更好的疾病控制。
结论：有相互矛盾的证据来推断ESS的时间是否影响CRS患者的疾病特异性措施。较早接受手术的患者似乎对医疗保健利用的要求较低，包括就诊和处方使用。我们的研究表明，有必要增加与管理CRS患者的外科专家的接触，以及初级保健专家在无法获得专家访问权限时如何管理CRS的更好理解。
目的：本研究的目的是系统评估现有文献中关于患者鼻内镜手术（ESS）等待时间与患者报告结果指标的术后变化之间的关系。
方法：奥维德，MEDLINE,CINAHL,搜索了2000年1月至2023年9月1日之间的Cochrane系统评论图书馆。共有931项研究由2名评审员独立筛选。两项研究被纳入荟萃分析，而另外4人被纳入叙述性审查。
结果：两项由1606名患者组成的研究被纳入荟萃分析。22项鼻中结果测试（SNOT-22）的平均差为-0.3（95％CI=-3.9至3.3，I2=89％，在“长”组和“短”组之间观察到P<.01，而SNOT-22的平均差为-0.1(95%CI=-2.5至2.3，I2=80%，P=.03）在“长”和“中”组之间观察到。在疾病过程中较早接受手术的患者（即，从诊断到最终手术的早期)似乎需要更少的医疗资源，包括处方药，因此建议更好的疾病控制。
结论：有相互矛盾的证据来推断ESS的时间是否影响CRS患者的疾病特异性措施。较早接受手术的患者似乎对医疗保健利用的要求较低，包括就诊和处方使用。我们的研究表明，有必要增加与管理CRS患者的外科专家的接触，以及初级保健专家在无法获得专家访问权限时如何管理CRS的更好理解。
