Abstract
Objective: The management of recurrent acute bacterial rhinosinusitis (RARS) remains a controversial subject. Distinguishing RARS from viral upper respiratory infection (URI) is difficult, and when to consider surgery is unclear. This study seeks to identify a threshold number of infections where the benefit of surgery balances the lost productivity from RARS.
Method: An economic model was constructed using literature-reported medical and surgical response rates, as well as measures of quality of life and productivity. This data was utilized to estimate event frequency thresholds for which surgery would be beneficial.
Results: Time lost for the perioperative period balances out lost productivity from RARS exacerbations when patients suffer from 6 episodes/year (range, 2.9-16.8) or 3 episodes/year (range, 1.5-8.4) over 2 years, or 2 episodes per year (range, 1-5.6) over 3 years. Because of possible confusion with URIs, we propose an approach similar to that adopted by the Rhinosinusitis Task Force. The average number of viral URIs suffered by adults annually is approximately 2 (1.4-2.3). Thus, we suggest adding 2 to the above calculated thresholds, prior to considering surgery.
Conclusion: In terms of lost productivity, surgery should be considered when patients suffer from 8, 5, or 4 RARS episodes per year for the past 1, 2, or 3 years, respectively. Discussion with the patient must include a rational consideration of the burden of disease and overall patient quality of life.
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