(1215) Exploring Predictive Factors for Chronic Rhinosinusitis Surgery: Retrospective Analysis of Initial Patient Complaints and Management

Introduction: Patients with Chronic Rhinosinusitis (CRS) often experience a protracted healthcare journey before reaching a definitive diagnosis and treatment. This study aims to assess how initial patient complaints can predict the necessity for surgical intervention in CRS with the goal of streamlining diagnosis, reducing clinic visits, and improving patient access to effective treatments.

Methods: A retrospective review was conducted of 884 adult patients who presented to our tertiary rhinology clinic from 2017-2019 with a sinus-related chief complaint. Chief complaints were categorized into major and minor sinus categories, and data on demographics, medical/surgical management, final diagnoses, and follow up rates was collected. Chi squared analysis, independent t-tests, and Kruskal-Wallis tests were employed.

Results: Patients presenting with minor sinus category symptoms were less likely to receive a surgical referral (5.3% vs 12.6%, p = 0.036). Patients who presented to the clinic with an initial diagnosis of CRS were more likely to receive a surgical referral (9.7% vs 3%, p = 0.001). Additionally, patients who eventually received sinonasal surgery were prescribed antibiotics more frequently during the first visit ( 51.4% vs 21.7%, p < 0.001), and were less likely to receive saline, topical steroids, oral steroids or topical histamine (p < 0.001 for all).

Conclusions: Our study interestingly revealed no associations between patients presenting with a major sinus category and surgical referral rates, but showed a negative correlation between minor sinus category symptoms and surgical referral rates. Our results also revealed a standard medication protocol for patients who eventually received a surgical referral. While these findings highlight the need to obtain precise chief complaints, they also depict the complexities of using patient reported complaints to fully dictate diagnosis and management.