Author

Jess C. Mace

Date

June 2007

Document Type

Thesis

Degree Name

M.P.H.

Department

Dept. of Public Health and Preventive Medicine

Institution

Oregon Health & Science University

Abstract

Background: Depression is a known determinant of worse postoperative outcome for a variety of surgical conditions, as well as causal implications toward decreased health related quality of life (HRQoL). The primary purpose of this study was to determine if self-reported depression significantly predicts postoperative improvement in HRQoL domains, following functional endoscopic sinus surgery (FESS) for chronic sinusitis (CRS). Measures of surgical success, as evaluated through the Lund-Kennedy scoring system, may be a secondary predictor of HRQoL domain improvement on two validated disease specific survey instruments - the Rhinosinusitis Disability Index (RSDI) and Chronic Sinusitis Survey (CSS). Methods: This investigation was guided via an adaptation of Wilson and Cleary's Quality of Life model. A prospective adult (>18 years) cohort of 23 depressed patients and 79 non-depressed patients opting for FESS were followed for 12 ± 2 months postoperatively at a tertiary rhinology clinic at the Medical College of Wisconsin. Patient characteristics, HRQoL measures, endoscopy, and CT scores were examined preoperatively. Quality of life measures and endoscopy scores were compared postoperatively. Results: The prevalence of race, acetylsalicyclic acid sensitivity, asthma, nasal polyposis, smoking, allergy, and revision surgery was similar for both patients with and without depression. There was significantly higher prevalence of women (p=0.002) and total weeks of follow-up (p=0.004) for the depressed subgroup. Reductions in endoscopic scores were significant for patients with polyps (p=0.012) and revision surgery (p=0.022) with polyp patients experiencing the highest improvement in endoscopic scores compared to patients without polyposis (-4.34 ± 5.05 vs. -1.95 ± 4.15). Depressed patients reported significantly lower pre- and postoperative HRQoL scores on all RSDI subscales, but similar levels of improvement to that of nondepressed patients. Patient with depression also reported significantly worse postoperative sinus symptoms (p=0.033) and worse preoperative medication usage (p=0.039) than their nondepressed counterparts. Without adjusting for baseline in regression modeling, self-reported depression was not found to be a significant predictor of postoperative functional, emotional, or physical status change, nor a determinant of worse sinus symptoms or medication usage. After adjustment, improvement in Lund-Kennedy endoscopy scores were found to significantly associated with postoperative improvement in the functional (p=0.017) and physical (p=0.005) domains of the RSDI, as well as the symptom domain (p=0.003) of the CSS. Conclusion: Patients with and without coexisting CRS and depression experience the same benefit from FESS in terms of disease specific quality of life improvement. Chronic rhinosinusitis and depression are likely acting as separate, independent disease pathways. Improvement in the ethmoid sinus region, as measured by endoscopic score changes, is significantly predicting HRQoL improvements in the functional, physical, and symptom domains. Additional investigation into this population is needed as a dichotomous measure of depression may not adequately detect differences in disease specific postoperative outcomes for this subgroup. Variations in treatment strategy may be warranted for coexisting CRS and depression.

Identifier

doi:10.6083/M41G0J85

School

School of Medicine

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