xRead - Nasal Obstruction (September 2024) Full Articles

20426984, 2021, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/alr.22741 by Stanford University, Wiley Online Library on [01/07/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

229

Orlandi et al.

for surgical intervention should take into

consideration baseline patient reported symptom burden

sinus interventions are likely reasonable

options in patients with minimal OMC or

maxillary sinus disease

Option: Use in patients undergoing ESS,

especially in the setting

of anatomic complexity or the need for more

advanced procedures

hypotension (MAP

between 60 and 70

mmHg) is safe and

improves the surgical field

Option: Patient selection

Option: Less extensive

Option: Controlled

Benefit-Harm Assessment Policy Level

In short term follow-up,

conservative

approaches do not

appear to increase harmfrom recurrence in

patients with

limited sinus disease

Likely benefit over harmwith

acknowledgement

that certain patients with low SNOT-22 may still benefit from surgery

benefit over harm in selected cases

benefit over harm

Preponderance of

Preponderance of

Balloon-dilation technology is

associated with increased

equipment

costs per case

Ignorance of individual specific

symptoms or loss of

productivity at

work if criteria

for surgery not met

Costs related to longer

operating time

and the need

for specialized equipment

cost to achieve targetMAP

TABLE I-6 Grade A/B evidence-based recommendations for surgical management of CRS Intervention Grade Benefit Harm Cost Hypotensive Anesthesia B Controlled hypotension with MAPs between 60 and70mmHg improves the surgical field MAP < 60mmHg may result in cerebral ischemia Low additional Patient Selection to Achievea Post-Operative MCID B Use of baseline disease-specific QoL metrics (eg, SNOT-22 ≥ 20) as criteria can help standardize selection for patients with high likelihood of Exclusion of patients based on SNOT-22 scores alone who may otherwise benefit from surgery Extent of Surgery B Reduced tissue achieving a post-op MCID

Limited techniques can result in

insufficient removal of diseased tissue, persistent

inflammation,

reduced topical

delivery, less access for postoperative care, and faster relapseof symptoms

Increased operating time, IGS failure leading to inaccurate

localization of instruments

manipulation of mucosa with

limited approaches (eg, balloons) has the potential to

reduce surgical time

Image Guidance B Reduced complications, improved

outcomes, more

extensive surgery

performed, reduced surgeon stress