Effects of Depression on Quality of Life Improvement After Endoscopic Sinus Surgery

Authors

  • Jess Mace MPH,

    1. Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology–Head and Neck Surgery, Portland, Oregon, U.S.A.
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  • Yvonne L. Michael PhD,

    1. Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, Oregon, U.S.A.
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  • Nichole E. Carlson PhD,

    1. Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, Oregon, U.S.A.
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  • Jamie R. Litvack MD, MS,

    1. Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology–Head and Neck Surgery, Portland, Oregon, U.S.A.
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  • Timothy L. Smith MD, MPH

    Corresponding author
    1. Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Department of Otolaryngology–Head and Neck Surgery, Portland, Oregon, U.S.A.
    • Dr. Timothy L. Smith, Division of Rhinology and Sinus Surgery/Outcomes Research Unit, Department of Otolaryngology– Head and Neck Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, PV-01, Portland, OR 97239.
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  • This research was made possible by a grant from the NIH/NIDCD #R01 DC005805 and support from the Master of Public Health graduate program within the Department of Public Health and Preventive Medicine at Oregon Health & Science University.

Abstract

Objectives/Hypothesis: To determine whether self- reported depression predicts lesser postoperative improvement in health-related quality of life (HRQoL) after endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS).

Study Design: Prospective open cohort.

Methods: An adult (≥18 yr) cohort of 23 patients with depression and 79 patients without depression undergoing ESS were followed for 12 ± 2 months. Patient characteristics and computed tomography scores were examined preoperatively. Endoscopy scores and two HRQoL measures, the Rhinosinusitis Disability Index (RSDI) and Chronic Sinusitis Survey, were analyzed pre- and postoperatively. Univariate and multivariate analyses were used to evaluate outcome differences for patients with depression.

Results: There was a significantly higher prevalence of women (P = .002) and longer duration of follow-up (P = .004) for the depressed subgroup. Depressed patients reported significantly lower pre- and postoperative HRQoL scores on all RSDI subscales (P < .05). Without baseline adjustment, depression was not associated with significant differences in postoperative change for disease-specific HRQoL scores (P > .10) in multivariate analysis.

Conclusions: Depressed patients with CRS present similarly but have worse pre- and postoperative HRQoL scores and experience similar disease-specific QoL improvements from sinus surgery compared with other CRS patients. Sinus surgery is not effective in alleviating the effect of depression on disease-specific HRQoL, and it is likely that comorbid depression and CRS are operating on independent disease pathways. Additional research and hypothesis testing using continuous, objective measures is warranted.

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