{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T20:20:45Z","timestamp":1781295645772,"version":"3.54.1"},"reference-count":26,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2014,8,21]],"date-time":"2014-08-21T00:00:00Z","timestamp":1408579200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int Forum Allergy Rhinol"],"published-print":{"date-parts":[[2014,11]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The management of chronic rhinosinusitis with nasal polyposis (CRSwNP) becomes unclear when patients require multiple courses of corticosteroids to maintain quality of life. Repeated courses of corticosteroids carry increased risks to patients. Although endoscopic sinus surgery (ESS) is an effective therapeutic modality, it also carries inherent risks. This study aims to identify the threshold at which the risks of repeated courses of corticosteroid exceed the risks of surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An evidence\u2010based risk analysis was simulated using literature\u2010reported complication rates, quality of life changes, and Medicare costs. Simulations were performed from the Medicare patient perspective, societal perspective, and the universal healthcare patient perspective.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All 3 simulations demonstrate a breakeven threshold favoring surgery over medical therapy when patients require oral corticosteroids (OCS) more often than once every 2 years in CRSwNP, once per year in CRSwNP\/asthma, or twice per year for Samter's triad patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This represents the first rationalized evidence\u2010based analysis for when surgery should be considered in place of repeated courses of oral corticosteroids. This threshold provides a guide for otolaryngologists to use when making clinical decisions with patients.<\/jats:p><\/jats:sec>","DOI":"10.1002\/alr.21377","type":"journal-article","created":{"date-parts":[[2014,8,21]],"date-time":"2014-08-21T15:18:26Z","timestamp":1408634306000},"page":"871-876","source":"Crossref","is-referenced-by-count":42,"title":["When do the risks of repeated courses of corticosteroids exceed the risks of surgery?"],"prefix":"10.1002","volume":"4","author":[{"given":"Randy M.","family":"Leung","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Faculty of Medicine, University of Toronto  Toronto Ontario Canada"},{"name":"Royal Victoria Regional Health Centre  Barrie Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith","family":"Dinnie","sequence":"additional","affiliation":[{"name":"Kelis Consulting Inc  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy L.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Oregon Health Sciences University  Portland OR"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,8,21]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"Healthcare Cost and Utilization Project (HCUP).http:\/\/www.hcup\u2010us.ahrq.gov. 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