{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,9,16]],"date-time":"2023-09-16T07:10:32Z","timestamp":1694848232662},"reference-count":13,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2018,7,12]],"date-time":"2018-07-12T00:00:00Z","timestamp":1531353600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int Forum Allergy Rhinol"],"published-print":{"date-parts":[[2018,12]]},"abstract":"Background<\/jats:title>In uncomplicated chronic rhinosinusitis (CRS), a consensus regarding appropriate medical therapy (AMT) before surgical intervention has been published in the form of \u201cappropriateness criteria\u201d for endoscopic sinus surgery (ESS). We sought to determine why tertiary surgeons may deviate from the suggested criteria and evaluated whether those deviations result in change in outcomes.<\/jats:p><\/jats:sec>Methods<\/jats:title>Patients with uncomplicated CRS were prospectively enrolled over the course of 1 year. The 22\u2010item Sino\u2010Nasal Outcomes Test (SNOT\u201022), a general health outcome out of 100, and a physician form, indicating management pathway and decision making, was completed at each visit over a 6\u2010month follow\u2010up period. A descriptive analysis was used to quantify reasons for veering from the \u201cappropriateness criteria,\u201d and repeated linear regression modeling was used to measure whether compliance impacted SNOT\u201022, general health, and Lund\u2010Kennedy (LK) scores over the period of study.<\/jats:p><\/jats:sec>Results<\/jats:title>One hundred fifty\u2010five patients were enrolled. Sixty\u2010eight percent followed the appropriate management pathway based on their presentation and the suggested criteria. Disparate reasons were documented for deviation in the other 32%, and, despite establishing several predictive categories, \u201cother\u201d was the most common reason, with various explanations well documented. SNOT\u201022, general health, and LK scores were not statistically impacted by compliancy status (p<\/jats:italic> > 0.05).<\/jats:p><\/jats:sec>Conclusion<\/jats:title>The suggested \u201cappropriateness criteria\u201d predict a management pathway for the majority of CRS patients. However, in a tertiary sinus center, surgeons may deviate from that model with a significant minority of their patients, for multiple reasons, without causing a change in outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1002\/alr.22184","type":"journal-article","created":{"date-parts":[[2018,7,12]],"date-time":"2018-07-12T14:41:47Z","timestamp":1531406507000},"page":"1389-1394","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Precision medicine: why surgeons deviate from \u201cappropriateness criteria\u201d in the management of chronic rhinosinusitis and effects on outcomes"],"prefix":"10.1002","volume":"8","author":[{"given":"Andrew","family":"Thamboo","sequence":"first","affiliation":[{"name":"Division of Rhinology, Department of Otolaryngology\u2013Head and Neck Surgery Stanford University School of Medicine Palo Alto CA"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of British Columbia Vancouver BC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aakanksha","family":"Rathor","sequence":"additional","affiliation":[{"name":"Division of Rhinology, Department of Otolaryngology\u2013Head and Neck Surgery Stanford University School of Medicine Palo Alto CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole A.","family":"Borchard","sequence":"additional","affiliation":[{"name":"Division of Rhinology, Department of Otolaryngology\u2013Head and Neck Surgery Stanford University School of Medicine Palo Alto CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jayakar V.","family":"Nayak","sequence":"additional","affiliation":[{"name":"Division of Rhinology, Department of Otolaryngology\u2013Head and Neck Surgery Stanford University School of Medicine Palo Alto CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter H.","family":"Hwang","sequence":"additional","affiliation":[{"name":"Division of Rhinology, Department of Otolaryngology\u2013Head and Neck Surgery Stanford University School of Medicine Palo Alto CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zara M.","family":"Patel","sequence":"additional","affiliation":[{"name":"Division of Rhinology, Department of Otolaryngology\u2013Head and Neck Surgery Stanford University School of Medicine Palo Alto CA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,7,12]]},"reference":[{"key":"e_1_2_6_2_1","first-page":"1","article-title":"Ambulatory surgery in the United States, 2006","volume":"11","author":"Cullen KA","year":"2009","journal-title":"Natl Health Stat Rep"},{"issue":"2","key":"e_1_2_6_3_1","first-page":"S1","article-title":"Clinical practice guideline (update): adult sinusitis","volume":"152","author":"Rosenfeld RM","year":"2015","journal-title":"Otolaryngol Head Neck 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