Predictive value of SNOT-22 on additional opiate prescriptions after endoscopic sinus surgery

Sarek A. Shen, Aria Jafari, David Bracken, John Pang, Adam S. DeConde

Research output: Contribution to journalArticlepeer-review


Background: Endoscopic sinus surgery (ESS) is generally well tolerated, yet a subset of patients require an additional opiate prescription in the postoperative period. The purpose of this study was to quantify differences in both preoperative and immediate postoperative 22-item Sino-Nasal Outcome Test (SNOT-22) scores between patients with a single prescription and those requiring additional opiate prescriptions (AOPs). Methods: Patients undergoing ESS between November 2016 and August 2017 were reviewed retrospectively. The Medical and Controlled Substance Utilization Review and Evaluation System (CURES) records were reviewed; patients requiring AOP within 60 days after surgery were identified. The primary and secondary outcomes of interest were the association of baseline and first postoperative visit SNOT-22 total and domain scores with AOP. Results: A total of 121 patients were reviewed, 22 (18.2%) required AOP. Baseline SNOT-22 scores were higher in aggregate (58.7 ± 16.0 vs 46.1 ± 22.5) and ear/facial domain (11.4 ± 4.8 vs 8.5 ± 5.4) in the AOP group (p < 0.01). AOP patients also demonstrated higher scores across all SNOT-22 domains (p < 0.001) at the immediate preoperative visit. There was no difference in the absolute improvement between groups (15.5 ± 18.30 vs 12.3 ± 23.9, p = 0.54). AOP patients experienced less relative improvement (20.2% vs 34.8%, p < 0.05) and smaller mean effect size (0.57 vs 0.70, p < 0.001) after ESS. Conclusion: Patients reporting increased ear and facial symptoms at baseline have an increased risk of additional opiate prescription after surgery; preoperative SNOT-22 scores may provide utility in identifying these patients. Subjects in both cohorts report symptomatic improvement after ESS; however, relative, not absolute, improvement in SNOT-22 scores is more predictive of AOP.

Original languageEnglish (US)
Pages (from-to)1021-1027
Number of pages7
JournalInternational Forum of Allergy and Rhinology
Issue number9
StatePublished - Sep 2018
Externally publishedYes


  • SNOT-22
  • Sino-Nasal Outcome Test-22
  • chronic rhinosinusitis
  • domains
  • endoscopic sinus surgery
  • informed consent
  • opioid
  • outcomes
  • pain management
  • quality of life

ASJC Scopus subject areas

  • Immunology and Allergy
  • Otorhinolaryngology


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