Effects of depression on quality of life improvement after endoscopic sinus surgery

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 (> or =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.