(1253) Preoperative disparities in endoscopic sinus surgery among patients with chronic rhinosinusitis

Introduction: Disparities in access to endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) are not well described. We evaluated factors associated with receipt of ESS.

Methods: Retrospective cross-sectional study of adults with CRS at a tertiary care center (Oct 2017-Nov 2024). Outcome was ESS. Variables included Area Deprivation Index (ADI), ZIP-code distance to hospital, race/ethnicity, primary language, diagnosing specialty, and allergic rhinitis. Groups were compared with Wilcoxon rank-sum and chi-square tests; multivariable regression and random forest were used for adjusted associations and variable importance.

Results: Among 9444 CRS patients, 2799 (29.6%) underwent ESS. ADI distributions differed by ESS status (p=0.05). Non-ESS patients lived farther from the hospital (28.42±129.71 vs 24.53±122.81 miles; p=0.04), more often had a non-English primary language (7% vs 5%; p=0.006), and were more often from minoritized racial/ethnic groups (17% vs 14%; p=0.02). CRS diagnosis by a non-otolaryngologist (46% vs 43%; p=0.045) and allergic rhinitis (17% vs 14%; p=0.03) were more common in non-ESS patients. In random forest, distance to hospital and ADI had the highest relative importance for ESS status.

Conclusions: Socioeconomic, geographic, language, and race/ethnicity differences were associated with lower likelihood of ESS for CRS.