Functional endoscopic sinus surgery (ESS) has undergone exponential growth since its introduction in the mid-1980s, revolutionizing the field of rhinology. Use of new technologies have led to considerable advances in endoscopic endonasal techniques. As a result, >250,000 cases are performed by both private and academic otolaryngologists in the U.S. annually [1,2]. ESS represents the mainstay of surgical treatment for chronic rhinosinusitis (CRS) refractory to medical management. Consequently, endoscopic techniques are now a routine part of otolaryngology residency training and surgical practice. Growing utilization of ESS in the management of CRS emphasizes the need for providers to regularly evaluate their surgical approach to ensure the highest standards of surgical care are met.

For patients with medically recalcitrant CRS, the degree of ESS performed relies on a multitude of personalized, patient-specific factors including severity of disease, need for topical medication delivery, and risk for future recurrence [3]. Appropriate decision-making around the extent of ESS should not be based solely on radiographic evidence of sinus opacification; however, completeness of treatment is often informed by objective disease burden on computed tomography (CT) [4]. Current evidence is conflicting, but radiographic severity of sinus mucosal thickening has been demonstrated to bear influence on patient-reported outcome measures (PROMs) in CRS symptomatology and quality of life (QOL) metrics after ESS [3,5,6]. Thus, there is educational merit in reviewing the extent of ESS performed relative to radiographic findings as a primitive starting point for surgeon self-evaluation.

Optimizing surgical patient outcomes requires rigorous and deliberate effort to critically reflect upon the steps with which a surgery was performed. However, the field of sinus surgery lacks standardized constructs for self-assessment. Furthermore, the Accreditation Council for Graduate Medical Education (ACGME) core competency of practice-based learning and improvement (PBLI) outlines the use of quality metrics as an important tool in the systematic approach to self-appraisal [7]. For the primary purpose of systematic self-evaluation, this article presents the design of a rudimentary quality metric tool which retrospectively assesses ESS extent by calculating a simple ratio of pre-operative Lund-Mackay (LM) scoring to the number of sinuses surgically addressed in a case. This ratio may serve as a basic clinical reference for established surgeons to engage in self-evaluation, question their tactics, identify areas for improvement, and hone their craft.