The ACCOMPLISH Score: a New Intraoperative Endoscopic Scoring System Grading the Extent of Surgery in Chronic Rhinosinusitis With Nasal Polyps

Limitations of current scores grading the extent of endoscopic sinus surgery (ESS) indicate the need for simpler endoscopic scores utilized also by less experienced otorhinolaryngologists. We prospectively recorded in 30 subjects with chronic rhinosinusitis with nasal polyps the surgical field at the end of ESS. Five raters with different experience scored the videos based on the identification of objective, easily recognizable, and ordinally distributed anatomical criteria for each sinus, such as the posterior wall, roof, skull base, or lamina papyracea. The greater the number of identified anatomical criteria, the more extensive the surgery. The score was titled ACCOMPLISH, with values from 1 (greater extent) to 0 (lesser extent of ESS). We measured the inter-rater agreement with the intraclass correlation coefficient (ICC) and Gwet AC2 coefficient. The median ACCOMPLISH score of the raters, ordered from greatest to least surgical experience, was 0.95, 0.97, 0.70, 0.82, and 0.88. The inter-rater agreement was moderate between all raters (ICC=0.69; P<0.001), excellent between the most experienced raters (0.91; P<0.001), and good between experienced and inexperienced raters (0.81; P<0.001). The inter-rater agreement of all raters for the ACCOMPLISH criteria was almost perfect for the anterior and posterior ethmoidal sinus (Gwet AC2: 0.86-0.91; all P<0.001), substantial for the frontal and sphenoid sinus (0.61-0.72; all P<0.001), and fair for the maxillary sinus (0.21-0.22; both P<0.035). The ACCOMPLISH score fairly succeeded as a simple, intraoperative, endoscopic score grading the extent of ESS. Its repeatability was excellent among experienced rhinologists and remained good among less experienced rhinologists.