Does comorbid obesity impact quality of life outcomes in patients undergoing endoscopic sinus surgery?

Abstract

Background Both obesity and chronic rhinosinusitis (CRS) are characterized by inflammation. Furthermore, both disease processes are independently associated with decreases in quality-of-life (QOL). We sought to investigate the role of comorbid obesity in QOL outcomes in CRS patients undergoing endoscopic sinus surgery (ESS). Methods Adult patients with medically refractory CRS (n=241) were prospectively enrolled into a multi-institutional treatment outcomes investigation. Body mass index (BMI) calculations were used to differentiate patient weight groups (normal weight: 18.5–24.9, overweight: 25.0–29.9; and obese: ≥30.0). Preoperative and postoperative QOL (Rhinosinusitis Disability Index (RSDI) and the 22-item Sinonasal Outcome Test (SNOT-22)) were evaluated compared across BMI groups and obesity subclasses. Results The prevalence of comorbid obesity was 41% (n=99). Higher prevalence of comorbid disease was found across increasing BMI groups including diabetes mellitus, asthma, and depression. No significant differences were found in mean preoperative QOL measures between any BMI groups. Significant improvement between preoperative and postoperative QOL mean scores (p≤0.050) was found for all BMI groups. Despite no significant difference in mean QOL improvement between BMI groups (p≥0.142), overweight and obese patients reported reduced relative mean percentage (%) improvement compared to normal weight participants on the RSDI total score (33% and 37% vs. 55%, respectively) and SNOT-22 total score (29% and 40% vs. 48%, respectively). Conclusions Patients with comorbid obesity experience significant improvement in average QOL gains following ESS though the percentage of relative improvement in QOL may be decreased in patients with comorbid obesity and CRS as compared to those without.

Systematic Review and Meta‐analysis of SNOT‐22 Outcomes after Surgery for Chronic Rhinosinusitis with Nasal Polyposis

“…Studies with the same cohort of patients were considered duplicates, leading to 31 excluded studies. 17-47 An additional 78 studies failed to meet inclusion criteria, leading to a final list of 15 distinct patient studies. 48-62…”

Sino‐Nasal outcome test‐22 outcomes after sinus surgery: A systematic review and meta‐analysis

“…Full‐length texts were then reviewed, and an additional 23 studies identified from references. A total of 31 studies were considered to be duplicates from the same cohort, and an additional 53 failed to meet inclusion/exclusion criteria. The final study list included 40 unique patient cohorts published from 2008 to 2016 and representing institutions from North America (n = 14), Europe (n = 12), Middle East (n = 6), Australia (n = 3), Asia (n = 3), and South America (n = 2) .…”

Normative data for the Nasal Obstruction Symptom Evaluation Scale in the general Australian population

“…Conversely, Kanagalingam et al . and Steele's group demonstrated obesity had no effect on severity of sinonasal disease symptoms in asthmatics or in patients prior to endoscopic sinus surgery 22,23 …”

“…21 Conversely, Kanagalingam et al and Steele's group demonstrated obesity had no effect on severity of sinonasal disease symptoms in asthmatics or in patients prior to endoscopic sinus surgery. 22,23 The link between smoking and nasal airway obstruction seemed a little stronger, however. For example, the sequelae of smoking (chronic obstructive airways disease) lead to higher SNOT-22 scores.…”