Factors affecting revision rate of chronic rhinosinusitis

Abstract

ObjectiveChronic rhinosinusitis (CRS) is a variable multifactorial disease. It can be divided into forms with nasal polyps (CRSwNP) and without (CRSsNP). Sinus and/or nasal polypectomy surgery are considered if maximal conservative treatment is insufficient. The predictive factors of the need of revision surgery comprise mostly the CRSwNP phenotype and are not fully understood.Study DesignThe aim of this follow‐up study was to evaluate the factors associated with the revision surgery rate in CRS patients with variable extent of disease.MethodsData of CRS patients (N = 178) undergoing sinus surgery and/or nasal polypectomy in 2001 to 2010 were used. Patient characteristics and follow‐up data were collected from patient records and questionnaires. Associations were analyzed by Fisher's exact, Mann Whitney U, and the Kaplan‐Meier method with log‐rank test. Unadjusted Cox's proportional hazard models were used for 12 variables and were fitted for the need for revision sinus surgery and/or nasal polypectomy during follow‐up of in average 9 years.ResultsThe proportion of CRS patients who had undergone revision in 5 years was 9.6%. After adjustment, the following factors associated significantly with the need for recurrent CRS surgery: allergic rhinitis, corticosteroid treatment, previous surgery of CRS, and recurrent NP.ConclusionIncreased risk of progressive CRS phenotypes with the need for revision surgery would putatively be recognized by relatively simple clinical questions. Further studies with increased sample size are needed to evaluate whether these predictive factors would be relevant for developing better detection and management of progressive CRS.Level of Evidence2b.

Revision surgery rates in chronic rhinosinusitis with nasal polyps: meta‐analysis of risk factors

“…13 We carried out random effects analyses based on the Freeman-Tukey method, assessed statistical heterogeneity using the I 2 statistic, and calculated approximate 95% prediction intervals to estimate the likely effects in a clinical setting, using the methods described by Higgins et al 14,15 Revision rate in CRSwNP and subtypes Forty-five studies comprised of 34,220 subjects were included in the overall weighted CRSwNP revision rate. 4,7,9, The overall rate was 18.6%, with a 95% CI Records idenƟfied through database searching (n =1245)…”

“…Reasons for failure could include underlying mechanisms of inflammatory disease, such as aspirin‐exacerbated respiratory disease (AERD), allergic fungal rhinosinutis (AFRS), or cystic fibrosis. Incomplete initial surgery or lack of compliance to prescribed, long‐term medical therapy may be other reasons . Numerous single‐institution studies have been performed to identify factors impacting CRSwNP revision rates, but reporting has varied significantly .…”

“…Incomplete initial surgery or lack of compliance to prescribed, longterm medical therapy may be other reasons. 3,7 Numerous single-institution studies have been performed to identify factors impacting CRSwNP revision rates, but reporting has varied significantly. 8,9 Further study is needed to gain an understanding of the broader applicability of these findings to clinical management.…”

Factors impacting revision surgery in patients with chronic rhinosinusitis with nasal polyposis

“…Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a subtype of chronic rhinosinusitis that tends to be persistent and presents a challenge to the clinician . Endoscopic sinus surgery (ESS) is frequently used to treat CRSwNP in conjunction with medical therapy, but subsets of patients have recurrence and undergo revision surgery . There are a number of patient‐specific factors that have been reported to impact disease course in CRSwNP.…”

“…These include more effective means of delivering steroids and altering extent of surgery to optimize delivery of topical medications , . Surgeon‐specific factors that may decrease revision rates include performance of septoplasty, endoscopic Lothrop surgery, complete ESS rather than targeted or focal surgery, and use of postoperative steroid rinses . There have been numerous single‐institution studies exploring revision rates in CRSwNP; however, these studies often examined patient‐ or surgeon‐specific factors in isolation .…”