Improved Lung Function after Sinus Surgery in Cystic Fibrosis Patients with Moderate Obstruction

Abstract

Objectives Cystic fibrosis (CF) is characterized by infection and inflammation of the sinorespiratory tract. Functional endoscopic sinus surgery (FESS) is an option for patients with severe sinusitis. We sought to evaluate pulmonary function testing after FESS in pediatric and adult patients with CF. Study Design Retrospective chart review using data from all patients with CF who underwent FESS from January 2009 to July 2014. Setting Patients were from a single institution. Subjects and Methods Data were extracted for 181 patients and 320 surgeries. Lung function data, including the forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC, were retrieved within 1 year before and after surgery. Mixed-effects regression was used to compare FEV1 trajectories before and after surgery. The effect of surgery was stratified by presurgery FEV1 to compare patients with mild/no lung disease (FEV1 >80%) and moderate/severe lung disease (FEV1 <80%). Results Of the 181 patients reviewed, 131 with primary FESS had FEV1 data. Presurgery average age was 16 years (95% confidence interval [CI], 14.27-17.73), and FEV1 mean was 85% (95% CI, 81.02-88.98). There were 88 patients with FEV1 >80% and 43 patients with FEV1 <80%. For the entire cohort, lung function did not change related to FESS. Among patients with FEV1 <80%, FEV1 declined presurgery by 3.5% per year (95% CI, -6.1% to -0.8%; P = .010), which halted after surgery with these patients, then showing no subsequent change in FEV1 (95% CI, 0.9%-3.7%; P = .240). No benefit was identified for patients with FEV1 >80%. Conclusion Pulmonary function testing improved in patients with moderate/severe lung disease 1 year following FESS. This suggests FESS may benefit pulmonary outcomes.

Abstracts from the 25th Italian Congress of Cystic Fibrosis and the 15th National Congress of Cystic Fibrosis Italian Society

“…ESS also plays a critical role in reducing or eradicating pulmonary colonization of pathogens in CF patients [8]. Surgery leads to relieve nasal obstruction, decrease purulent nasal discharge, increase activity level and improve olfaction [9]. At our ENT-CF clinic, established 1989, CF patients are evaluated with CT and cone-beam CT (CBCT) for pediatric patients; radiological results are qualitatively and quantitatively evaluated using Lund-Mackay score and together with endoscopic Meltzer's Score and SNAQ-11 questionnaire are used for the assessment of a CF sinus score (CFSS).…”

“…Disease progression and burden in patients with cystic fibrosis homozygous for F508del across Europe in an observational registry (VOICE study) Carlo Castellani 1 , Edward F McKone 2 , Harry Heijerman 3 , Amparo Sole 4 , Siobhán B Carr 5 , Jane C Davies 5,6 , Rainald Fischer 7 , Celeste Barreto 8 , Isabelle Fajac 9 , Zheng (Jason) Yuan 10 , Nils Kinnman 10…”

Surgical Management of Chronic Rhinosinusitis in Cystic Fibrosis

“…Kovell et al demonstrated an improvement in PFTs in pediatric CF patients following ESS, although some of the benefits were mitigated by lower socioeconomic status [23]. Khalfoun and colleagues found that the decline in FEV1 was prevented by ESS in patients with moderate to severe lung disease [8]. Large systematic reviews evaluated the entire aggregate of CF patients; subgroup analysis of high versus low-risk mutations may provide additional insights and can be an area of future research.…”

“…Refractory to medical therapy, endoscopic sinus surgery (ESS) has been shown to improve sinonasal symptoms and quality of life outcomes and reduce pulmonary bacterial colonization [5,7]. However, currently available data on the effect of ESS on pulmonary functions are conflicting [5,8]. In this manuscript, our objective is to provide an up-to-date review of current evidence in the surgical management of CRS in CF patients.…”

Perioperative Risk Factors Associated With Morbidity and Mortality Following Pediatric Inpatient Sinus Surgery

“…[7][8][9][10] Prior work has focused on independent factors of postoperative outcomes, particularly for acute sinusitis with intracranial complications, cystic fibrosis (CF), and chronic sinusitis. [11][12][13] However, among the common indications (ie, paranasal or skull base tumors, inflammatory paranasal disease, and nasal polyposis) for pediatric sinus surgery, it remains unclear which medical comorbidities are associated with significant morbidity and mortality following sinus surgery. 14 Because of non-nationally representative data, small cohort experiences, and a limited evaluation of comorbidities, it is difficult to draw conclusions regarding the comorbidity burden and risk factors associated with inpatient morbidity and mortality following pediatric sinus surgery with the currently available evidence.…”