Inpatient Mortality After Endoscopic Sinus Surgery for Invasive Fungal Rhinosinusitis

Abstract

Objectives: Invasive fungal rhinosinusitis is a rare, life-threatening condition that affects the paranasal sinuses. The standard of care after diagnosis includes surgical debridement and aggressive medical management. Despite treatment, mortality remains unacceptably high. Most data are derived from small cohort experiences, with limited identification of mortality risk factors in the acute setting. The authors used a large national database to better understand clinical factors associated with inpatient mortality for this challenging condition. Methods: Using the 2000-2014 National (Nationwide) Inpatient Sample database, the authors identified 979 adult patients with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code of mucormycosis or aspergillosis and a procedure code of sinus surgery. Multivariate imputation by chained equation was performed to account for missing data, followed by multivariate logistic regression to identify predictors of inpatient mortality. Results: In total, 979 adult patients were identified, with a median age of 57 years. The inpatient mortality rate was 15.8%. The most prevalent comorbidity was hematologic disorders (42.9%). Mucormycosis versus aspergillosis was associated with increased odds of inpatient mortality (odds ratio, 2.95; 95% confidence interval, 2.00-4.34; P < .001). The odds of inpatient mortality were significantly increased between patients with hematologic disorders and those without (odds ratio, 1.92; 95% confidence interval, 1.08-3.39; P = .024). Diabetes (odds ratio, 0.53; 95% confidence interval, 0.34 − 0.80; P = .003) was associated with the lowest odds of inpatient mortality. Conclusions: This represents the first population-based study evaluating the factors associated with inpatient mortality. These findings support prior observations demonstrating that the underlying immune dysfunction and type of fungal infection are important predictors of early mortality.

Retrospective Analysis of Patients With Acute Invasive Fungal Rhinosinusitis in a Single Tertiary Academic Medical Center: A 10-Year Experience

“…The presence of atypical organisms was not associated with worse outcomes in our patient population. A recent large database study by Burton et al 5 found that the presence of Mucor was associated with a higher inpatient mortality, similar to our findings that patients with Mucor/Rhizopus had a higher mortality (76.4%) compared with patients with Aspergillus alone (66.7%).…”

“…4,8,10,11 The literature is confounded among publications, reporting diabetes as both a negative 10 and positive prognostic factor. 5,7 Our study found diabetic patients to have a mortality of 76% compared with 47% in nondiabetic patients, therefore supporting its association with poor outcome. We went onto further investigate whether or not the presence of multiple immunosuppressant comorbidities was associated with worsened outcomes and found that mortality rates increased with an increasing number of comorbidities.…”

“…3,4 Outcomes in patients with AIFRS are variable but uniformly unfavorable, with mortality noted in the literature as high as 50% to 80%. 1,5 Prompt diagnosis of AIFRS is critical, as it is correlated with early treatment and lower rates of morbidity and mortality. 1 However, given the heterogeneous nature of initial presenting symptoms of AIFRS, prompt diagnosis remains a challenge.…”

“…3,4 Outcomes in patients with AIFRS are variable but uniformly unfavorable, with mortality noted in the literature as high as 50% to 80%. 1,5…”

Cultural Properties of Fungi of the Family Mucoraceae, the Genus Aspergillus as Causative Agents of Zooanthroponosis

“…Раніше мукормікоз реєстрували надзвичайно рідко у порівнянні з аспергільозом чи кандидозом. Однак, в останні роки частота випадків мукормікозу має тенденцію до зростання як в Україні, так і в інших країнах [11,12,13,14,15]. Також у групі ризику щодо контакту зі спорами пліснявих грибів знаходяться працівники галузі сільського господарства або мікробіологічної промисловості.…”