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. 2015 Apr 29;5(4):e006680.
doi: 10.1136/bmjopen-2014-006680.

The burden of revision sinonasal surgery in the UK-data from the Chronic Rhinosinusitis Epidemiology Study (CRES): a cross-sectional study

Carl Philpott  1 , Claire Hopkins  2 , Sally Erskine  3 , Nirmal Kumar  4 , Alasdair Robertson  5 , Amir Farboud  6 , Shahzada Ahmed  7 , Shahram Anari  8 , Russell Cathcart  9 , Hisham Khalil  10 , Paul Jervis  11 , Sean Carrie  12 , Naveed Kara  13 , Peter Prinsley  14 , Robert Almeyda  15 , Nicolas Mansell  16 , Sankalp Sunkaraneni  17 , Mahmoud Salam  18 , Jaydip Ray  19 , Jaan Panesaar  20 , Jonathan Hobson  21 , Allan Clark  2 , Steve Morris  22
Affiliations

The burden of revision sinonasal surgery in the UK-data from the Chronic Rhinosinusitis Epidemiology Study (CRES): a cross-sectional study

Carl Philpott et al. BMJ Open. .

Abstract

Objectives: The aim of this study was to investigate the surgical revision rate in patients with chronic rhinosinusitis (CRS) in the UK CRS Epidemiology Study (CRES). Previous evidence from National Sinonasal Audit showed that 1459 patients with CRS demonstrated a surgical revision rate 19.1% at 5 years, with highest rates seen in those with polyps (20.6%).

Setting: Thirty secondary care centres around the UK.

Participants: A total of 221 controls and 1249 patients with CRS were recruited to the study including those with polyps (CRSwNPs), without polyps (CRSsNPs) and with allergic fungal rhinosinusitis (AFRS).

Interventions: Self-administered questionnaire.

Primary outcome measure: The need for previous sinonasal surgery.

Results: A total of 651 patients with CRSwNPs, 553 with CRSsNPs and 45 with AFRS were included. A total of 396 (57%) patients with CRSwNPs/AFRS reported having undergone previous endoscopic nasal polypectomy (ENP), of which 182 of the 396 (46%) reported having received more than one operation. The mean number of previous surgeries per patient in the revision group was 3.3 (range 2-30) and a mean duration of time of 10 years since the last procedure. The average length of time since their first operation up to inclusion in the study was 15.5 years (range 0-74). Only 27.9% of all patients reporting a prior ENP had received concurrent endoscopic sinus surgery (ESS; n=102). For comparison, surgical rates in patients with CRSsNPs were significantly lower; 13% of cases specifically reported ESS, and of those only 30% reported multiple procedures (χ(2) p<0.001).

Conclusions: This study demonstrated that there is a high burden of both primary and revision surgery in patients with CRS, worst in those with AFRS and least in those with CRSsNPs. The burden of revision surgery appears unchanged in the decade since the Sinonasal Audit.

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Figures

Figure 1
Figure 1
Flow chart for inclusion of surgical data from CRES (CRS, chronic rhinosinusitis; CRES, CRS Epidemiology Study).
Figure 2
Figure 2
Frequency of sinonasal surgery (AFRS, allergic fungal rhinosinusitis; CRSsNPs, chronic rhinosinusitis without nasal polyps; CRSwNPs, chronic rhinosinusitis with nasal polyps).
Figure 3
Figure 3
Frequency of multiple ENPs being performed in patients who have previously undergone surgery. AFRS, allergic fungal rhinosinusitis; CRSwNPs, chronic rhinosinusitis with nasal polyps; ENP, endoscopic nasal polypectomy.
Figure 4
Figure 4
Duration of time since first sinonasal surgery for patients with chronic rhinosinusitis with nasal polyps (surgical time impact).
Figure 5
Figure 5
Duration of time since most recent surgery in patients with chronic rhinosinusitis with nasal polyps (recurrence needing secondary care input).
See this image and copyright information in PMC

References

    1. Hastan D, Fokkens WJ, Bachert C et al. . Chronic rhinosinusitis in Europe—an underestimated disease. A GA(2)LEN study. Allergy 2011;66:1216–23. 10.1111/j.1398-9995.2011.02646.x - DOI - PubMed
    1. Kim YS, Kim NH, Seong SY et al. . Prevalence and risk factors of chronic rhinosinusitis in Korea. Am J Rhinol Allergy 2011;25:117–21. 10.2500/ajra.2011.25.3630 - DOI - PubMed
    1. Pilan RR, Pinna FR, Bezerra TF et al. . Prevalence of chronic rhinosinusitis in Sao Paulo. Rhinology 2012;50:129–38. - PubMed
    1. Hospital Episode Statistics: Department of Health, 2013.
    1. Hopkins C, McCombe A, Philpott C et al. . Commissioning guide: rhinosinusitis: ENT UK/Royal College of Surgeons of England, 2013.

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