Factors affecting revision rate of chronic rhinosinusitis

Abstract

Objective: Chronic 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 design: The 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.

Methods: Data 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.

Results: The 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.

Conclusion: Increased 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 evidence: 2b.

Keywords: Antrochoanal polyp; aspirin intolerance; aspirin‐exacerbated respiratory disease; inflammation; nasal polyp; recurrence; revision surgery; sinus surgery; sinusitis.

Figure 1

Comparison of number of revision sinus operations and/or revision nasal polypectomies in different CRS patient groups during follow‐up of in average 9 years. CRS patient group (A) with/without the presence of allergic rhinitis. (B) The presence of aspirin‐exacerbated respiratory disease. (C) The regular use of intranasal corticosteroid. (D) Preoperative peroral corticosteroid course. (E) Recurrent nasal polyps. (F) Previous sinus surgery and/or nasal polypectomy. P values by Fisheŕs exact test. AERD = aspirin‐exacerbated respiratory disease; CRS = chronic rhinosinusitis.

Figure 2

Predictive effect of different factors to the time until revision sinus surgery and/or nasal polypectomy was performed according to the Kaplan‐Meier method. (A) Predictive effect of a patient history of doctor‐diagnosed allergic rhinitis in all CRS patients (N = 174). (B) Predictive effect of a patient history of doctor‐diagnosed AERD in all CRS patients (N = 178). (C) Predictive effect patient‐reported regular need of intranasal corticosteroid treatment in all CRS patients (N = 169). (D) Predictive effect of preoperative peroral corticosteroid treatment in all CRS patients (N = 172). (E) Predictive effect of previous sinus surgery and/or nasal polypectyomy in all CRS patients (N = 177). (F) Predictive effect of recurrent nasal polyps in all CRS patients (N = 178). (G) Predictive effect of maxillary sinus operation technique in all the CRS patients who underwent current maxillary sinus surgery (N = 146). (H) Predictive effect of maxillary sinus operation technique in the subgroup of CRSsNP patients who underwent current maxillary sinus surgery (N = 81). P values by log‐rank test. AERD = aspirin‐exacerbated respiratory disease; CRS = chronic rhinosinusitis; CRSsNP = chronic rhinosinusitis without nasal polyps; ESS = endoscopic sinus surgery; mini‐invasive ESS = uncinectomy‐only in one side and uncinectomy + antrostomy on the other side of each patient.