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. 2019 Apr;9(4):402-408.
doi: 10.1002/alr.22264. Epub 2018 Dec 20.

Long-term revision rates for endoscopic sinus surgery

Kristine A Smith  1   2 , Richard R Orlandi  2 , Gretchen Oakley  2 , Huong Meeks  3   4 , Karen Curtin  3   4 , Jeremiah A Alt  2
Affiliations

Long-term revision rates for endoscopic sinus surgery

Kristine A Smith et al. Int Forum Allergy Rhinol. 2019 Apr.

Abstract

Background: Reported revision rates for endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) vary significantly. Several investigations examining revision rates for ESS have been limited by duration of follow-up, academic centers, or small surgeon cohorts. The objective of this study was to define the long-term revision rates for ESS and to determine those unique patient factors that increase the risk of revision ESS.

Methods: The Utah Population Database was queried for Current Procedural Terminology codes for ESS from 1996 to 2016. Patient demographics and comorbid diagnoses were collected. Revision rates and risk factors for surgery were determined by Cox proportional hazard modeling.

Results: A total of 29,934 patients were identified, with a mean length of follow-up of 9.7 years. The long-term revision rate was found to be 15.9%. The mean time between surgeries decreased with higher number of revision surgeries. The time between the first and second surgery was 4.39 years and the time between the fourth and fifth surgery decreased to 2.18 years. Female gender, older age at first surgery, nasal polyps, comorbid asthma, allergy, and a family history of CRS all increased the risk of requiring revision surgery (p < 0.001).

Conclusion: The long-term revision rate for ESS exceeds 15% and the time between revision surgeries decreased with each additional surgery being performed. Unique patient factors increased the risk of requiring revision ESS. Understanding patients' risk for revision surgery may help physicians select and counsel patients with CRS undergoing ESS.

Keywords: chronic rhinosinusitis; endoscopic sinus surgery; patient factors; revision surgery; risk factors.

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Conflict of interest statement

Potential Conflict(s) of Interest:

Kristine A. Smith: None

Gretchen Oakley: None

Huong Meeks: None

Karen Curtin: None

Richard R. Orlandi: Consultant for Medtronic, Lyra Therapeutics, and BioInspire

Jeremiah A. Alt: Consultant for Medtronic, Spirox, Optinose and GlycoMira Therapeutics

Figures

Figure 1.
Figure 1.
Duration between revision surgeries. There was no significant difference between the durations comparing chronic rhinosinusitis with nasal polyposis (CRSwNP) versus without nasal polyposis (CRSsNP). Note how duration between revision surgeries decreases as the number of surgeries increases.
Figure 2.
Figure 2.
Histogram plots of distribution of duration between surgeries (years) overlaid with density plot and mean line (blue). A. Duration between 1st and 2nd surgeries B. Duration between 2nd and 3rd surgeries C. Duration between 3rd and 4th surgeries D. Duration between 4th and 5th surgeries
See this image and copyright information in PMC

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