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Observational Study
. 2019 Aug;9(8):831-841.
doi: 10.1002/alr.22369. Epub 2019 Jun 17.

Long-term outcomes of endoscopic sinus surgery in the management of adult chronic rhinosinusitis

Timothy L Smith  1 , Rodney J Schlosser  2 , Jess C Mace  1 , Jeremiah A Alt  3 , Daniel M Beswick  4 , Adam S DeConde  5 , Kara Y Detwiller  1 , Jose L Mattos  6 , Zachary M Soler  2
Affiliations
Observational Study

Long-term outcomes of endoscopic sinus surgery in the management of adult chronic rhinosinusitis

Timothy L Smith et al. Int Forum Allergy Rhinol. 2019 Aug.

Abstract

Background: There is a striking lack of long-term, prospective outcomes data for endoscopic sinus surgery (ESS) in chronic rhinosinusitis (CRS) using validated instruments. Our primary objective in this study was to report long-term outcomes (>10 years) after ESS for CRS obtained by prospective data collection.

Methods: An observational cohort (n = 59) of adult patients with CRS electing ESS was enrolled between 2004 and 2008. Long-term, disease-specific quality-of-life (QOL) outcomes, health utility values (HUV), revision surgery rate, development of asthma, and patient expectations/satisfaction with outcomes of ESS were examined using descriptive statistics and simple fixed-effects linear modeling.

Results: Fifty-nine adult patients were followed for 10.9 years (±13.8 months), on average. Mean QOL significantly improved between baseline and 6 months and remained durable to 10 years. HUV improved to normal. A 17% revision surgery rate within the 10-year follow-up period was observed with a 25% revision rate in CRS with polyposis. New-onset asthma after ESS occurred at a rate of 0.8%/year. Patient satisfaction with ESS outcomes was generally high.

Conclusions: Ten-year prospective outcomes of ESS for CRS demonstrate that the initial clinically significant improvements in QOL seen 6 months postoperatively are durable over the long term. Over 75% of patients reported clinically significant long-term QOL and HUV improvement. HUV returned to normal. Revision surgery rate was 17% and worse postoperative endoscopy scores within 18 months of initial ESS were associated with higher likelihood of revision surgery. Most patients would pursue ESS again and recommend the procedure to other patients considering this treatment option.

Trial registration: ClinicalTrials.gov NCT02720653.

Keywords: chronic disease; outcome assessment (health care); quality of life; sinusitis.

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Conflict of interest statement

Potential Conflicts of Interest: None

Figures

Figure 1:
Figure 1:
Within-subject trends in average scores of the RhinoSinusitis Disability Index (RSDI) compared across all study visits (n=59)
Figure 2:
Figure 2:
Within-subject trends in average scores of the Chronic Sinusitis Survey (CSS) compared across all study visits (n=59)
Figure 3:
Figure 3:
Within-subject trends in mean SF-6D health utility value scores compared across all study visits (n=59)
Figure 4:
Figure 4:
Average RSDI total scores compared across all study visits for patients with and without nasal polyposis.
Figure 5:
Figure 5:
Average CSS total scores compared across all study visits for patients with and without nasal polyposis.
Figure 6:
Figure 6:
Average SF-6D health utility values compared across all study visits for patients with and without nasal polyposis.
See this image and copyright information in PMC

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