Efficacy of steroid-eluting stents in management of chronic rhinosinusitis after endoscopic sinus surgery: updated meta-analysis

Abstract

Background: Recently, there has been mounting evidence suggesting the efficacy of steroid-eluting stents (SES) for management of chronic rhinosinusitis after endoscopic sinus surgery (ESS). This meta-analysis serves to evaluate the efficacy of SES in improving postoperative outcomes after ESS.

Methods: A systematic literature search was performed of PubMed for articles published between 1985 and 2018. The outcome variables were reported at, on average, 30 days postintervention.

Results: Seven of the 76 published studies, all of which were industry-sponsored, were included for a collective cohort of 444 SES and 444 control sinuses. In patients who received SES vs controls, collective odds ratios (ORs) for postoperative need for intervention, surgery, and oral steroid were 0.45 (95% confidence interval [CI], 0.33-0.62; p < 0.001), 0.30 (95% CI, 0.18-0.52; p < 0.001), and 0.58 (95% CI, 0.40-0.84; p = 0.004), respectively. In addition, collective ORs for frontal sinus ostia (FSO) patency, moderate-to-severe adhesion/scarring, and increase in polyp score were 2.53 (95% CI, 1.61-3.97; p < 0.001), 0.28 (95% CI, 0.13-0.59; p < 0.001), and 0.42 (95% CI, 0.25-0.74; p = 0.002), respectively. Collective mean differences for FSO/ethmoid inflammation and FSO diameter were -10.86 mm (p < 0.001) and +1.34 mm (p < 0.001), respectively.

Conclusion: Aggregate evidence suggests that SES can improve ESS outcomes by reducing rates of postoperative intervention and recurrent polyposis and inflammation, while promoting FSO patency. All included and analyzed studies were industry-sponsored and ruling-out publication bias was not possible. Future independent and nonsponsored studies to further evaluate SES's long-term efficacy are warranted.

Keywords: chronic rhinosinusitis; endoscopic sinus surgery; meta-analysis; steroid-eluting stent.

FIGURE 1.

Flowchart of study inclusion.

FIGURE 2.

Forest plots demonstrating an overall 0.45, 0.30, and 0.58 odds ratios of need for post-operative intervention, surgery, and oral steroids, respectively. Lines represent the 95% confidence interval and boxes represent the post-operative intervention rate with each box’s size correlating to the respective study’s effect size.

FIGURE 3.

Forest plots demonstrating an overall 2.53 and 0.42 odds ratios of FSO patency and polyposis formation, respectively. Lines represent the 95% confidence interval and boxes represent the post-operative intervention rate with each box’s size correlating to the respective study’s effect size.