Long-term outcomes from the English national comparative audit of surgery for nasal polyposis and chronic rhinosinusitis

Claire Hopkins, Robert Slack, Valerie Lund, Peter Brown, Lynn Copley, John Browne
Laryngoscope 2009, 119 (12): 2459-65

OBJECTIVES/HYPOTHESIS: We present a large, prospective cohort study following patients who underwent surgery for chronic rhinosinusitis (CRS), with or without nasal polyps, in hospitals in England and Wales. Five-year outcomes will be reported, and we will revisit a previous analysis of the effectiveness of extensive surgery in the treatment of nasal polyposis.

METHODS: Baseline clinical data was collected for 3,128 patients undergoing surgery for CRS (with or without nasal polyps). Outcomes are described in terms of the proportion of patients undergoing revision surgery and mean Sino-Nasal Outcome Test (SNOT-22) scores.

RESULTS: A total of 1,459 (52.2%) patients responded to 5-year follow-up. Revision surgery rates increased at each time point. Of the patients responding, 279 patients (19.1%) had undergone further surgery during the 5 years since their original operation. Of the patients with polyps, 20.6% had undergone revision compared to 15.5% of patients with CRS alone. The mean SNOT-22 score for all patients was 28.2 (standard deviation [SD] = 22.4) at 5 years after surgery. This is remarkably similar to the results observed at 3 months (25.5), 12 months (27.7), and 36 months (27.7), and represents a 14-point improvement over the baseline score. Polyp patients report better SNOT-22 scores at 5 years (mean = 26.2; SD = 21.6) than patients with CRS alone (mean = 33.3; SD = 23.7). Of the patients who had originally received simple polypectomy, 21.2% had undergone revision surgery compared to 20.0% of patients who had also received additional sinus surgery. The difference in unadjusted revision surgery rates is not statistically significant (chi(2) = 0.22; P = .64). However, the difference becomes statistically significant when a multivariate logistic regression is used to adjust for baseline characteristics, with patients undergoing additional sinus surgery being less likely to undergo further surgery within the study period (adjusted odds ratio = 0.66; P = .04).

CONCLUSIONS: We have shown sinonasal surgery to be safe and effective in reducing the symptoms associated with CRS over a 5-year period. The reduction in symptoms is large, with no significant decline in symptomatic improvement from 12 to 60 months postsurgery. However, revision surgery rates approach 20% over this time, and patients should be counseled accordingly prior to surgery.

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