Clinical predictors of revision surgery for chronic rhinosinusitis with nasal polyposis within 5-year follow-up

Ching Lung Wu, Ta Jen Lee, Chi Che Huang, Po Hung Chang, Chia Hsiang Fu*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

10 Scopus citations

Abstract

Background: Chronic rhinosinusitis with nasal polyposis (CRSwNP) remains a difficult-to-cure disease. The aim of this study was to determine the potential long-term predictors of revision sinus surgery for CRSwNP. Methods: Prospectively gathered patients with bilateral CRSwNP who received primary endoscopic sinus surgery were enrolled. Clinical variables, including the preoperative Lund-Mackay score (LMS), were collected to clarify possible risk factors for revision surgery within a 5-year follow-up. The symptomatic burden was measured using a 10-cm visual analog scale (VAS) before and 1 year after surgery. Further survival analysis was performed to present the revision-free survival in Kaplan−Meier plotting. Results: Eighty four qualified patients were identified and all of them experienced significant improvement in VAS after primary surgery. The 5-year revision rate was 19.05%, and the mean time of revision surgery was 25.31 ± 17.11 months postoperatively. Nasal allergy (OR = 9.287; p = 0.011) and LMS (OR = 1.29; p = 0.06) were found to be the independent risk factors for revision surgery. The discriminatory power of LMS for revision surgery was acceptable (AUC = 0.79) with the best cutoff point located at LMS > 13.5. Patients with both nasal allergy and LMS≧14 had only half of revision-free survival in comparison to overall survival (38.1% vs. 80.95%, p < 0.001). Conclusions: In patients with CRSwNP who have concurrent nasal allergy and higher preoperative LMS may indicate an advanced disease status and eventually be in a high risk of revision surgery after a long-term follow-up. An outcome-based staging system will be helpful in the future to improve the prognosis for CRSwNP.

Original languageEnglish
Article number102654
JournalAmerican Journal of Otolaryngology - Head and Neck Medicine and Surgery
Volume41
Issue number6
DOIs
StatePublished - 01 11 2020
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2020 Elsevier Inc.

Keywords

  • Chronic rhinosinusitis
  • Lund-Mackay score
  • Nasal allergy
  • Nasal polyposis
  • Recurrent rhinosinusitis
  • Survival analysis

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