Determinants of Outcomes of Sinus Surgery: A Multi‐Institutional Prospective Cohort Study
Open accessAbstract
OBJECTIVES: 1) To measure the proportion of patients with chronic rhinosinusitis (CRS) who experience clinically significant improvement after endoscopic sinus surgery (ESS) in a prospective, multi‐institutional fashion. 2) To identify preoperative characteristics that predict clinically significant improvement in quality of life (QOL) after ESS. STUDY DESIGN: Prospective, multi‐institutional cohort study. SETTING: Academic tertiary care centers. SUBJECTS AND METHODS: A total of 302 patients with CRS from three centers were enrolled between July 2004 and December 2008 and followed for an average of 17.4 months postoperatively. Preoperative patient characteristics, CT scan, endoscopy score, and pre‐ and postoperative quality of life (QOL) data were collected. Univariate and multivariate analyses were performed. RESULTS: Patients improved an average of 15.8 percent (18.9 points) on the Rhinosinusitis Disability Index and 21.2 percent (21.2 points) on the Chronic Sinusitis Survey (both P < 0.001). Patients significantly improved on all eight Medical Outcomes Study Short Form‐36 (SF‐36) subscales (all P < 0.001). Among patients with poor baseline QOL, 71.7 percent of patients experienced clinically significant improvement on the RSDI and 76.1 percent on the CSS. Patients undergoing primary surgery were 2.1 times more likely to improve on the RSDI (95% confidence interval [CI], 1.2, 3.4; P = 0.006) and 1.8 times more likely to improve on the CSS (95% CI, 1.1, 3.1; P = 0.020) compared with patients undergoing revision surgery. CONCLUSION: In this prospective, multi‐institutional study, most patients experienced clinically significant improvement across multiple QOL outcomes after ESS. Specific patient characteristics provided prognostic value with regard to outcomes.
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Endoscopic surgical treatment is beneficial in patients with chronic rhinosinusitis with nasal polyps who have severe symptoms and do not respond to appropriate medical treatment.
“In CRS with NP , endoscopic surgical treatment has been shown to be beneficial in patients with severe symptoms who do not respond to appropriate medical treatment [20,127,128,212-218] and may be more cost-effective [219,220].”
From Position Paper on Nasal Obstruction: Evaluation and Treatment (2018) · cites this paper as [214]
The Discussion (page not available) reports clinically significant quality-of-life improvement after endoscopic sinus surgery in 72–76% of patients with CRS and poor baseline quality of life. The Study Participants and Data Collection section says patients elected surgery after failing antibiotics and oral and topical steroids. The paper does not report this benefit specifically for patients with nasal polyps, so the claim is more specific than its findings. (LLM, conf=0.86)
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Cites
Norman, G. R., Sloan, J. A., & Wyrwich, K. W. (2003) · Medical Care · doi:10.1097/01.mlr.0000062554.74615.4c · Cited by 4,700 · see citing works
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International Consensus Statement on Allergy and Rhinology: Rhinosinusitis
Orlandi, R. R., Kingdom, T. T., Hwang, P. H., Smith, T. L., Alt, J. A., Baroody, F. M., Batra, P. S., Bernal‐Sprekelsen, M., Bhattacharyya, N., Chandra, R. K., et al. (2016) · International Forum of Allergy & Rhinology · doi:10.1002/alr.21695 · Cited by 892 · see citing works
Self-citationPosition Paper on Nasal Obstruction: Evaluation and Treatment
SEAIC Rhinoconjunctivitis Committee & SEORL Rhinology, A., Valero, A., Navarro, A., del Cuvillo, A., Alobid, I., Benito, Jr., Colás, C., de los Santos, G., Fernández Liesa, R., García-Lliberós, A., et al. (2018) · Journal of Investigational Allergology and Clinical Immunology · doi:10.18176/jiaci.0232 · Cited by 76 · see citing works
Alt, J. A., DeConde, A. S., Mace, J. C., Steele, T. O., Orlandi, R. R., & Smith, T. L. (2015) · JAMA Otolaryngology–Head & Neck Surgery · doi:10.1001/jamaoto.2015.1673 · Cited by 53 · see citing works
Self-citation
- Authors
- Smith, T. L., Litvack, J. R., Hwang, P. H., Loehrl, T. A., Mace, J. C., Fong, K. J., & James, K. E.
- Affiliations
- Oregon Health & Science University (US)
- Stanford Medicine (US)
- Medical College of Wisconsin (US)
- California Sinus Centers Walnut Creek CA
- Corresponding author
- Smith, Timothy L.
- Venue
- Otolaryngology–Head and Neck Surgery
- Publisher
- Wiley
- Published
- 2010-01
- Volume
- 142
- Issue
- 1
- Pages
- 55-63
- ISSN
- 0161-6439 (ISSN-L)
- 0194-5998
- 1097-6817
- PMC
- PMC2815335
- OpenAlex
- W2100263956
- Cited by
- 260
- References
- 1
- Citations by year
- 2026: 7 · 2025: 15 · 2024: 9 · 2023: 7 · 2022: 5 · 2021: 13 · 2020: 20 · 2019: 16 · 2018: 21 · 2017: 9 · 2016: 29 · 2015: 23 · 2014: 25 · 2013: 21 · 2012: 11
- FWCI
- 12.75
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Otolaryngology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Deafness and Other Communication Disorders (R01DC005805)
- Topics
- Health Sciences › Medicine › Otorhinolaryngology › Sinusitis and nasal conditions
- Health Sciences › Medicine › Surgery › Nasal Surgery and Airway Studies
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cystic Fibrosis Research Advances
- Keywords
- chronic rhinosinusitis, endoscopic sinus surgery, quality of life, surgical outcomes, prognostic factors, Rhinosinusitis Disability Index, SF-36, reoperation
- MeSH terms
- Chronic Disease, Female, Humans, Male, Middle Aged, Prospective Studies, Quality of Life, Rhinitis, Sinusitis, Otorhinolaryngologic Surgical Procedures, Treatment Outcome
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