Revision endoscopic sinus surgery rates by chronic rhinosinusitis subtype

Miglani, Amar; Divekar, Rohit; Azar, Antoine; Rank, Matthew A.; Lal, Devyani

doi:10.1002/alr.22146

Cited by 60 publications

(77 citation statements)

References 20 publications

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“…Asthma and AERD have been previously associated with recalcitrant CRSwNP . Our study found that patients with recurrent CRSwNP were more likely to have AERD than patients with primary CRSwNP.…”

Section: Discussionsupporting

confidence: 88%

“…Studies have shown that CRSwNP negatively affects quality of life and is a common problem worldwide, with prevalence estimates of 0.2%‐4% . While surgery provides significant benefit in symptomatology and respiratory health, as many as 40% of the patients with CRSwNP may develop recurrent polyposis within 12 months postoperatively . Clinical factors such as asthma prevalence, as well as aspirin‐exacerbated respiratory disease (AERD), appear to be associated with higher recurrence rates of nasal polyps .…”

Section: Introductionmentioning

confidence: 99%

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Histopathological characteristics of surgical tissue from primary vs recurrent chronic rhinosinusitis with nasal polyposis patients

Donnell

Marino

Zarka

et al. 2020

Laryngoscope Investig Oto

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Objective The histopathological characteristics of primary vs recurrent nasal polyps in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) have not been studied comprehensively. Identification of these features may be helpful for prognostication, postoperative management, and consideration of novel eosinophil‐targeting biologic therapy. This study investigates the histopathological differences in primary vs recurrent CRSwNP tissue. Methods Patients undergoing endoscopic sinus surgery for CRSwNP were included if all 13 histopathological and mucin characteristics on a standardized report were available. Histopathology parameters were compared in surgical tissue and mucin from primary vs recurrent CRSwNP. Results Complete structured histopathology reports were available for 96 patients (39 primary polyps and 57 recurrent polyps). Compared to primary polyp tissue, recurrent CRSwNP mucin was significantly more likely to feature eosinophil aggregates (57.9% vs 35.9%; P = .047). Tissue eosinophilia (using a threshold >10 per high power field [HPF]) was not significantly different in primary and recurrent CRSwNP tissue. Other histopathologic parameters and clinical characteristics were similar. Conclusion Eosinophil aggregates on histopathology are significantly more likely to be present in recurrent CRSwNP. In the limited series, tissue eosinophilia (>10 per HPF) was not significantly different in primary and recurrent CRSwNP. Therefore, in addition to the study of tissue eosinophilia levels, Rhinologic surgeons should also direct attention to CRSwNP mucin. Mucin eosinophilic aggregates are an independent marker of severe inflammation that is associated more likely with recurrent vs primary polyposis. Further study of this marker may help determine its role of choice of postoperative medical therapies, including anti‐eosinophilic biologics. Level of Evidence 4

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Histopathological characteristics of surgical tissue from primary vs recurrent chronic rhinosinusitis with nasal polyposis patients

Donnell

Marino

Zarka

et al. 2020

Laryngoscope Investig Oto

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“…Recurrence rates of CRS have been reported in a large retrospective cohort study of 61,000 patients which found that the revision ESS rate is 6.65%. This same study used multivariable regression modeling to identify patients with CRSwNP as being at higher risk of having revision surgery [60]. The impact of S. aureus on the effectiveness of ESS has not been studied in detail, but variations in the nasal microbiome may impact the outcome of sinus surgery [61].…”

Section: Role Of Surgerymentioning

confidence: 99%

The Role of Staphylococcus aureus in Patients with Chronic Sinusitis and Nasal Polyposis

Vickery

Ramakrishnan²,

Suh

2019

Curr Allergy Asthma Rep

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Purpose of Review Staphylococcus aureus (S. aureus) is correlated with the development of persistent severe inflammatory disease of the upper airway including chronic rhinosinusitis with nasal polyps (CRSwNP). The presence of S. aureus is associated with atopic disease including allergic rhinitis and atopic dermatitis and is associated with poor outcomes. Recent Findings Several different strains of S. aureus generate different toxins and gene products that can account for organism pathogenicity. S. aureus bacteria and its antigens shape the bacterial and fungal microbiome and the mucosal niche which generates host responses that can account for inflammation. The multiple disease phenotypes and molecular endotypes seen in CRSwNP can be characterized by T-helper cell environment within the inflammatory milieu, the presence of epithelial barrier dysfunction, aberrant eicosanoid metabolism, poor wound healing, and dysfunctional host-bacteria interactions which lead to recalcitrant disease and worse surgical outcomes. Summary Understanding the pathomechanisms that S. aureus utilizes to promote nasal polyp formation, prolonged tissue inflammation, and bacterial dysbiosis are essential in our efforts to identify new therapeutic approaches to resolve this chronic inflammatory process.

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“…There are a number of patient‐specific factors that have been reported to impact disease course in CRSwNP. Patients with allergic fungal rhinosinusitis (AFRS) and aspirin‐exacerbated respiratory disease (AERD) phenotypes typically undergo revision surgery at higher rates . Younger age, comorbid asthma, allergy, and prior surgery have also been associated with increased revision rates …”

mentioning

confidence: 99%

“…Surgeon‐specific factors that may decrease revision rates include performance of septoplasty, endoscopic Lothrop surgery, complete ESS rather than targeted or focal surgery, and use of postoperative steroid rinses . There have been numerous single‐institution studies exploring revision rates in CRSwNP; however, these studies often examined patient‐ or surgeon‐specific factors in isolation . For example, despite increased use of postoperative steroid rinses in recent years, there have been few single‐institution studies that considered compliance with medical therapy along with extent of surgery when predicting surgical success rates .…”

mentioning

confidence: 99%

Factors impacting revision surgery in patients with chronic rhinosinusitis with nasal polyposis

Loftus

Soler

Desiato

et al. 2020

Int Forum Allergy Rhinol

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Background Surgical treatment of chronic rhinosinusitis with nasal polyposis (CRSwNP) has evolved over the last decade as rhinologists have increasingly used topical steroid therapies and altered surgical techniques. It is important to understand the changes in success rates of surgery and frequency of revision endoscopic sinus surgery (ESS) in CRSwNP. The aim of this study was to retrospectively review the revision surgical rate of CRSwNP patients by evaluating outcomes in a cohort from the Medical University of South Carolina (MUSC). Methods Retrospective review of CRSwNP patients operated upon at the MUSC between 2002 and 2019 by a single surgeon was performed. Assessed factors included demographics, comorbidities, CRSwNP subtype, extent of surgery, and steroid rinse compliance. Logistic regression was performed to identify factors associated with revision surgery. Results Among 338 patients with at least 6 months of follow‐up, 24.9% had revision surgery, with a mean follow‐up of 52.6 months. In patients with any person‐time measure, the revision rate was 5.58 per 100 person‐years. Independent risk factors associated with increased odds ratio (OR) for revision surgery were: younger age (OR, 1.1); prior surgery (OR, 3.3); longer follow‐up (OR, 1.1); and surgery before 2009 (OR, 2.4) (p < 0.05 for all). Conclusion The revision surgery rate for CRSwNP was 24.9% among those with at least 6 months of follow‐up. Risk factors for higher revision rates included younger age, previous surgery, longer follow‐up, and surgery at the MUSC prior to 2009. As we enter an era of personalized medicine, it is important to consider patient‐ and surgeon‐specific factors, which impact revision surgery rates.

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Revision endoscopic sinus surgery rates by chronic rhinosinusitis subtype

Cited by 60 publications

References 20 publications

Histopathological characteristics of surgical tissue from primary vs recurrent chronic rhinosinusitis with nasal polyposis patients

Histopathological characteristics of surgical tissue from primary vs recurrent chronic rhinosinusitis with nasal polyposis patients

The Role of Staphylococcus aureus in Patients with Chronic Sinusitis and Nasal Polyposis

Factors impacting revision surgery in patients with chronic rhinosinusitis with nasal polyposis

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