The Effect of Smoking on Quality of Life following Sinus Surgery: 10-Year Follow-Up

Abstract

Objectives: The purpose of this study is to investigate the 10-year postoperative quality of life outcomes in smokers and nonsmokers with chronic rhinosinusitis. Study Design: This is a single-institution prospective cohort study. Methods: 235 patients who have previously been enrolled in a 4-year follow-up study were identified and contacted for a telephone interview. Rates of revision surgery, smoking status and 20-item sinonasal outcomes test (SNOT-20) scores were obtained. Preoperative SNOT-20 scores were compared with those obtained at the 10-year follow-up. Results: Of the patients enrolled in the initial 4-year study, 22.5% were available for a telephone interview, including 43 out of 185 nonsmokers (23.2%) and 9 out of 50 smokers (18%). Demographic data including age, sex and race were analyzed and found to be similar between the two groups. Preoperative SNOT-20 scores were similar between nonsmokers and smokers (28.9 vs. 25.8, p = 0.89). There was no significant difference in long-term SNOT-20 scores (10 years postoperatively) between nonsmokers and smokers (31.5 vs. 28.2, p = 0.629). Conclusions: While cigarette smoke may have long-term adverse effects on the sinonasal mucosa, we found no difference in quality of life outcomes between smokers and nonsmokers 10 years after functional endoscopic sinus surgery.

Long‐term outcomes of endoscopic sinus surgery in the management of adult chronic rhinosinusitis

“…This rate is lower than in our typical published studies with <2‐year follow‐up, which is approximately 70‐80% . This long‐term follow‐up rate is humbling and demonstrates the barriers to achieving 10‐year prospective longitudinal data in CRS; however, it is reasonably consistent with other published reports by Hopkins et al (52% for 5‐year follow‐up), White et al (22.5% for 10‐year follow‐up), and Senior et al (60% for 7.8‐year follow‐up). Given these follow‐up rates, the reader should consider the possibility of follow‐up bias in all of these studies.…”

“…Our results are from a single institution and the sample size was smaller relative to our other published studies. However, the sample size we used is consistent with the published literature of studies approaching 10‐year follow‐up, including White et al (n = 42) and Senior et al (n = 72). To date, our investigation represents the longest term prospective follow‐up study with the largest sample size measuring outcomes in ESS for CRS.…”

“…In a commonly referenced study on this topic, Senior et al reported long‐term follow‐up (mean 7.8 years) in a retrospective evaluation of nonvalidated measures in 72 patients, whereas 98.4% of patients reported “improvement” and 18% required revision procedures . In a study primarily examining the effect of smoking on QOL after ESS, White et al reported 10‐year outcomes by telephone interview on 53 patients . They found no difference between smokers and nonsmokers in QOL improvement.…”

“…Currently, the literature suggests that most patients will report symptomatic improvement after ESS with some suggestion that these improvements may dissipate over time . The prevailing literature is limited primarily by retrospective data collection, subjective definitions of patient “improvement” after surgery, secondary database analyses, and/or a 5‐year maximum time frame for prospectively collected long‐term follow‐up results . .…”

Evaluating the Efficacy and Trend of Sinus Surgery

“…White et al suggest that there is no difference in QOL scores in smokers and nonsmokers after sinus surgery. 12 Alternatively, some studies suggest that while both smokers and nonsmokers may improve significantly from their preoperative QOL scores, some smokers experienced worsening in postoperative QOL scores after 6 months, depending on the smoking volume, 13 and had a higher rate of revision surgery 14 compared with nonsmokers, 20% versus 7%, respectively.…”