Predictors of revision endoscopic sinus surgery in Finnish patients with chronic rhinosinusitis with nasal polyps

IF 4 2区医学 Q2 ALLERGY Clinical and Translational Allergy Pub Date : 2025-01-29 DOI:10.1002/clt2.70032

Sanna Toppila-Salmi, Annina Lyly, Johanna Simin, Juhani Aakko, Helga Haugom Olsen, Lauri Lehtimäki

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Abstract

Background

Although patients with chronic rhinosinusitis with nasal polyps (CRSwNP) may benefit from endoscopic sinus surgery (ESS), some patients will experience polyp recurrence, adding to the overall disease burden of CRSwNP. We aimed to investigate predictors of revision ESS in patients with CRSwNP.

Methods

A nationwide population-based study including all adults diagnosed with CRSwNP who had surgical procedure codes for ESS (N = 3506), followed up between January 2012 and December 2019. Logistic regression models provided adjusted odds ratios (OR) with 95% confidence intervals (CIs) for the odds of revision surgery within one and 3 years post-index surgery.

Results

559 (15.9%) of the patients had at least one revision surgery during the follow-up. Median time to revision of ESS was 425 days (interquartile range: 213–898). Baseline asthma (OR = 1.58, 95% CI 1.17–2.12) and antibiotic use (OR = 1.61, 95% CI 1.27–2.04) were associated with higher odds of revision ESS, particularly within 3 years post-index surgery, whereas Increasing age was inversely associated with the odds of ESS revision (OR = 0.82, 95% CI 0.76–0.88). The highest odds of revision ESS were observed within 3 years post-index surgery in patients who had undergone extensive surgery at index (OR = 14.13, 95% CI 3.41–95.64) compared with those who had undergone limited surgery. OCS use was frequent among CRSwNP patients, with a higher cumulative dose in patients undergoing multiple ESS revisions (63%, n = 97, median daily dose 3.29 mg, IQR: 1.64–3.70) compared with patients without revisions (49%, n = 1361 and 1.64 mg, IQR: 1.64–3.29, respectively. p-value <0.001).

Conclusions

A small proportion of CRSwNP patients require revision ESS with associated high cumulative OCS doses, highlighting the need for additional therapies to achieve disease control and reduce the corticosteroid burden. A few simple baseline characteristics can predict the need for recurrent surgery among the patients with CRSwNP.

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芬兰慢性鼻窦炎合并鼻息肉患者翻修内窥镜鼻窦手术的预测因素。

背景：虽然慢性鼻窦炎合并鼻息肉（CRSwNP）患者可能受益于内窥镜鼻窦手术（ESS），但一些患者会经历息肉复发，增加了CRSwNP的总体疾病负担。我们的目的是研究CRSwNP患者改良ESS的预测因素。方法：一项基于全国人群的研究，包括所有被诊断为CRSwNP且手术代码为ESS的成年人（N = 3506），于2012年1月至2019年12月进行随访。Logistic回归模型提供校正优势比（OR）， 95%置信区间（ci）为指数手术后1年和3年内翻修手术的几率。结果：559例（15.9%）患者在随访期间至少进行了一次翻修手术。到ESS修订的中位时间为425天（四分位数范围：213-898）。基线哮喘（OR = 1.58, 95% CI 1.17-2.12）和抗生素使用（OR = 1.61, 95% CI 1.27-2.04）与ESS修订的几率较高相关，特别是在指数手术后3年内，而年龄的增加与ESS修订的几率呈负相关（OR = 0.82, 95% CI 0.76-0.88）。与那些接受有限手术的患者相比，在指数手术后3年内，接受广泛手术的患者的翻修ESS的几率最高（OR = 14.13, 95% CI 3.41-95.64）。在CRSwNP患者中，OCS的使用较为频繁，接受多次ESS修订的患者累积剂量（63%,n = 97，中位日剂量3.29 mg, IQR: 1.64-3.70）高于未接受ESS修订的患者（49%,n = 1361和1.64 mg, IQR: 1.64-3.29）。结论：一小部分CRSwNP患者需要修改ESS并相关的高累积OCS剂量，强调需要额外的治疗来实现疾病控制和减少皮质类固醇负担。一些简单的基线特征可以预测CRSwNP患者是否需要再手术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical and Translational Allergy Immunology and Microbiology-Immunology

CiteScore

7.50

自引率

4.50%

发文量

117

审稿时长

12 weeks

期刊介绍： Clinical and Translational Allergy, one of several journals in the portfolio of the European Academy of Allergy and Clinical Immunology, provides a platform for the dissemination of allergy research and reviews, as well as EAACI position papers, task force reports and guidelines, amongst an international scientific audience. Clinical and Translational Allergy accepts clinical and translational research in the following areas and other related topics: asthma, rhinitis, rhinosinusitis, drug hypersensitivity, allergic conjunctivitis, allergic skin diseases, atopic eczema, urticaria, angioedema, venom hypersensitivity, anaphylaxis, food allergy, immunotherapy, immune modulators and biologics, animal models of allergic disease, immune mechanisms, or any other topic related to allergic disease.