Long-Term Outcomes From the English National Comparative Audit of Surgery for Nasal Polyposis and Chronic Rhinosinusitis
Long-Term Outcomes From the English National Comparative Audit of Surgery for Nasal Polyposis and Chronic Rhinosinusitis
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DOI：
10.1002/lary.20653
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发表时间：
2009-12-01
期刊：
影响因子：
2.6
通讯作者：
Browne, John
中科院分区：
文献类型：
--
作者：
Hopkins, Claire;Slack, Robert;Browne, John
目标/假设：我们针对在英格兰和威尔士的医院接受慢性鼻窦炎 (CRS) 手术（无论有无鼻息肉）的患者进行了一项大型前瞻性队列研究。我们将报告五年的结果，并且我们将重新审视之前对广泛手术治疗鼻息肉病的有效性的分析。方法：收集了 3,128 名接受 CRS 手术的患者（有或没有鼻息肉）的基线临床数据。结果以接受翻修手术的患者比例和平均鼻鼻结果测试 (SNOT-22) 评分来描述。结果：共有 1,459 名 (52.2%) 患者对 5 年随访有反应。每个时间点的修复手术率都有所增加。在做出回应的患者中，279 名患者 (19.1%) 在最初手术后的 5 年内接受过进一步手术。在患有息肉的患者中，20.6% 的患者接受了翻修手术，而仅患有 CRS 的患者中这一比例为 15.5%。术后 5 年，所有患者的平均 SNOT-22 评分为 28.2（标准差 [SD] = 22.4）。这与 3 个月 (25.5)、12 个月 (27.7) 和 36 个月 (27.7) 时观察到的结果非常相似，并且比基线分数提高了 14 分。息肉患者 5 年时的 SNOT-22 评分（平均值 = 26.2；SD = 21.6）比单独患有 CRS 的患者（平均值 = 33.3；SD = 23.7）更好。在最初接受单纯息肉切除术的患者中，21.2% 的患者接受了修复手术，而接受额外鼻窦手术的患者的这一比例为 20.0%。未经调整的翻修手术率差异不具有统计学意义（chi(2) = 0,22；P = .64）。然而，当使用多变量逻辑回归来调整基线特征时，差异变得具有统计学意义，接受额外鼻窦手术的患者在研究期间接受进一步手术的可能性较小（调整后的比值比 = 0.66；P = .04）。 结论：我们已经证明，在 5 年期间，鼻窦手术在减少与 CRS 相关的症状方面是安全有效的。症状明显减轻，术后 12 至 60 个月症状改善没有显着下降。然而，在此期间翻修手术率接近 20%，患者应在手术前接受相应的咨询。
Objectives/Hypothesis: We present a large, prospective cohort study following patients who underwent surgery for chronic rhinosinusitis (CRS), with or without nasal polyps, in hospitals in England and Wales. Five-year outcomes will be reported, and we will revisit a previous analysis of the effectiveness of extensive surgery in the treatment of nasal polyposis.Methods: Baseline clinical data was collected for 3,128 patients undergoing surgery for CRS (with or without nasal polyps). Outcomes are described in terms of the proportion of patients undergoing revision surgery and mean Sino-Nasal Outcome Test (SNOT-22) scores.Results: A total of 1,459 (52.2%) patients responded to 5-year follow-up. Revision surgery rates increased at each time point. Of the patients responding, 279 patients (19.1%) had undergone further surgery during the 5 years since their original operation. Of the patients with polyps, 20.6% had undergone revision compared to 15.5% of patients with CRS alone. The mean SNOT-22 score for all patients was 28.2 (standard deviation [SD] = 22.4) at 5 years after surgery. This is remarkably similar to the results observed at 3 months (25.5), 12 months (27.7), and 36 months (27.7), and represents a 14-point improvement over the baseline score. Polyp patients report better SNOT-22 scores at 5 years (mean = 26.2; SD = 21.6) than patients with CRS alone (mean = 33.3; SD = 23.7). Of the patients who had originally received simple polypectomy, 21.2% had undergone revision surgery compared to 20.0% of patients who had also received additional sinus surgery. The difference in unadjusted revision surgery rates is not statistically significant (chi(2) = 0,22; P = .64). However, the difference becomes statistically significant when a multivariate logistic regression is used to adjust for baseline characteristics, with patients undergoing additional sinus surgery being less likely to undergo further surgery within the study period (adjusted odds ratio = 0.66; P = .04).Conclusions: We have shown sinonasal surgery to be safe and effective in reducing the symptoms associated with CRS over a 5-year period. The reduction in symptoms is large, with no significant decline in symptomatic improvement from 12 to 60 months postsurgery. However, revision surgery rates approach 20% over this time, and patients should be counseled accordingly prior to surgery.