Risk Model Establishment of Endoscopic Sinus Surgery for Patients with Chronic Rhinosinusitis: a Multicenter Study in Korea

Jin-Young Min; Yong Min Kim; Dae Woo Kim; Jeong-Whun Kim; Jin Kook Kim; Ji-Hun Mo; Jae-Min Shin; Kyu-Sup Cho; Sanggyu Kwak; Seung-Heon Shin

doi:10.3346/jkms.2021.36.e264

Risk Model Establishment of Endoscopic Sinus Surgery for Patients with Chronic Rhinosinusitis: a Multicenter Study in Korea

J Korean Med Sci. 2021 Oct 18;36(40):e264. doi: 10.3346/jkms.2021.36.e264.

Authors

Jin-Young Min¹, Yong Min Kim², Dae Woo Kim³, Jeong-Whun Kim⁴, Jin Kook Kim⁵, Ji-Hun Mo⁶, Jae-Min Shin⁷, Kyu-Sup Cho⁸, Sanggyu Kwak⁹, Seung-Heon Shin¹⁰

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea.
² Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Chungnam National University, Daejeon, Korea.
³ Department of Otolaryngology-Head and Neck Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
⁴ Department of Otolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea.
⁵ Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Konkuk University, Seoul, Korea.
⁶ Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Dankook University, College of Medicine, Cheonan, Korea.
⁷ Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Korea University, Seoul, Korea.
⁸ Department of Otolaryngology-Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea.
⁹ Department of Medical Statistics, School of Medicine, Catholic University of Daegu, Daegu, Korea.
¹⁰ Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Catholic University of Daegu, Daegu, Korea. [email protected].

Abstract

Background: Endoscopic sinus surgery (ESS) is the mainstay treatment for refractory chronic rhinosinusitis (CRS). Since various factors may contribute to the surgical outcome, it is challenging for physicians to predict surgical outcomes. The aim of study was to analyze the prognostic factors of postoperative outcomes and to establish the prediction model with the risk factors that impact the postoperative outcomes.

Methods: Medical records of CRS patients who underwent ESS at 9 institutions in 2005, 2010, and 2016 were retrospectively reviewed. We classified the patients into 2 groups based on postoperative objective endoscopic outcomes. Demographics, nose-specific symptoms, olfactory function, eosinophil counts in blood (EoB) and nasal tissue (EoT), and Lund-Mackay CT score (LMS) were collected. Univariate and multivariate analyses were performed and established a prediction equation for postoperative endoscopic objective outcomes.

Results: In total (n = 1,249), 27.0% were not satisfied under postoperative endoscopic examination. Of 10 variables, LMS (> 5), sinus dominancy (maxillary sinus and ethmoid sinus), EoB (> 210), and EoT (> 100) were statistically significant in univariate analysis (P < 0.05, all). In multivariate analysis, EoT (> 100) and LMS (> 5) were significantly associated with poor postoperative outcome. Furthermore, 5 significant variables were employed to establish the risk model of postoperative outcomes and P (the value of prediction probability) = 1 / (1 + exp [-0.392 + 1.088 × EoT (> 100) + 0.123 × mean LMS (> 5) - 0.366 × sinus dominancy (maxillary) + 0.064 × sinus dominancy (similar) + 0.200 × EoB (4%) + 0.344 × EoB (> 210)] was developed.

Conclusion: Tissue eosinophil count and radiographic severity predispose to a poorer outcome of ESS and the risk model established may be helpful to predict postoperative outcomes of ESS.

Keywords: Chronic Rhinosinusitis; Computed Tomography; Endoscopic Sinus Surgery; Eosinophilia; Multicenter Study; Prognostic Factor.

MeSH terms

Adult
Chronic Disease
Endoscopy
Eosinophils / cytology
Ethmoid Sinus / pathology
Female
Humans
Logistic Models
Male
Middle Aged
Patient Satisfaction
Postoperative Period
Prognosis
Republic of Korea
Retrospective Studies
Rhinitis / pathology
Rhinitis / surgery*
Risk Factors
Severity of Illness Index
Sinusitis / pathology
Sinusitis / surgery*
Treatment Outcome