Assessing adequacy of surgical extent in CRSwNP: The Completion of Surgery Index

IF 7.2 2区医学 Q1 OTORHINOLARYNGOLOGY

International Forum of Allergy & Rhinology Pub Date : 2024-09-12 DOI:10.1002/alr.23450

Alan D. Workman, Krithika Kuppusamy, David K. Lerner, John V. Bosso, Jennifer E. Douglas, Michael A. Kohanski, Nithin D. Adappa, James N. Palmer

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引用次数: 0

Abstract

BackgroundEndoscopic sinus surgery (ESS) maximized for topical steroid irrigations is highly effective for polyp disease. As extent and completeness of ESS varies widely by situation and practitioner, it is important to understand when revision surgery is appropriate, particularly in the era of biologic treatments.MethodsA Completion of Surgery Index (CoSI) was developed to assess operative changes in polyp patients using pre‐ and postoperative computed tomography scans. The CoSI was then applied and tested in a cohort of consecutive chronic rhinosinusitis with nasal polyps (CRSwNP) patients, and examined within the context of quality‐of‐life improvements.ResultsThe CoSI assesses surgical extent on a scale of 0–100, with 100 representing the highest possible degree of surgical completeness. Among 100 consecutive CRSwNP patients undergoing ESS in 2021 with postoperative topical steroid irrigations, including 75 revision surgeries, SNOT‐22 scores improved at 6 months postoperatively, with durable and consistent improvement at 24 months (p < 0.001). Preoperative CoSI scores in revision surgery patients were 49.4 ± 26.0, improving to 91.0 ± 8.1 postoperatively. SNOT‐22 scores for primary ESS patients and patients with a preoperative CoSI score of less than 70 improved by 26.4 and 28.1 points, respectively, in contrast to patients with a preoperative CoSI of 70 or greater (14.1 points, p = 0.029).ConclusionsIt is important to define extent of surgery in CRSwNP to stratify postsurgical patients based on likelihood to benefit from revision surgery or alternative medications. The CoSI can be utilized to identify patients who are likely to improve significantly with revision surgical intervention.

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评估 CRSwNP 中手术范围的充分性：手术完成指数

背景内窥镜鼻窦手术（ESS）最大限度地利用局部类固醇冲洗对息肉疾病非常有效。由于ESS的程度和完整性因情况和医生的不同而有很大差异，因此了解何时适合进行翻修手术非常重要，尤其是在生物治疗时代。方法开发了手术完成指数（CoSI），利用术前和术后计算机断层扫描评估息肉患者的手术变化。结果CoSI以0-100分评估手术程度，100分代表手术的最高完成度。在 2021 年接受 ESS 并在术后进行局部类固醇冲洗的 100 例连续 CRSwNP 患者中，包括 75 例翻修手术患者，SNOT-22 评分在术后 6 个月时有所改善，在 24 个月时持续改善（p <0.001）。翻修手术患者术前的 CoSI 评分为 49.4 ± 26.0，术后提高到 91.0 ± 8.1。初诊ESS患者和术前CoSI评分小于70分的患者的SNOT-22评分分别提高了26.4分和28.1分，而术前CoSI评分大于等于70分的患者则提高了14.1分（P = 0.029）。CoSI可用于确定哪些患者有可能通过翻修手术干预获得显著改善。

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

International Forum of Allergy & Rhinology OTORHINOLARYNGOLOGY-

CiteScore

11.70

自引率

10.90%

发文量

185

审稿时长

6-12 weeks

期刊介绍： International Forum of Allergy & Rhinologyis a peer-reviewed scientific journal, and the Official Journal of the American Rhinologic Society and the American Academy of Otolaryngic Allergy. International Forum of Allergy Rhinology provides a forum for clinical researchers, basic scientists, clinicians, and others to publish original research and explore controversies in the medical and surgical treatment of patients with otolaryngic allergy, rhinologic, and skull base conditions. The application of current research to the management of otolaryngic allergy, rhinologic, and skull base diseases and the need for further investigation will be highlighted.