title: Endoscopic and quality-of-life outcomes after revision endoscopic sinus surgery.
abstract: OBJECTIVE
  First, to examine the impact of endoscopic sinus surgery (ESS) on endoscopic and quality-of-life (QOL) outcomes after revision ESS as compared to primary ESS. Second, to evaluate whether or not other risk factors and/or co-morbidities influence the relationship between revision surgery status and outcomes of ESS.
  
  
  METHODS
  Prospective observational study with an internal comparison group.
  
  
  METHODS
  Preoperative computed tomography scores, pre and postoperative endoscopy scores, and two validated disease-specific QOL instruments, the Rhinosinusitis Disability Index (RSDI) and Chronic Sinusitis Survey (CSS), were collected on a prospective cohort of patients undergoing ESS for chronic rhinosinusitis. Data were analyzed using Pearson's chi and multiple logistic regression models.
  
  
  RESULTS
  Mean preoperative Lund-Mackay computed tomography scan scores were similar in primary and revision surgery patients. In patients without polyps, revision ESS patients were 3.88 times more likely to improve on endoscopy scores than primary ESS patients (95% confidence interval 1.70, 8.83; P = .001). In nasal polyp patients, there was no difference by revision status (odds ratio 0.48; 95% confidence interval 0.15, 1.59; P = .23). The odds of improving on the RSDI (odds ratio 0.51, 95% confidence interval 0.25, 1.04, P = .065) and CSS (odds ratio 0.98, 95% confidence interval 0.51, 1.89, P = .950) were not significantly different by revision status.
  
  
  CONCLUSIONS
  Both revision and primary ESS patients improved after ESS with regard to endoscopy, RSDI, and CSS scores. In non-polyp patients, revision ESS patients were more likely to improve on endoscopy scores than primary ESS patients; there was no difference in polyp patients by revision status. Revision ESS patients and primary ESS patients were equally as likely to improve on two QOL instruments.
authors: Department of Otolaryngology-Head & Neck Surgery, Oregon Health and Science University, Portland, OR 97201, USA. robinjam@ohsu.edu
authors: Jamie R
authors: JR
authors: Litvack
authors: Susan
authors: S
authors: Griest
authors: Kenneth E
authors: KE
authors: James
authors: Timothy L
authors: TL
authors: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D011788:Quality of Life; D012086:Reoperation; D012220:Rhinitis / Q000150:complications / Q000523:psychology / Q000601:surgery*; D012852:Sinusitis / Q000150:complications / Q000523:psychology / Q000601:surgery*; D016896:Treatment Outcome