Risk factors for recurrent sinus surgery in cystic fibrosis: review of a decade of experience.
BACKGROUND
Patients with cystic fibrosis (CF) who undergo endoscopic sinus surgery often require multiple revision procedures. Our objective was to identify risk factors for revision sinus surgery in patients with CF, to better identify this subset of patients who might be better suited for alternative interventions at their initial procedure.


METHODS
Patients with CF who presented to our academic tertiary care sinus clinic between 1994 and 2003 were reviewed. Data were collected from CT scans using the Lund-Mackay scale. Data are collected on demographics, comorbidities, CF genotype, number and type of sinus surgeries, and pulmonary function tests.


RESULTS
Eighty-one patients met inclusion criteria. Fifty patients were <18 years old at presentation. Forty-one patients were A508 homozygotes, 32 patients were A508 heterozygotes, and 5 patients were non-A508 heterozygotes. Respiratory comorbidities were asthma alone (28%) and aspirin triad (5%). Eighteen (22%) patients either smoked or lived with smokers. The mean Lund-Mackay score before the initial surgery was 16. Twenty patients were treated with medication only; 35 patients underwent 1 surgery; 14 patients underwent 2 surgeries; 8 patients underwent 3 surgeries; 2 patients underwent 4 surgeries; and 2 patients underwent 5 surgeries. Patients with higher Lund-Mackay scores at their initial CT were more likely to undergo repeat surgeries (p < 0.05).


CONCLUSIONS
CF patients with high Lund-Mackay scores at their initial surgery are more likely to undergo several revision surgeries. These patients should be considered for more alternative initial management of their sinuses.
Becker
Samuel S
SS
University of Virginia Health System, Department of Otolaryngology and Head and Neck Surgery, Charlottesville, Virginia 22908-0713, USA. sambecker6@gmail.com
de Alarcon
Alessandro
A
Bomeli
Steven R
SR
Han
Joseph K
JK
Gross
Charles W
CW
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000453:epidemiology*; D004724:Endoscopy; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012852:Sinusitis / Q000453:epidemiology* / Q000601:surgery*