title: Fatigue improvement following endoscopic sinus surgery: a systematic review and meta-analysis.
abstract: BACKGROUND
  Fatigue is a common symptom of chronic rhinosinusitis (CRS), yet the response of fatigue to endoscopic sinus surgery (ESS) has not been systematically evaluated.
  
  
  METHODS
  Studies published in any language were retrieved by searching MEDLINE, EMBASE, Web of Science, Cochrane databases, and additional Web-based sources (from 1980-2007); by examining bibliographies of retrieved articles; and by contacting investigators in the field. Studies consisting of more than 10 adult patients analyzing the response of fatigue, vitality, energy, or malaise following ESS were included. Two authors independently evaluated studies for inclusion, rated the methods, and summarized relevant data using a standardized protocol.
  
  
  RESULTS
  Using within-subject comparisons, 28 identified observational studies noted substantial improvement in fatigue after ESS. A subgroup analysis of 11 studies measuring outcomes using the 36-Item Short Form Health Survey (SF-36) demonstrated a moderate-sized combined effect of 0.47 (95% confidence interval, 0.38-0.56; I = 0%), corresponding to a mean +/- standard deviation improvement of 9.7 +/- 3.4 units on the SF-36 vitality domain scores. In studies measuring outcomes using symptom rating scores, the preoperative severity scores and improvement after surgery for fatigue were similar to the respective values for other pooled CRS symptoms.
  
  
  CONCLUSIONS
  All 28 studies described substantial improvement in fatigue following ESS based on presurgery and postsurgery comparisons. A subgroup analysis of 11 studies reporting results by the SF-36 vitality domain scores demonstrated a moderate-sized combined effect. Preoperative fatigue severity scores and improvement noted after surgery were similar to the respective values for other pooled CRS symptoms.
authors.affiliation: Department of Medicine, Georgetown University Hospital, Washington, DC, USA. achester@foxhallinternists.com
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Chester
authors.forename: Raj
authors.initials: R
authors.lastname: Sindwani
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Smith
authors.forename: Neil
authors.initials: N
authors.lastname: Bhattacharyya
mesh_terms: D000328:Adult; D002908:Chronic Disease; D019992:Databases as Topic; D004724:Endoscopy; D005221:Fatigue / Q000628:therapy*; D006801:Humans; D012220:Rhinitis / Q000601:surgery*; D012852:Sinusitis / Q000601:surgery*