title: Revision rates after endoscopic sinus surgery: a recurrence analysis.
abstract: OBJECTIVE
  Chronic rhinosinusitis with nasal polyposis is often refractory to medical and surgical management, especially in patients with asthma and aspirin intolerance. We used a contemporary database to investigate recurrence and revision surgery rates following endoscopic sinus surgery.
  
  
  METHODS
  We performed a cohort study using a survival analysis technique. Records were reviewed of 549 patients with nasal polyposis who underwent endoscopic sinus surgery over a 10-year period. The main outcome measure was disease-free and surgery-free survival following endoscopic sinus surgery, investigated with Kaplan-Meier analyses.
  
  
  RESULTS
  Patients with Samter's triad were significantly more likely to have a recurrence and undergo a second surgery following recurrence (risk-odds ratio, 2.7; 95% confidence interval, 1.5 to 3.2; p < 0.01) than were patients without asthma or with only asthma from the triad. The presence of initial frontal sinus disease also increased the likelihood of revision surgery (risk-odds ratio, 1.6; 95% confidence interval, 1.2 to 1.8; p < 0.05).
  
  
  CONCLUSIONS
  This is the first study to use survival analysis to document revision surgery rates following endoscopic sinus surgery. Revision surgery occurs at a high rate, especially in patients with asthma, Samter's triad, or frontal sinus disease. Patients should routinely be informed during clinical consultations about the likelihood of recurrence. Early intervention for frontal sinus disease may be considered.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London.
authors.forename: Daniel
authors.initials: D
authors.lastname: Mendelsohn
authors.forename: Goran
authors.initials: G
authors.lastname: Jeremic
authors.forename: Erin D
authors.initials: ED
authors.lastname: Wright
authors.forename: Brian W
authors.initials: BW
authors.lastname: Rotenberg
mesh_terms: D016022:Case-Control Studies; D002908:Chronic Disease; D004724:Endoscopy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000601:surgery*; D010256:Paranasal Sinuses / Q000601:surgery*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D012220:Rhinitis / Q000601:surgery*; D012852:Sinusitis / Q000601:surgery*