title: Outcomes of complete vs targeted approaches to endoscopic sinus surgery.
abstract: BACKGROUND
  Functional endoscopic sinus surgery (FESS) was historically predicated on targeted widening of narrow anatomic structures that caused postobstructive persistent sinus inflammation. It is now clear that chronic rhinosinusitis (CRS) is a multifactorial disease with subsets of patients which may require a more extensive surgical approach. This study compares quality-of-life (QOL) and disease severity outcomes after FESS based on the extent of surgical intervention.
  
  
  METHODS
  Participants with CRS were prospectively enrolled into an ongoing, multi-institutional, observational, cohort study. Surgical extent was determined by physician discretion. Participants undergoing bilateral frontal sinusotomy, ethmoidectomy, maxillary antrostomy, and sphenoidotomy were considered to have undergone "complete" surgery, whereas all other participants were categorized as receiving "targeted" surgery. Improvement was evaluated between surgical subgroups with at least 6-month follow-up using the 22-item Sino-Nasal Outcome Test (SNOT-22) and the Brief Smell Inventory Test (B-SIT).
  
  
  RESULTS
  A total of 311 participants met inclusion criteria with 147 subjects undergoing complete surgery and 164 targeted surgery. A higher prevalence of asthma, acetylsalicylic acid (ASA) sensitivity, nasal polyposis, and a history of prior sinus surgery (p ≤ 0.002) was present in participants undergoing complete surgery. Mean improvement in SNOT-22 (28.1 ± 21.9 vs 21.9 ± 20.6; p = 0.011) and B-SIT (0.8 ± 3.1 vs 0.2 ± 2.4; p = 0.005) was greater in subjects undergoing complete surgery. Regression models demonstrated a 5.9 ± 2.5 greater relative mean improvement on SNOT-22 total scores with complete surgery over targeted approaches (p = 0.016).
  
  
  CONCLUSIONS
  Complete surgery was an independent predictor of greater postoperative SNOT-22 score improvement, yet did not achieve clinical significance. Further study is needed to determine the optimal surgical extent.
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California, San Diego, San Diego, CA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: DeConde
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Suh
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, Oregon Health and Science University, Portland, OR.
authors.forename: Jess C
authors.initials: JC
authors.lastname: Mace
authors.affiliation: Division of Head and Neck Surgery, Rhinology-Sinus and Skull Base Surgery Program, Department of Surgery, University of Utah, Salt Lake City, UT.
authors.forename: Jeremiah A
authors.initials: JA
authors.lastname: Alt
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, Oregon Health and Science University, Portland, OR.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Smith
mesh_terms: D001241:Aspirin / Q000009:adverse effects; D001249:Asthma / Q000150:complications; D002908:Chronic Disease; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000150:complications; D011182:Postoperative Care; D011446:Prospective Studies; D011788:Quality of Life; D012044:Regression Analysis; D012220:Rhinitis / Q000150:complications / Q000601:surgery*; D012852:Sinusitis / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D001241:Aspirin
keywords: diagnosis; endoscopy; quality of life; sinusitis; therapy