The burden of revision sinonasal surgery in the UK-data from the Chronic Rhinosinusitis Epidemiology Study (CRES): a cross-sectional study.
OBJECTIVE
The aim of this study was to investigate the surgical revision rate in patients with chronic rhinosinusitis (CRS) in the UK CRS Epidemiology Study (CRES). Previous evidence from National Sinonasal Audit showed that 1459 patients with CRS demonstrated a surgical revision rate 19.1% at 5 years, with highest rates seen in those with polyps (20.6%).


METHODS
Thirty secondary care centres around the UK.


METHODS
A total of 221 controls and 1249 patients with CRS were recruited to the study including those with polyps (CRSwNPs), without polyps (CRSsNPs) and with allergic fungal rhinosinusitis (AFRS).


METHODS
Self-administered questionnaire.


METHODS
The need for previous sinonasal surgery.


RESULTS
A total of 651 patients with CRSwNPs, 553 with CRSsNPs and 45 with AFRS were included. A total of 396 (57%) patients with CRSwNPs/AFRS reported having undergone previous endoscopic nasal polypectomy (ENP), of which 182 of the 396 (46%) reported having received more than one operation. The mean number of previous surgeries per patient in the revision group was 3.3 (range 2-30) and a mean duration of time of 10 years since the last procedure. The average length of time since their first operation up to inclusion in the study was 15.5 years (range 0-74). Only 27.9% of all patients reporting a prior ENP had received concurrent endoscopic sinus surgery (ESS; n=102). For comparison, surgical rates in patients with CRSsNPs were significantly lower; 13% of cases specifically reported ESS, and of those only 30% reported multiple procedures (χ(2) p<0.001).


CONCLUSIONS
This study demonstrated that there is a high burden of both primary and revision surgery in patients with CRS, worst in those with AFRS and least in those with CRSsNPs. The burden of revision surgery appears unchanged in the decade since the Sinonasal Audit.
James Paget University Hospital NHS Foundation Trust, Gorleston, UK Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK Spire Norwich Hospital, Norwich, Norfolk, UK.
Carl
C
Philpott
Guys & St Thomas' Hospital, London, UK.
Claire
C
Hopkins
James Paget University Hospital NHS Foundation Trust, Gorleston, UK.
Sally
S
Erskine
Wrightington, Wigan & Leigh NHS Foundation Trust, Wigan, UK.
Nirmal
N
Kumar
Southern General Hospital, Glasgow, UK.
Alasdair
A
Robertson
Wrexham Maelor Hospital, Wales, UK.
Amir
A
Farboud
University Hospitals Birmingham, Birmingham, UK.
Shahzada
S
Ahmed
Heart of England NHS Foundation Trust, Birmingham, UK.
Shahram
S
Anari
Cumberland Infirmary, Carlisle, UK.
Russell
R
Cathcart
Derriford Hospital, Plymouth, UK.
Hisham
H
Khalil
Northampton General Hospital, Northampton, UK.
Paul
P
Jervis
Freeman Hospital, Newcastle, UK.
Sean
S
Carrie
Sunderland Royal Infirmary, Newcastle, UK.
Naveed
N
Kara
Norfolk & Norwich University Hospital, Norwich, UK.
Peter
P
Prinsley
Oxford University Hospitals, Oxford, UK.
Robert
R
Almeyda
Royal Berkshire NHS Foundation Trust, Reading, UK.
Nicolas
N
Mansell
Royal Surrey County Hospital, Guildford, UK.
Sankalp
S
Sunkaraneni
The Ipswich Hospital, Ipswich, UK.
Mahmoud
M
Salam
Sheffield Teaching Hospitals, Sheffield, UK.
Jaydip
J
Ray
Luton & Dunstable Hospital, Luton, UK.
Jaan
J
Panesaar
Warrington and Halton Hospitals NHS Foundation Trust, Warrington, UK.
Jonathan
J
Hobson
Guys & St Thomas' Hospital, London, UK.
Allan
A
Clark
Department of Applied Health Research, University College London, London, UK.
Steve
S
Morris
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000601:surgery; D013517:Otorhinolaryngologic Surgical Procedures / Q000706:statistics & numerical data*; D012086:Reoperation / Q000706:statistics & numerical data*; D012220:Rhinitis / Q000601:surgery*; D012852:Sinusitis / Q000601:surgery*; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D006113:United Kingdom; D055815:Young Adult