Patients With CRSwNP, Comorbidities at Greater Risk for Revision Sinus Surgery

Incidence of comorbidities among patients with chronic rhinosinusitis with nasal polyps (CRSwNP) was associated with an increased risk of requiring revision endoscopic sinus surgery (ESS), as well as a greater cost to the health care system overall. Findings were published recently in Rhinology.

As a chronic inflammatory condition linked with significant morbidity and adverse quality of life, previous research shows CRSwNP burden to be more severe for certain cohorts of patients with comorbidities.

Specifically, more frequent use of systemic corticosteroids and recurrence of nasal polyps after surgery, which is already common in patients, have been cited in those with comorbidities such as asthma and nonsteroidal anti-inflammatory drug–exacerbated respiratory disease (NERD).

“Given the underlying immunological pathology of CRSwNP, the use of surgery to treat the condition, whilst improving quality of life, fails to treat the underlying cause of the nasal polyps themselves,” explained the study authors. “This results in high rates of polyp recurrence and subsequent revision surgeries, whilst also increasing burden on the UK health care system due to increased cost and resource utilization.”

They conducted a retrospective cohort study of patients registered in the Hospital Episode Statistics database to further evaluate and compare ESS revision rates and cost burden among patients with CRSwNP alone and those with comorbidities (asthma or asthma with NERD).

Participants were evaluated over a 10-year time period (April 2010-March 2020), in which resource use attributable to CRSwNP of the National Health Service in England was assessed for all patients who had undergone sinus surgery.

Among the cohort of 101,054 patients (mean age, 52.3 years; 67.8% male; 36.2% reported incidence of comorbidites), 85.6% (n = 86,527) were recorded as having undergone a single sinus surgery and 14.4% (n = 14,528) underwent 2 or more surgeries within the analytical time window.

For those who underwent at least 1 sinus surgery in relation to their nasal polyps, Kaplan Meier survival analysis estimated that the 10-year probability of revision was between 71% and 90% for comorbid patients and 51% for noncomorbid patients.

Regarding risk of revision ESS, patients with CRSwNP who had the relevant comorbidities were 2.4 times more likely to undergo at least 1 revision surgery during the 10-year analytical time window compared with those without comorbidity (P < .0001). Patients with asthma/NERD exhibited the highest likelihood of undergoing more than 1 surgery and were 4.7 times more likely to undergo multiple surgeries vs those without comorbidity (P < .0001).

Furthermore, comorbid patients had a higher tariff associated with their CRSwNP care across the analytical time window and were likely to be more costly to the health care system.

“This study demonstrates that there is a high burden attached to CRSwNP-related sinus surgery and that comorbidities are a key driver of NHS resource use,” concluded the study authors.

Reference

Hopkins C, Conlon S, Chavda S, Hudson R, Rout R. Investigating the secondary care system burden of CRSwNP in sinus surgery patients with clinically relevant comorbidities using the HES database. Rhinology. Published online March 1, 2022. doi:10.4193/Rhin21.264