芬兰慢性鼻-鼻窦炎伴鼻息肉患者再次内镜鼻窦手术的预测因素
Predictors of revision endoscopic sinus surgery in Finnish patients with chronic rhinosinusitis with nasal polyps.
作者信息
Toppila-Salmi Sanna, Lyly Annina, Simin Johanna, Aakko Juhani, Olsen Helga Haugom, Lehtimäki Lauri
机构信息
Department of Otorhinolaryngology, University of Eastern Finland, Kuopio, Finland.
Department of Otorhinolaryngology, Wellbeing Services County of Pohjois-Savo, Kuopio, Finland.
出版信息
Clin Transl Allergy. 2025 Feb;15(2):e70032. doi: 10.1002/clt2.70032.
BACKGROUND
Although patients with chronic rhinosinusitis with nasal polyps (CRSwNP) may benefit from endoscopic sinus surgery (ESS), some patients will experience polyp recurrence, adding to the overall disease burden of CRSwNP. We aimed to investigate predictors of revision ESS in patients with CRSwNP.
METHODS
A nationwide population-based study including all adults diagnosed with CRSwNP who had surgical procedure codes for ESS (N = 3506), followed up between January 2012 and December 2019. Logistic regression models provided adjusted odds ratios (OR) with 95% confidence intervals (CIs) for the odds of revision surgery within one and 3 years post-index surgery.
RESULTS
559 (15.9%) of the patients had at least one revision surgery during the follow-up. Median time to revision of ESS was 425 days (interquartile range: 213-898). Baseline asthma (OR = 1.58, 95% CI 1.17-2.12) and antibiotic use (OR = 1.61, 95% CI 1.27-2.04) were associated with higher odds of revision ESS, particularly within 3 years post-index surgery, whereas Increasing age was inversely associated with the odds of ESS revision (OR = 0.82, 95% CI 0.76-0.88). The highest odds of revision ESS were observed within 3 years post-index surgery in patients who had undergone extensive surgery at index (OR = 14.13, 95% CI 3.41-95.64) compared with those who had undergone limited surgery. OCS use was frequent among CRSwNP patients, with a higher cumulative dose in patients undergoing multiple ESS revisions (63%, n = 97, median daily dose 3.29 mg, IQR: 1.64-3.70) compared with patients without revisions (49%, n = 1361 and 1.64 mg, IQR: 1.64-3.29, respectively. p-value <0.001).
CONCLUSIONS
A small proportion of CRSwNP patients require revision ESS with associated high cumulative OCS doses, highlighting the need for additional therapies to achieve disease control and reduce the corticosteroid burden. A few simple baseline characteristics can predict the need for recurrent surgery among the patients with CRSwNP.
背景
尽管伴有鼻息肉的慢性鼻-鼻窦炎（CRSwNP）患者可能从鼻内镜鼻窦手术（ESS）中获益，但部分患者会出现息肉复发，增加了CRSwNP的整体疾病负担。我们旨在研究CRSwNP患者再次行ESS的预测因素。
方法
一项基于全国人口的研究，纳入所有诊断为CRSwNP且有ESS手术操作编码的成年人（N = 3506），随访时间为2012年1月至2019年12月。逻辑回归模型提供了索引手术后1年和3年内再次手术几率的调整比值比（OR）及95%置信区间（CI）。
结果
559例（15.9%）患者在随访期间至少接受了一次再次手术。ESS再次手术的中位时间为425天（四分位间距：213 - 898天）。基线哮喘（OR = 1.58，95% CI 1.17 - 2.12）和使用抗生素（OR = 1.61，95% CI 1.27 - 2.04）与再次行ESS的几率较高相关，尤其是在索引手术后3年内，而年龄增加与ESS再次手术的几率呈负相关（OR = 0.82，95% CI 0.76 - 0.88）。与接受有限手术的患者相比，索引手术时接受广泛手术的患者在索引手术后3年内再次行ESS的几率最高（OR = 14.13，95% CI 3.41 - 95.64）。CRSwNP患者中经常使用口服糖皮质激素（OCS），多次行ESS再次手术的患者累积剂量更高（63%，n = 97，每日中位剂量3.29 mg，IQR：1.64 - 3.70），而未再次手术的患者为49%（n = 1361，1.64 mg，IQR：1.64 - 3.29，p值<0.001）。
结论
一小部分CRSwNP患者需要再次行ESS，且累积OCS剂量较高，这凸显了需要额外的治疗来实现疾病控制并减轻皮质类固醇负担。一些简单的基线特征可以预测CRSwNP患者再次手术的需求。
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