Department of Head and Neck Surgery, University of California Los Angeles, Los Angeles, CA.
Int Forum Allergy Rhinol. 2018 Jan;8(1):32-40. doi: 10.1002/alr.22034. Epub 2017 Oct 30.
Functional endoscopic sinus surgery (FESS) is an effective treatment for chronic rhinosinusitis (CRS). Postoperative management strategies after FESS often vary from surgeon to surgeon. Recent data suggests that nasal saline irrigation following FESS is almost universally recommended; however, patient adherence has not been formally evaluated. The purpose of this study is to evaluate postoperative nasal irrigation practices and its effects on short-term outcomes in post-FESS patients.
Eighty-two patients were followed prospectively following FESS at a tertiary-academic medical institution for 3 postoperative visits. Patients were surveyed on their irrigation practices (start date, frequency, and volume per irrigation per side), and adherence to prescribed antibiotic and steroid regimens. At each visit, 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaires and endoscopic examinations were evaluated by the Lund-Kennedy Endoscopy Score (LKES). Factors evaluated include: patient demographics (age, sex, ethnicity), preoperative Lund-Mackay and SNOT-22 scores, comorbidities, extent of procedure, and use of nasal packing and/or spacers.
Adherence to irrigation instructions was 82.9%. Factors significantly associated with compliance with irrigation instructions included younger age (p = 0.0022), prior irrigation (p < 0.0001), revision surgery (p = 0.0014), and non-native English language speaking (p = 0.0095). Patients were more likely to irrigate with larger volumes if they were younger (p = 0.0284), had prior irrigation (p < 0.0001), or had revision surgery (p = 0.0056).
Multiple factors are associated with patient compliance with nasal saline irrigation after FESS. Ethnic and cultural considerations, such as language barriers, should also be considered to improve outcomes. Identification of patients who may be noncompliant could potentially benefit from increased preoperative counseling to improve adherence rates.
功能性内镜鼻窦手术（FESS）是治疗慢性鼻-鼻窦炎（CRS）的有效方法。FESS 后的术后管理策略因外科医生而异。最近的数据表明，FESS 后进行鼻腔盐水冲洗几乎是普遍推荐的；然而，尚未对患者的依从性进行正式评估。本研究的目的是评估 FESS 后患者的鼻腔冲洗实践及其对短期结局的影响。
在一家三级学术医疗机构对 82 例 FESS 后患者进行前瞻性随访，共进行了 3 次术后访视。患者接受了关于其冲洗实践（开始日期、频率和每侧每次冲洗的体积）以及对处方抗生素和类固醇方案的依从性的调查。在每次就诊时，通过 22 项鼻-鼻窦结局测试（SNOT-22）问卷和 Lund-Kennedy 内镜评分（LKES）评估鼻内镜检查。评估的因素包括：患者人口统计学特征（年龄、性别、种族）、术前 Lund-Mackay 和 SNOT-22 评分、合并症、手术范围以及鼻腔填塞和/或隔离器的使用。
对冲洗说明的依从率为 82.9%。与遵循冲洗说明显著相关的因素包括年龄较小（p = 0.0022）、既往冲洗（p < 0.0001）、翻修手术（p = 0.0014）和非母语为英语（p = 0.0095）。如果患者年龄较小（p = 0.0284）、有既往冲洗史（p < 0.0001）或接受翻修手术（p = 0.0056），则更有可能使用较大的冲洗量。
多种因素与 FESS 后患者对鼻腔盐水冲洗的依从性相关。还应考虑种族和文化因素，例如语言障碍，以改善结局。识别可能不依从的患者可能会受益于增加术前咨询，以提高依从率。
