Soler Zachary M, Jones Rabun, Le Phong, Rudmik Luke, Mattos Jose L, Nguyen Shaun A, Schlosser Rodney J
Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A.
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
Laryngoscope. 2018 Mar;128(3):581-592. doi: 10.1002/lary.27008. Epub 2017 Nov 22.
OBJECTIVES/HYPOTHESIS: The goal of the study was to perform a systematic review with meta-analysis to determine the mean change in the 22-item Sino-Nasal Outcome Test (SNOT-22) across patients who have had endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) in the literature.
A literature search was performed to identify studies that assessed SNOT-22 scores before and after ESS in adult patients with CRS. A random effects model with inverse variance weighting was used to generate the mean change after surgery, along with the forest plot and 95% confidence interval (CI). The impact of patient-specific factors across studies was assessed using a mixed-effects meta-regression.
The final study list included 40 unique patient cohorts published from 2008 to 2016. All studies showed a statistically significant change in mean SNOT-22 scores between baseline and postoperative time points (P < .001), ranging from 12.7 to 44.8, at an average follow-up of 10.6 months. The summary change in mean SNOT-22 across all studies was 24.4 (95% CI: 22.0-26.8). After forward, step-wise multivariate modeling, studies with higher mean preoperative SNOT-22 score and higher asthma prevalence were associated with greater changes in SNOT-22 score after ESS, whereas studies with longer mean follow-up had smaller changes in SNOT-22 score.
Studies evaluating quality-of-life outcomes after sinus surgery using the SNOT-22 instrument universally show significant improvement after ESS. Across the published literature, the magnitude of change is quite variable and appears to be influenced by a number of factors including baseline SNOT-22 score, asthma prevalence, and length of follow-up. Laryngoscope, 128:581-592, 2018.
目的/假设：本研究的目的是进行一项荟萃分析的系统评价，以确定文献中接受慢性鼻窦炎（CRS）内镜鼻窦手术（ESS）患者的22项鼻鼻窦结局测试（SNOT-22）的平均变化。
进行文献检索，以识别评估CRS成年患者ESS前后SNOT-22评分的研究。采用具有逆方差加权的随机效应模型来生成术后平均变化，以及森林图和95%置信区间（CI）。使用混合效应荟萃回归评估各研究中患者特异性因素的影响。
最终研究列表包括2008年至2016年发表的40个独特患者队列。所有研究均显示基线和术后时间点之间的平均SNOT-22评分有统计学显著变化（P <.001），范围为12.7至44.8，平均随访10.6个月。所有研究中SNOT-22的平均汇总变化为24.4（95% CI：22.0 - 26.8）。经过向前逐步多变量建模后，术前平均SNOT-22评分较高且哮喘患病率较高的研究与ESS后SNOT-22评分的更大变化相关，而平均随访时间较长的研究SNOT-22评分变化较小。
使用SNOT-22工具评估鼻窦手术后生活质量结局的研究普遍显示ESS后有显著改善。在已发表的文献中，变化幅度差异很大，似乎受多种因素影响，包括基线SNOT-22评分、哮喘患病率和随访时间。《喉镜》，2018年，第128卷：581 - 592页 。
