Guy’s and St Thomas’ NHS Foundation Trust, London, UK.
Royal National Throat, Nose and Ear Hospital, UCLH Foundation Trust, London, UK.
Rhinology. 2021 Jun 1;59(3):277-283. doi: 10.4193/Rhin21.017.
When considering the introduction of biological treatments for Chronic Rhinosinusitis with nasal polyps (CRSwNP), treatment guidelines must consider not only which patients will best respond to biologicals, but also which patients derive least benefit from current treatment pathways. Using data collected as part of the National Audit of Surgery for Chronic Rhinosinusitis and Nasal Polyps, we sought to evaluate if patients with a history of prior surgery are more likely to need a further revision operation, and whether the interval between surgery may help predict the need for further surgical intervention.
In the original study, patients were prospectively and consecutively enrolled at the time of sinus surgery in multiple centres in England and Wales. Follow-up captured symptomatic outcomes and revision surgery rates at 3, 12, 36 and 60 months after surgery. Revision surgery rates 5 years after the index procedure, in patients with CRSwNP were analysed with regards to baseline demographics.
Complete data were available for 980 subjects, with a 5 year revision rate of 15.1%. 45.9% had a history of previous surgery before the index procedure, and this group had significantly higher rates of additional surgery compared with those undergoing their first sinus surgery (20.2% versus 9.8%). Patients with an interval of 3 years or less between their previous surgery and the index procedure had the highest rates of further surgery. In a multiple regression, time interval between previous operations was a better prediction of subsequent revision surgery than asthma. Having N-ERD was the strongest predicator of need for further surgery while more extensive surgery was associated with lower revision rates.
Patients presenting with a symptomatic recurrence within 3 years of surgery have a high risk of treatment failure, defined as the need for further surgery. Time to failure after previous surgery may be used to help select patients who may not benefit from current treatment pathways and may be good candidates for alternative strategies, including biologicals.
在考虑为慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）患者引入生物疗法时，治疗指南不仅必须考虑哪些患者对生物制剂的反应最好，还要考虑哪些患者从当前治疗途径中获益最小。我们利用作为英国全国慢性鼻-鼻窦炎和鼻息肉手术审计一部分所收集的数据，评估既往手术史的患者是否更有可能需要进一步的修正手术，以及手术间隔时间是否有助于预测进一步手术干预的需求。
在原始研究中，患者在英格兰和威尔士的多个中心进行鼻窦手术时前瞻性地连续入组。在术后 3、12、36 和 60 个月时，通过随访获取症状结果和修正手术率。分析了 CRSwNP 患者索引手术后 5 年的修正手术率与基线人口统计学数据的关系。
共纳入 980 例患者，5 年修正率为 15.1%。45.9%的患者在索引手术前有过既往手术史，与首次鼻窦手术相比，这组患者有更高的额外手术率（20.2%比 9.8%）。在索引手术前 3 年内进行的手术患者有更高的再次手术率。在多元回归中，两次手术之间的时间间隔是后续修正手术的更好预测因素，而哮喘则不是。非变应性鼻炎伴鼻后滴注（N-ERD）是进一步手术的最强预测因素，而更广泛的手术与较低的修正率相关。
在手术 3 年内出现症状复发的患者有很高的治疗失败风险，定义为需要进一步手术。既往手术的失败时间可能用于帮助选择可能无法从当前治疗途径中获益的患者，并且可能是替代策略（包括生物疗法）的良好候选者。
