den Heijer Marc C, van der Ven Merel M, Joustra Gonneke E, Vermeulen Karin M, Feijen Robert A, Korsten-Meijer Astrid G W
Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Graduate School of Medical Sciences, University of Groningen, Groningen, the Netherlands.
Clin Otolaryngol. 2025 Sep;50(5):856-863. doi: 10.1111/coa.14331. Epub 2025 May 4.
Functional endoscopic sinus surgery (FESS) has been shown to be effective in improving health-related quality of life (HRQoL) in patients with chronic rhinosinusitis with nasal polyps (CRSwNP), though patient selection remains crucial for optimising outcomes. This study aimed to identify predictors of improved postoperative HRQoL and predictors of revision surgery in CRSwNP patients undergoing FESS.
Cohort study.
Tertiary referral hospital.
A total of 153 patients were enrolled in this study. They were asked to fill out the Endonasal Endoscopic Sinus and Skull Base Surgery Questionnaire (EES-Q) preoperatively, and then at 2 weeks, 3 months and 1 year postoperatively.
Linear mixed model (LMM) analyses were performed to evaluate the overall postoperative HRQoL and the separate health domains, as well as the impact of specific variables (sex, age, ASA classification, smoking, asthma, aspirin-exacerbated respiratory disease, allergic rhinitis, Lund-Mackay score, surgical procedure, postoperative antibiotics, postoperative prednisolone, FESS history, eosinophilia and preoperative EES-Q score) on HRQoL improvement. Using the same variables, a logistic regression analysis was performed to identify predictors of revision surgery.
The total EES-Q score (p < 0.001), as well as the physical (p < 0.001) and social (p < 0.001) domains, significantly improved postoperatively. In the LMM analysis, the preoperative EES-Q score was the only significant variable on the postoperative HRQoL outcome (p < 0.001). Eosinophilia was the only significant variable on revision surgery (p = 0.036).
FESS significantly improved postoperative HRQoL. Patients reporting worse preoperative HRQoL showed the greatest improvement postoperatively. Proven eosinophilia was the only significant predictor of revision surgery.
功能性鼻内镜鼻窦手术（FESS）已被证明能有效改善慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）患者的健康相关生活质量（HRQoL），不过患者选择对于优化手术效果仍然至关重要。本研究旨在确定接受FESS的CRSwNP患者术后HRQoL改善的预测因素以及再次手术的预测因素。
队列研究。
三级转诊医院。
本研究共纳入153例患者。要求他们在术前、术后2周、3个月和1年填写鼻内镜鼻窦和颅底手术问卷（EES-Q）。
采用线性混合模型（LMM）分析来评估术后总体HRQoL和各个健康领域，以及特定变量（性别、年龄、美国麻醉医师协会（ASA）分级、吸烟、哮喘、阿司匹林诱发的呼吸道疾病、变应性鼻炎、Lund-Mackay评分、手术方式、术后抗生素、术后泼尼松龙、FESS病史、嗜酸性粒细胞增多和术前EES-Q评分）对HRQoL改善的影响。使用相同变量进行逻辑回归分析，以确定再次手术的预测因素。
术后EES-Q总分（p < 0.001）以及身体（p < 0.001）和社会（p < 0.001）领域均有显著改善。在LMM分析中，术前EES-Q评分是术后HRQoL结果的唯一显著变量（p < 0.001）。嗜酸性粒细胞增多是再次手术的唯一显著变量（p = 0.036）。
FESS显著改善了术后HRQoL。术前HRQoL较差的患者术后改善最大。已证实的嗜酸性粒细胞增多是再次手术的唯一显著预测因素。
