Does time from previous surgery predict subsequent treatment failure in Chronic Rhinosinusitis with Nasal Polyps?

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.