The Completeness of Surgery Index Predicts Success in CRSwNP With Asthma by SNOT-22 and Asthma Control Test

More extensive endoscopic sinus surgery (ESS) has been shown to correlate with better disease control for chronic rhinosinusitis with nasal polyps (CRSwNP). The Completion of Surgery Index (CoSI) is a recently developed radiologic scoring system that assesses the extent of surgery, where CoSI <70 (previous incomplete surgery) correlated with greater sino-nasal outcome test (SNOT-22) improvement after revision surgery. However, the benefit of complete surgery on asthma outcomes has not been defined. Here, we evaluated the impact of CoSI on SNOT-22 and Asthma Control Test (ACT) improvements after surgery in CRSwNP with asthma.

CRSwNP patients with asthma who underwent ESS between January 2018 and December 2023 were identified. Subjects were placed into two groups based on the preoperative CT scans: CoSI <70 (previous incomplete surgery) and CoSI 70 or greater (previous complete surgery). SNOT-22 and ACT data were collected at baseline and over 2 years postoperatively.

Seventy CRSwNP patients with comorbid asthma underwent revision surgery, of which 49 (70.0%) patients had a preoperative CoSI <70. The CoSI <70 group had a greater average SNOT-22 improvement than the CoSI 70 or greater group from baseline to 2 years postoperatively (30.8 ± 20.5 vs. 20.4 ± 14.9, p = 0.042). In uncontrolled asthma, the average ACT improvement was significantly greater for the CoSI <70 group than the CoSI 70 or greater group (3.9 ± 2.2 vs. 0.88 ± 1.4, p = 0.029).

Preoperative CoSI <70 was associated with significantly greater long-term improvements in SNOT-22 and ACT after revision surgery than CoSI 70 or greater group, supporting the need for complete surgery in CRSwNP with asthma.