Long-Term Risk of Revision Surgery Following Balloon Sinuplasty Versus Endoscopic Sinus Surgery

We aimed to compare revision surgery risk and postoperative healthcare utilization between patients with chronic rhinosinusitis (CRS) who undergo balloon sinuplasty (BSP) versus endoscopic sinus surgery (ESS).

Using the TriNetX US database, patients 18 years or older with CRS were retrospectively followed for five years, excluding those with a history of cystic fibrosis or sinonasal malignancy. The cohort was stratified into patients who underwent BSP versus ESS, and subsequently propensity score matched by age, sex, race, ethnicity, history of asthma, allergic rhinitis, nicotine dependence, and nasal polyposis. The primary outcome was revision ESS or BSP. Secondary outcomes included postoperative oral antibiotic and steroid utilization.

Of the 4,632 patients included, 26.0% had nasal polyps. Within five years of initial surgery, 215 (9.70%) BSP patients underwent either revision BSP or ESS compared to 160 (7.22%) patients with initial ESS (p=0.0004). Initial BSP was associated with a greater risk of undergoing revision BSP at one year [OR 2.70; 95%CI (1.49,4.90)], three years [OR 2.41; 95%CI (1.49,3.90)], and five years [OR 3.02; 95%CI (1.87,4.86)] postoperatively. Notably, after one year of initial surgery, there was no difference in postoperative antibiotic or steroid utilization between patients who underwent ESS or BSP.

Patients with CRS who undergo BSP are at a greater five-year-risk for revision ESS or BSP, as compared to patients who undergo ESS. However, long-term postoperative healthcare utilization does not vary significantly between patients who undergo either procedure.