Evaluation of prognostic factors affecting the outcome in full house endoscopic sinus surgery in patients with chronic rhinosinusitis with nasal polyps

Background: Full-house endoscopic sinus surgery (FESS) is a well-established treatment for chronic rhinosinusitis (CRS) with nasal polyps unresponsive to medical management. However, complete eradication of this chronic condition remains impossible. The SNOT-22 (Sinonasal Outcome Test) is a commonly used patient-reported outcome measure in CRS. This study aims to identify and evaluate prognostic factors that may influence surgical outcomes in CRS patients, a subject not yet explored in Sri Lanka.
Methods: This cross-sectional study reviewed patients who underwent full-house endoscopic sinus surgery between January 2015 and September 2019 at Teaching Hospital Anuradhapura. Prognostic factors were assessed through preoperative and one-year postoperative SNOT-22 scores.
Results: A total of 53 patients were included, with 54.7% male and a mean age of 45.6 years. Of the cohort, 28.3% had prior polyp surgery, 24.5% had asthma, and 15.1% had diabetes mellitus. Preop mean Lund-Mackay scores for patients with a good surgical response was 16.03, compared to 16.65 for those with a poor response. Patients with prior polyp surgery had a significantly poorer outcome, with only 21% showing improvement post-surgery (p = 0.006). In contrast, 79% of patients without previous polyp surgery had favourable outcomes. Asthma (p = 0.211) and NSAID allergy (p = 0.186) did not significantly affect surgical outcomes, though these factors showed trends toward less favourable results.
Conclusion: A history of prior polyp surgery was the only statistically significant prognostic factor for poor surgical outcomes in this cohort. Although asthma, NSAID allergy, diabetes(with preoperative steroid non-use) , high preoperative SNOT-22, and Preop Lund-Mackay scores were associated with less favourable outcomes, these factors were not statistically significant.