2018 Section 5 - Rhinology and Allergic Disorders

TABLE I. Baseline Characteristics

Total, n 5 61,339

No Revision, N 5 57,261

Revision, N 5 4,078

Parameter

OR (95% CI)

P Value

Nasal polyps, no. (%) Age, yr, mean 6 SD Female sex, no. (%) Ethnicity, no. (%) White

19,093 (31.1)

17,703 (30.9)

1,390 (34.1)

1.16 (1.08-1.24)

< .001*

49.21 6 14.77

49.20 6 14.81

49.35 6 14.20

.512

28,310 (46.2)

26,259 (45.9)

2,051 (50.3)

1.19 (1.12-1.27)

< .001*

38,863 (63.4)

36,260 (63.3)

2,603 (63.8)

1.02 (0.96-1.09)

.517 .267

1.13 (0.91 5 1.39)

Black

1,310 (2.1)

1,213 (2.1)

97 (2.4)

Hispanic

6,289 (10.3)

5,917 (10.3)

372 (9.1)

0.87 (0.78-0.97)

.014*

Asian

3,002 (4.9)

2,820 (4.9)

182 (4.5)

0.90 (0.77-1.05)

.187 .174

Native American

26 (.04)

26 (.05)

0

NA

Other

11,849 (19.3)

11,025 (19.3)

824 (20.2)

1.06 (0.98-1.15)

.137

Insurance, no. (%) Public

12,696 (20.7)

11,841 (20.7)

855 (21.0)

1.02 (0.94-1.10)

.662

Private

46,609 (76.0)

43,545 (76.0)

3,064 (75.1)

0.95 (0.88-1.02)

.188

Income, no. (%) First quartile

9,431 (15.4)

8,828 (15.4)

603 (14.8)

0.95 (0.87-1.04)

.281

Second quartile

13,665 (22.3)

12,797 (22.4)

868 (21.3)

0.94 (0.87-1.02)

.115

Third quartile

16,235 (26.5) 20,791 (33.9)

15,115 (26.4) 19,385 (33.9)

1,120 (27.5) 1,406 (34.5)

1.06 (0.98-1.13) 1.03 (0.96-1.10)

.135 .416

Fourth quartile

Urban setting

55,979 (91.3)

52,221 (91.2)

3,758 (92.1)

1.13 (1.01-1.28)

.037*

Patient data are split by those who underwent revision surgery versus those who did not. Data are presented as the number of patients and percentage of total (i.e., 30.92% of patients who did not have revision surgery had nasal polyps). A t test was performed for age. All other analyses are logistic regression yielding odds ratios with 95% confidence intervals. *Significant differences ( P < .05). CI 5 confidence interval; NA 5 not applicable; OR 5 odds ratio; SD 5 standard deviation.

polyps (log-rank P < .001). Overall actuarial survival rate at 5 years for males was 93.0% versus 90.7% for females (log-rank P < .001). For all non-Hispanic patients, the 5-

year survival was 91.4% versus 91.6% for Hispanics (log- rank P 5 .245). A Cox proportional hazards model (Table III) was performed to determine predictive variables. Variables included were the same for the multivariable model described previously, except age was excluded as it had a varying hazard ratio over time. The presence of nasal polyps was predictive of revision surgery (hazards ratio [HR]: 1.19, 95% CI: 1.11-1.27, P < .001), as was female gender (HR: 1.24, 95% CI: 1.16-1.32, P < .001) and public insurance (HR: 1.10, 95% CI: 1.03-1.19, P 5 .008). His- panic ethnicity was not predictive, and no other covari- ates were significantly predictive. Women accounted for 48.0% of the total cohort but accounted for only 38.4% of patients with CRSwNP ver- sus 52.4% of those with CRS without nasal polyps CRSsNP ( P < .001). Among patients with CRSwNP, women accounted for 44.9% of patients who had a revi- sion surgery versus 37.9% of those who did not require revision ( P < .001). Among patients with CRSsNP, women accounted for 56.4% of patients who had a revi- sion surgery versus 52.1% of those who did not require revision ( P < .001). DISCUSSION The present study investigated the rate of revision surgery after endoscopic sinus surgery for CRS in the largest dataset published to date. These data reveal an overall revision rate of 6.65% and build on smaller cohort data, 6,7,9–11 reinforcing the association of revision

TABLE II. Multivariable Logistic Regression Showing Predictors of Revision Surgery

b (Standard Error)

Predictor

OR (95% CI)

P Value

Nasal polyps

0.18 (0.04)

1.2 (1.11-1.29)

< .001*

Age, yr

0.00004 (0.001)

1.0 (0.99-1.00)

.977

Female sex

0.18 (0.04)

1.20 (1.11-1.29) < .001*

Income

1st quartile

Reference

Reference

2 0.05 (0.06)

2nd quartile income

0.95 (0.84-1.07) 1.05 (0.94-1.18)

.390 .369

3rd quartile income 0.05 (0.06)

4th quartile income 0.03 (0.06)

1.03 (0.92-1.15)

.641

Public insurance

0.09 (0.05) 0.11 (0.08)

1.10 (1.00-1.21) 1.12 (0.96-1.30)

.048*

Urban setting

.136

Race

White

Reference

Reference

Black

0.06 (0.11)

1.07 (0.86-1.32)

.558

2 0.15 (0.06) 2 0.15 (0.08) 2 0.11 (0.01) 2 0.14 (0.12)

Hispanic

0.86 (0.77-0.97)

.011*

Asian/Pacific

0.86 (0.74-1.01)

.070 .917

Native American

NA

Other ethnicity

0.87 (0.70-1.09)

.236

*Significant differences ( P < .05). CI 5 confidence interval; NA 5 not applicable; OR 5 odds ratio.

Stein et al.: Revision Rates Following ESS

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