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Management of CRSwNPs Surgically

Objectives: Long-term follow-up of 1045 patients with chronic rhinosinusitis with nasal polyposis (CRSwNPs) in the national Sinonasal Audit demonstrated that at 5 years 20.6% of patients had undergone revision surgery. The aim of this study was to see if the Chronic Rhinosinusitis Epidemiology Study (CRES) data reflected a continued burden of revision surgery in patients with CRSwNPs. Methods: A prospective questionnaire-based study at 30 sites around the UK of patients with CRS presenting to secondary care between October 2007 and September 2013. This paper presents a specific analysis of patients with CRS who reported undergoing sinus surgery. Results: A total of 651 patients with CRSwNPs, 553 with CRSsNPs, and 45 with AFRS were included in the CRES. 365 (57%) of patients with CRSwNPs/AFRS reported undergoing endoscopic nasal polypectomy (ENP) in which 175 (25% or 48% of surgical cases) reported having received more than one ENP. The mean number of ENPs per patient in the revision group was 3.3 with a range of 2 to 30. Only 27.9% of patients reported concurrent endoscopic sinus surgery (n = 102). For comparison, patients with CRSsNPs reported ESS in 13% of cases with only 17% of those surgical cases reporting multiple procedures (chi-squared P < .001). Conclusions: This study demonstrated a significantly higher burden of both primary and revision surgery to the health care system for patients with CRSwNPs. Extrapolation of these findings to the HES data for 2011 and 2012 would suggest a bill of approximately £5.3 million per year spent on revision surgery.