Revision rates and time to revision following endoscopic sinus surgery: a large database analysis

Objectives: Endoscopic sinus surgery (ESS) is performed for patients with chronic rhiosinusitis (CRS) that have failed maximal medical therapy. This study seeks to determine the prevalence of revision surgery and factors predicting the need for revision after ESS using a large statewide surgery database. Study design: Large retrospective cohort study using the State Ambulatory Surgery Database for the state of CA between 2005-2011. Methods: We identified over 61,000 patients with CRS who underwent ESS, determined by CPT code. We identified which patients underwent a repeat surgery, and performed multivariate modeling to determine which factors (nasal polyps, age, gender, insurance, hospital setting, ethnicity) predicted the need for revision. Adjusted odds ratios (AOR) and 95% confidence intervals are presented. Results: Of 61,339 patients who underwent ESS, 4,078 (6.65%) returned for revision ESS during the time period investigated. In a multivariate logistic regression model, positive predictors of revision were a diagnosis of nasal polyps (AOR 1.20, 95% CI 1.11-1.29, p<0.001) and female gender (AOR 1.20, 95% CI 1.11-1.29, p<0.001); public insurance was marginally predictive of increased re-operation (AOR 1.10, 95% CI 1.00-1.21, p=0.048). Patients of Hispanic ethnicity were less likely to have revision surgery (AOR 0.86, 95% CI 0.77-0.97, p=0.011). Age, income, and hospital setting were not significant predictors. Conclusions: A minority of patients with CRS who undergo ESS will have a revision surgery. This likelihood is increased in female patients and those with nasal polyps, and decreased in patients of Hispanic ethnicity, even when controlling for income, insurance, and hospital setting