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Tan CJW, Leow BHW, Tan BKJ, Tan SFJ, Teo NWY, Charn TC. Association Between Smoking and Chronic Rhinosinusitis: A Systematic Review and Meta-Analysis. Laryngoscope 2024; 134:2513-2524. [PMID: 38112394 DOI: 10.1002/lary.31223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/11/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE Chronic rhinosinusitis (CRS) is a prevalent inflammatory disease of the upper airway. The impact of smoking on CRS has not been clearly established. We aim to clarify the association between first-hand cigarette smoking and the prevalence and prognoses of CRS. REVIEW METHODS PubMed, Embase, SCOPUS, and Cochrane Library were searched from inception until May 15, 2022. Three blinded reviewers selected relevant studies, extracted data, and evaluated study bias following a PROSPERO-registered protocol (CRD42022345585). We used random-effects meta-analyses to pool the prevalence of smoking in CRS, association between smoking status and CRS, and association of smoking with quality of life (QOL) before and after functional endoscopic sinus surgery (FESS). We also performed descriptive analyses of olfactory function, CT scores, and endoscopy scores before and after FESS. RESULTS We included 23 cross-sectional studies, 19 cohort studies, two case-control studies, and one prospective clinical trial. The pooled prevalence of ever-smokers was 40% (95% CI = 0.30-0.51) and 33% (95% CI = 0.25-0.43) in patients with and without CRS. Compared to never-smokers, active smokers and past smokers had 1.35 (95% CI = 1.18-1.55) and 1.23 (95% CI = 1.17-1.29) higher odds of having CRS. Among patients with CRS, non-smokers reported higher initial QOL than smokers (standardized mean difference [SMD] = 0.23, 95% CI = 0.11-0.35), although post-FESS QOL was similar (SMD = 0.10, 95% CI = -0.30-0.51). Descriptive analysis found no significant correlations between smoking and post-FESS olfactory function and endoscopy scores. CONCLUSIONS Cigarette smoking is associated with higher prevalence and odds of CRS. Clinicians should be aware that smoking predisposes to CRS, but does not negatively impact the rhinologic outcomes of FESS. Laryngoscope, 134:2513-2524, 2024.
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Affiliation(s)
- Claire Jing-Wen Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Bryan Hao Wei Leow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Benjamin Kye Jyn Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sean Fong-Jun Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Neville Wei Yang Teo
- Department of Otorhinolaryngology-Head & Neck Surgery, Singapore General Hospital, Singapore, Singapore
- Surgery Academic Clinical Program, SingHealth, Singapore, Singapore
| | - Tze Choong Charn
- Department of Otorhinolaryngology-Head & Neck Surgery, Singapore General Hospital, Singapore, Singapore
- Departments of Otorhinolaryngology-Head & Neck Surgery, Sengkang General Hospital, Singapore, Singapore
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Rubel KE, Rodman CP, Jones A, Sharma D, Campiti V, Falls M, Bolujo I, Ting JY, Illing EA. The Effect of Diabetes Mellitus on Post-Operative Outcomes in Patients Undergoing Endoscopic Sinus Surgery. Ann Otol Rhinol Laryngol 2023; 132:317-321. [PMID: 35473357 DOI: 10.1177/00034894221091348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Diabetes Mellitus (DM) and its associated immune dysfunction are well-studied risk factors for adverse surgical outcomes. The literature regarding endoscopic sinus surgery (ESS) is less robust and there have been conflicting reports on post-operative complications and surgical results in this patient population. The purpose of this study was to analyze the impact of diabetes mellitus on outcomes after ESS via rates of post-operative medical intervention in the first 6 months after surgery. METHODS This was a retrospective cohort study of 176 subjects who underwent ESS from 2015 to 2019 at a single institution by 2 fellowship-trained rhinologists. Subjects were divided into 2 groups, those with a documented Hemoglobin A1c (HbA1c) >6.5 or diagnosis of DM and those with HbA1C < 6.5. Patient age, demographics, 6-month preoperative HbA1c, surgical status and extent, and 6-monthpostoperative need for steroids and/or antibiotics were collected. RESULTS Out of n = 176 total patients, n = 39 (22.2%) were categorized into the DM group, which were older (46.4 vs 53.8 years, P = .004) and higher proportion of white patients (89.7% vs 68.6%, P = .008). There were no significant differences between the 2 groups in proportion of revision surgery, surgical extent, and post-operative use of antibiotics or steroids. When including all variables in binary logistic regression for use of postoperative antibiotics or steroids, the only significant variable predicting these outcomes was the extent of surgical resection including sphenoid sinus (P = .001, OR [95% CI] = 4.02 [1.73-9.34]) or frontal sinus (P < .001, OR [95% CI = 9.86 [4.00-24.33]). CONCLUSIONS Patients with DM do not appear to have worse post-operative outcomes outside of the initial 6-month postoperative period.
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Affiliation(s)
- Kolin E Rubel
- Department of Otolaryngology - Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | - Cole P Rodman
- Department of Otolaryngology - Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | - Alex Jones
- Department of Otolaryngology - Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | - Dhruv Sharma
- Department of Otolaryngology - Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | - Vince Campiti
- Department of Otolaryngology - Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | - Megan Falls
- Department of Otolaryngology - Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | - Ife Bolujo
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jonathan Y Ting
- Department of Otolaryngology - Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | - Elisa A Illing
- Department of Otolaryngology - Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
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Singh P, Debbaneh P, Rivero A. Racial Disparities in Tympanoplasty Surgery: A 30-Day Morbidity and Mortality National Cohort Study. Otol Neurotol 2022; 43:e1129-e1135. [PMID: 36351227 DOI: 10.1097/mao.0000000000003737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To assess the impact of race and ethnicity on 30-day complications after tympanoplasty surgery. METHODS The National Surgical Quality Improvement Program database was queried for tympanoplasty procedures from 2005 to 2019. Demographic, comorbidity, and postoperative complication data were compared according to race using univariate and binary logistic regression analyses. RESULTS A total of 11,701 patients were included, consisting of 80.3% White, 3.0% Black, 7.7% Asian, 5.7% Hispanic, 2.5% American Indian/Alaska Native, and 0.8% other. Binary logistic regression model indicated that Black patients had increased odds of unplanned readmittance (p = 0.033; odds ratio [OR], 3.110) and deep surgical site infections (p = 0.008; OR, 6.292). American Indian/Alaska Native patients had increased odds of reoperation (p = 0.022; OR, 6.343), superficial surgical site infections (p < 0.001; OR, 5.503), urinary tract infections (p < 0.001; OR, 18.559), surgical complications (p < 0.001; OR, 3.820), medical complications (p = 0.001; OR, 10.126), and overall complications (p < 0.001; OR, 4.545). CONCLUSION Although Black and American Indian/Alaskan Native patients were more likely to have complications after tympanoplasty surgery after adjusting for comorbidities, age, and sex, these results are tempered by an overall low rate of complications. Future studies should be devoted to understanding the drivers of these health inequities in access to otologic care and surgical treatment to improve outcomes and achieve equitable care.
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Affiliation(s)
- Priyanka Singh
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Peter Debbaneh
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente, Oakland, California
| | - Alexander Rivero
- Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente, Oakland, California
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Huang RJ, Teitelbaum JI, Issa K, Truong T, Kim H, Kuchibhatla M, Hachem RA, Goldstein BJ, Jang DW. Endoscopic Sinus Surgery in Older Patients With Significant Medical Comorbidities. Am J Rhinol Allergy 2022; 36:661-667. [PMID: 35578407 DOI: 10.1177/19458924221101438] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Endoscopic sinus surgery (ESS) offers excellent outcomes for patients with chronic rhinosinusitis (CRS) in the general population. It is unclear whether older patients with significant medical comorbidities experience similar benefits. OBJECTIVE The purpose of this study is to evaluate whether increasing medical comorbidity is associated with worse sinonasal quality of life outcomes after ESS in older patients. METHODS This is a retrospective study of CRS patients 55 years or older who underwent elective ESS at an academic institution from July 2017 to June 2019. 22-Item Sino-Nasal Outcomes Test (SNOT-22) scores were gathered at baseline as well as at 3 and 6 months following surgery. Data on demographics, medical comorbidities, preoperative Lund-Mackay (LM) scores, and postoperative complications were extracted from the medical record. The Charlson Comorbidity Index (CCI) was calculated for each patient. Multivariate linear regression was used to evaluate a potential association between CCI and change in SNOT-22 scores at 3 months postoperatively. RESULTS A total of 205 patients met inclusion criteria with a mean (SD) CCI score of 2 (2.4) and a CCI score range of 0 to 11. The mean (SD) LM score was 8 (5.3). Rates of asthma and nasal polyposis were 28.3% and 36.6%, respectively. The mean (SD) improvement in SNOT-22 scores at 3 and 6 months compared to baseline was 17.9 (19.7) and 20.9 (18.1) points, respectively. After adjusting for covariates, there was no significant association between CCI and change in SNOT-22 scores. CONCLUSION Greater medical comorbidity is not associated with worse SNOT-22 outcomes postoperatively, although future studies are needed to determine if comorbidities are associated with higher complication rates. A multidisciplinary approach to perioperative care is critical in maintaining the safety and efficacy of ESS in this patient population.
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Affiliation(s)
- Ryan J Huang
- Division of Rhinology & Endoscopic Skull Base Surgery, Department of Head and Neck Surgery & Communication Sciences, 22957Duke University Health System, Durham, NC
| | - Jordan I Teitelbaum
- Division of Rhinology & Endoscopic Skull Base Surgery, Department of Head and Neck Surgery & Communication Sciences, 22957Duke University Health System, Durham, NC
| | - Khalil Issa
- Division of Rhinology & Endoscopic Skull Base Surgery, Department of Head and Neck Surgery & Communication Sciences, 22957Duke University Health System, Durham, NC
| | - Tracy Truong
- Department of Biostatistics and Bioinformatics, 22957Duke University, Durham, NC
| | - Heewon Kim
- Department of Biostatistics and Bioinformatics, 22957Duke University, Durham, NC
| | | | - Ralph Abi Hachem
- Division of Rhinology & Endoscopic Skull Base Surgery, Department of Head and Neck Surgery & Communication Sciences, 22957Duke University Health System, Durham, NC
| | - Bradley J Goldstein
- Division of Rhinology & Endoscopic Skull Base Surgery, Department of Head and Neck Surgery & Communication Sciences, 22957Duke University Health System, Durham, NC
| | - David W Jang
- Division of Rhinology & Endoscopic Skull Base Surgery, Department of Head and Neck Surgery & Communication Sciences, 22957Duke University Health System, Durham, NC
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Sharma RK, Dodhia S, Golub JS, Overdevest JB, Gudis DA. Gender as a Predictor of Complications in Endoscopic Sinus Surgery. Ann Otol Rhinol Laryngol 2021; 130:892-898. [PMID: 33412907 DOI: 10.1177/0003489420987418] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Understanding patient-specific risk factors for complications of functional endoscopic sinus surgery (ESS) is critical. Previous work has investigated such risk factors, but a population-based analysis has not been performed to date. OBJECTIVES This study analyzes the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database to identify patient-specific risk factors associated with complications following ESS. METHODS A retrospective cohort study of patients who underwent ESS was conducted using the NSQIP database from 2011 to 2017. Patients were identified using CPT-codes for ESS procedures. The primary outcome analyzed was any postoperative complication. Simultaneous procedures with ESS were controlled for with regression analysis. Post-operative complications and 30-day readmission were evaluated using multivariate logistic regression controlling for age, gender, race, comorbidities (diabetes mellitus, hypertension, chronic obstructive pulmonary disease, congestive heart failure, renal failure, steroid use, and cancer history), smoking history, and intraoperative factors. RESULTS A total of 1279 patients who underwent ESS were identified. The average age of patients was 46.1 (SD = 16.8). Most patients (58.2%) had no major comorbidities. 594 (46.4%) patients had a tonsillectomy, adenoidectomy, or uvulopharyngoplasty at the same time as ESS. 101 (7.9%) patients experienced a complication post-operatively. 46 (3.6%) patients experienced a readmission postoperatively. The most common complication was reoperation (N = 40, 3.1%). Regression analysis revealed that gender was the only demographic factor associated with risk of post-operative complications, with women having a significantly lower risk than men (OR = 0.61, 95% CI 0.37-0.99, P = .046). CONCLUSIONS ESS is typically performed on a relatively young and healthy population. Women have a significantly lower risk of complications after controlling for comorbidities. Further analysis of gender-specific differences in surgical outcomes should be evaluated to understand this phenomenon.
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Affiliation(s)
- Rahul K Sharma
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Sonam Dodhia
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Justin S Golub
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Jonathan B Overdevest
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
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