Advanced Age in Sinus Surgery: Diminished Symptom Gains but Enhanced Surgical Durability in Chronic Rhinosinusitis.

Abstract

To assess whether patients of advanced age with chronic rhinosinusitis (CRS) experience comparable symptom improvement and disease control following endoscopic sinus surgery (ESS) compared to younger patients. Systematic searches were performed across PubMed, Embase, Web of Science, Scopus, and CENTRAL to May 2024. Following PRISMA guidelines, we included comparative studies with age-stratified cohorts reporting outcomes for CRS patients undergoing ESS. The primary outcome was symptom improvement measured by the 22-item Sinonasal Outcome Test (SNOT-22). Secondary outcomes were disease recurrence and revision rates. Meta-regression examined the influence of sex, preoperative symptom severity, nasal polyps, and prior ESS. Across the included studies, data from 3161 patients were analyzed. Advanced-age patients demonstrated significantly less SNOT-22 improvement than younger counterparts (SMD -0.36; 95% confidence interval [CI], -0.61 to -0.10; P = .01). Nevertheless, recurrence and revision rates were lower in the advanced-age group-12% and 3%, respectively-corresponding to a 50% reduction in combined risk (RR 0.50; 95% CI, 0.33-0.75; P < .001). Meta-regression identified male sex as a predictor of greater symptom improvement in advanced-age patients (β = 0.06, P = .03), whereas prior ESS was associated with diminished improvement (β = -0.05, P < .01). Patients of advanced age may experience less pronounced symptomatic improvement but lower recurrence and revision rates after ESS. These differences should be interpreted with caution, as they may reflect both surgical outcomes and other factors such as comorbidities or reoperation thresholds. Age alone should not preclude ESS, which remains an effective option when tailored to individual patient characteristics.