Impact of Early Versus Delayed Functional Endoscopic Sinus Surgery for Chronic Rhinosinusitis With Nasal Polyps.

Abstract

Previous studies have suggested a benefit to early functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis (CRS). With the approval of T2 biologics for CRS with nasal polyps (CRSwNP), it is important to re-evaluate FESS timing in relation to T2 biologic utilization. In this study, we aimed to understand the impact of FESS timing on CRSwNP disease control. Retrospective database study. Patients diagnosed with CRSwNP in the TriNetX platform. The TriNetX platform was queried to identify adult patients with one or more encounter diagnoses of CRSwNP. Among this cohort, we identified subgroups of individuals who underwent early (within 1 year) or delayed (1-2, 2-3, 3-4, 4-5, or >5 years after initial encounter) FESS, based on CPT codes. Pertinent outcomes, including the need for revision FESS and first-time T2 biologic prescription, were compared. After 1:1 propensity matching, we included a range of 264 to 1419 patients in each cohort. When followed for 2 and 5 years postoperatively, the delayed FESS (>5 years) cohort had 96% and 83% greater odds of new T2 biologic prescription (OR 1.96, 95% CI 1.40-2.73 and OR 1.83, 95% CI 1.40-2.40), but had no significant difference in the odds of revision FESS (2 year OR 1.03, 95% CI 0.73-1.47 and 5 year OR 1.23, 95% CI 0.93-1.63). Our findings demonstrate that the delayed FESS cohort had a higher T2 biologic prescription rate. Additional investigations are necessary to determine if this is due to the recent introduction of T2 biologics or a consequence of heightened disease severity necessitating long-term biologic use when surgery is delayed.