Does Psychological Dysfunction Impact 5-Year Quality of Life Outcomes After Endoscopic Sinus Surgery?

Abstract

In chronic rhinosinusitis (CRS) patients, psychological status influences whether symptoms are indicative of CT results and affects short-term outcomes after endoscopic sinus surgery (ESS). Our objective was to assess the impact of psychological status on 5-year outcomes following ESS. CRS patients undergoing ESS prospectively completed 22-item sinonasal outcome test (SNOT-22) surveys preoperatively and postoperatively at 3 months and annually for 5 years. Patients were stratified into high and low psychological dysfunction groups based on SNOT-22 psychological domain scores, and outcomes were compared. Of 1069 patients enrolled, 557 were in the high psychological dysfunction (HPD) cohort and 512 were in the low psychological dysfunction (LPD) cohort. 5-year outcome data were available for 205 patients in the HPD and 196 patients in the LPD group. Patients with HPD were more likely to be female and have a history of prior sinus surgery, allergy, and headaches. HPD patients had significantly higher SNOT-22 scores (61.1 vs. 32.8, p < 0.001) at baseline. Both groups had significant improvement at each postoperative timepoint and similar relative improvement (45.2% vs. 44.5% reduction at 5 years), although the HPD patients had significantly greater symptom severity at 5 years (33.5 vs. 18.2, p < 0.001). Multivariable regression revealed that preoperative psychological domain scores independently predicted higher postoperative non-psychological SNOT-22 scores (β = 0.29; 95% CI: 0.11-0.47; p = 0.001). ESS provides long-term benefit to patients regardless of psychological dysfunction severity. However, patients with HPD experienced significantly worse symptoms before ESS and for up to 5 years postoperatively. Preoperative psychological score independently predicts postoperative symptom severity.