Cohort study identifies predictors of refractory chronic rhinosinusitis requiring revision surgery or biologics after sinus surgery, highlighting the impact of type 2 inflammation.
Key Points
To identify independent preoperative clinical and demographic predictors of refractory primary chronic rhinosinusitis using a composite outcome of revision sinus surgery or biologic initiation.
Retrospective cohort study of adult patients with primary chronic rhinosinusitis (N = 24,759) undergoing functional endoscopic sinus surgery after 2015 from the TriNetX Research Network.
Evaluated a composite primary endpoint of refractory disease—defined as revision surgery or biologic initiation between 3 months and 5 years postoperatively—using multivariable Cox proportional hazards modeling with stepwise selection.
Refractory disease occurred in 2,866 patients (11.6%), of whom 66.6% underwent revision surgery, 42.0% initiated biologic therapy, and 8.7% received both treatments.
Significant independent multivariable predictors included asthma (HR 2.06, p < 0.001), analgesic allergy (HR 1.87, p < 0.001), nasal polyps (HR 1.67, p < 0.001), COPD (HR 1.27, p = 0.006), eosinophilia (HR 1.27, p < 0.001), and Black or African American race (HR 1.16, p = 0.044).