Functional Endoscopic Sinus Surgery Efficacious for Comorbid Chronic Rhinosinusitis, Asthma

New research is calling attention to differences in health care resource utilization in patients with both asthma and chronic rhinosinusitis who underwent functional endoscopic sinus surgery compared with those who did not.¹

Results showed patients who received functional endoscopic sinus surgery had less medication usage, pulmonary visits, and allergy visits than patients who did not undergo surgery. However, despite decreased medication use in the surgery group relative to the non-surgery group, the need for medication increased after surgery.¹

Despite asthma and chronic rhinosinusitis frequently occurring together, there is a lack of specific guidelines for treating patients with both conditions. A minimally invasive surgery used for serious sinus conditions, functional endoscopic sinus surgery can limit chronic sinus flares and is thought to improve both upper and lower airway symptoms. However, its use in the context of patients with both asthma and chronic rhinosinusitis is not well understood.^1,2

“Limitations of prior studies on patients with comorbid chronic rhinosinusitis and asthma include the lack of quantification of the number of emergency visits or hospitalizations and the lack of clarity on the efficacy of functional endoscopic sinus surgery,” Lauren Roland, MD, MSCI, an assistant professor in the otolaryngology division of rhinology at Washington University in St. Louis, and colleagues wrote.¹ “Further studies are needed to provide evidence-based insights.”

To address the shortcomings of previous research and fill gaps in knowledge about functional endoscopic sinus surgery in this patient population, investigators conducted a retrospective study using Truven Health Market Scan (IBM), a large claims database containing de-identified human subject data. They used ICD-9 and ICD-10 codes to identify patients with both chronic rhinosinusitis and asthma from 2009 to 2021.¹

Investigators then created 4 categories of healthcare utilization: medication usage, emergency department (ED) visits, pulmonary clinic visits, and allergy clinic visits. National Drug Codes were used to evaluate medication usage, including albuterol and oral steroids. The setting where the service occurred was used to determine emergency visits, and the provider type was used to determine pulmonary and allergy visits.¹

Additionally, investigators used functional endoscopic sinus surgery current procedural terminology (CPT) codes to create 2 cohorts of patients: those who did and did not undergo surgery during the study period.¹

Findings revealed greater ED visits in the surgical group compared with the non-surgical group (mean 8.3434 vs 4.7039; P <.0001), something investigators attributed to potential differences in disease severity between the groups that they could not control for in the analysis. They also called attention to a greater number of ED visits prior to surgery in patients who underwent functional endoscopic sinus surgery.¹

Compared with the surgery group, pulmonary (mean 1.8256 vs 1.6811; P = .0370) and allergy (mean 2.1659 vs 2.1000; P = .0646) visits were higher in the non-surgery group, as was medication use (mean 1.2150 vs 1.1862; P <.0001). Despite the decreased use of medication relative to patients who did not undergo surgery, investigators observed an increase in the need for medication following surgery (pre-surgery mean medication use 1.0707 vs post-surgery mean 1.2327; P <.0001), potentially related to asthma severity or immediate postoperative steroid use.¹

Investigators acknowledged multiple limitations to these findings, including the retrospective nature of the study and reliance on information from a database; the inability to account for the extent of surgery or asthma severity; and the need for future studies including allergic rhinitis comorbidity.¹

References

1. ^{Kabongo MM, Levy JM, Roland LT. Effects of functional endoscopic sinus surgery on asthma control in patients with comorbid chronic rhinosinusitis and asthma: A national database study. IFAR. https://doi.org/10.1002/alr.23462}
2. ^{Cleveland Clinic. Functional Endoscopic Sinus Surgery (FESS). April 4, 2022. Accessed October 16, 2024. https://my.clevelandclinic.org/health/treatments/17478-functional-endoscopic-sinus-surgery}