The national comparative audit of surgery for nasal polyposis and chronic rhinosinusitis

Clin Otolaryngol. 2006 Oct;31(5):390-8. doi: 10.1111/j.1749-4486.2006.01275.x.


Objectives: This study summarises the results of a National Audit of sino-nasal surgery carried out in England and Wales. It describes patient and operative characteristics as well as patient outcomes up to 36 months after surgery.

Design: Prospective cohort study.

Setting: NHS hospitals in England and Wales.

Participants: Consecutive patients undergoing surgery for nasal polyposis and/or chronic rhinosinusitis.

Main outcome measure: The total score derived from a 22-item version of the Sino-Nasal Outcome Test (SNOT-22). Lower scores represent better health-related quality of life.

Results: A total of 3128 consecutive patients at 87 NHS hospitals were enrolled. There is a large improvement in SNOT-22 scores from the pre-operative period (mean = 42.0) to 3 months after surgery (mean = 25.5). The scores for patients undergoing nasal polypectomy improved from 41.0 before surgery to 23.1 at 3 months after surgery, while the scores for patients undergoing surgery for chronic rhinosinusitis alone improved from 44.2 to 31.2. The SNOT-22 scores reported at 12 and 36 months after surgery were similar to those reported at 3 months. Excessive bleeding occurred in 5% of patients during the operation and in 1% of patients after the operation. Intra-orbital complications were reported in 0.2%. Of those patients undergoing primary surgery for bilateral grade I or II polyposis, 18% had not received a pre-operative course of steroid treatment. At the 36-month follow-up, 11.4% of patients had undergone revision surgery.

Conclusions: The audit confirms that sino-nasal surgery is generally safe and effective. There is some evidence that patient selection for surgery could be improved.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Chronic Disease
  • Comorbidity
  • Confounding Factors, Epidemiologic
  • England / epidemiology
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Management Audit*
  • Medical Audit*
  • Middle Aged
  • Nasal Polyps / epidemiology
  • Nasal Polyps / surgery*
  • Otorhinolaryngologic Surgical Procedures* / adverse effects
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Practice Patterns, Physicians'
  • Prospective Studies
  • Quality of Life
  • Rhinitis, Allergic, Perennial / epidemiology
  • Rhinitis, Allergic, Perennial / surgery*
  • Sinusitis / epidemiology
  • Sinusitis / surgery*
  • Surveys and Questionnaires
  • Treatment Outcome
  • Wales / epidemiology