Annals of Olology. Rhinology & Laryngology 12O(3):I62-166. © 2011 Annals Publishing Company. All rights reserved. Revision Rates After Endoscopie Sinus Surgery: A Recurrence Analysis Daniel Mendelsohn, MSc; Goran Jeremic, MD; Erin D. Wright, MD, MEd, FRCSC; Brian W. Rotenberg, MD, MPH, FRCSC Objectives: Chronic rhinosinusitis with nasal polyposis is often refractory to medical and surgical management, espe- cially in patients with asthma and aspirin intolerance. We used a contemporary database to investigate recurrence and revision surgery rates following endoscopie sinus surgery. Methods: We performed a cohort study using a survival analysis technique. Records were reviewed of 549 patients with nasal polyposis who underwent endoscopie sinus surgery over a 10-year period. The main outcome measure was disease- free and surgery-free survival following endoscopie sinus surgery, investigated with Kaplan-Meier analyses. Results: Patients with Samter's triad were significantly more likely to have a recurrence and undergo a second surgery following recurrence (risk-odds ratio, 2.7; 95% confidence interval, 1.5 to 3.2; p < 0.01) than were patients without asth- ma or with only asthma from the triad. The presence of initial frontal sinus disease also increased the likelihood of revi- sion surgery (risk-odds ratio, 1.6; 95% confidence interval, 1.2 to 1.8; p < 0.05). Conclusions: This is the first study to use survival analysis to document revision surgery rates following endoscopie sinus surgery. Revision surgery occurs at a high rate, especially in patients with asthma, Samter's triad, or frontal sinus disease. Patients should routinely be informed during clinical consultations about the likelihood of recurrence. Early in- tervention for frontal sinus disease may be considered. Key Words: endoscopie sinus surgery, frontal sinus, nasal polyposis, revision surgery. INTRODUCTION Chronic rhinosinusitis (CR) with nasal polyposis (NP) is a condition that affects up to 5% of the gen- eral population, causing nasal obstruction, anterior rhinorrhea, mucopurulent postnasal drip, and anos- mia.'-^ Several factors are known to be associated with inflammatory nasal polyps, including asthma and aspirin intolerance.'-^ The clinical presentation of asthma, aspirin intolerance, and NP is labeled Samter's triad."^ Nasal polyposis is present in 7% to 17% of patients with asthma alone'-^-^ and in 36% to 96% of patients with the full triad.-"* Chronic sinusitis with NP is commonly managed with local and sys- temic steroid-based treatments, but a large propor- tion of patients fail to benefit from a purely medi- cal approach.^-^ Fndoscopic sinus surgery (FSS) is often undertaken in this group, and generally has a very high initial success rate for symptomatic im- provement in quality of life, as well as for clinical eradication of polyps.^ Unfortunately, a high rate of recidivism follow- ing surgery makes the long-term management of this condition challenging for patients and clini- cians.^-^ Prior studies have suggested that recur- rence rates are higher in patients with asthma alone or with Samter's triad,^"'-^ but precise recurrence rates in these patients across time remain elusive. Moreover, a related unclear quantity is the propor- tion of patients with polyps who undergo revision surgery; how likely, and how soon, are important matters to address in counseling patients. At pres- ent, the literature does not supply the clinician with long-term data regarding the frequency of revision surgery and risk factors that might increase the like- lihood thereof. The purpose of this study was there- fore to use a contemporary database to conduct a recurrence analysis for polyposis revision surgery following primary FSS for CR with NP. MATERIALS AND METHODS We conducted a review of prospectively gathered patient data from a preexisting departmental data- base. Records were available for review from 2,649 From the Department of Otolaryngology-Head and Neck Surgery. University of Western Ontario, London (Mendelsohn, Jeremic, Rotenberg), and the Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton (Wright). Canada. This project was funded by the Schulich Research Opportunities Program Grant. Correspondence: Brian W. Rotenberg, MD, MPH, FRCSC, St Joseph's Health Care, 268 Grosvenor St, London, Ontario, N6A 4V2 Canada. 162