Nationwide Children's Hospital, Columbus, OH
Copyright 2016, American College of Chest Physicians. All Rights Reserved.
SESSION TITLE: Cystic Fibrosis
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM
PURPOSE: Cystic fibrosis (CF) is characterized by chronic infection and inflammation of the sino-respiratory tract. Sinusitis is almost universally present in patients with CF and functional endoscopic sinus surgery (FESS) may be a treatment option for patients with severe symptoms. The effect of sinus surgery on pulmonary outcomes in these patients is uncertain. Our objective was to evaluate changes in pulmonary function testing after FESS in a large cohort of pediatric and adult CF patients at a single institution, Nationwide Children’s Hospital (NCH).
METHODS: A retrospective chart review was performed using data collected from all pediatric and adult patients with CF who underwent FESS from January 2009 to July 2014. The hospital system’s electronic medical record (Epic) was used to compile data for 180 patients on whom 321 surgeries were performed over 4.5 years. Lung function data including FEV1, FVC and FEV1/FVC ratio were retrieved within one year before and after the surgery date. Mixed-effects regression was used to compare FEV1 trajectories before and after sinus surgery. The effect of surgery was stratified by the most recent pre-surgery FEV1. This was done to distinguish the effects among patients with mild or no obstruction (FEV1>80%) and patients with moderate/severe obstruction (FEV1<80%).
RESULTS: Of the 180 patients, 139 patients with first time FESS had available FEV1 data for analysis. Pre-surgery average age was 16.8 ± 10.5 years. 128 patients had genotype information available and 77 (60%) were deltaF508 homozygous. Pre-surgery FEV1 mean was 85.1% ± 22.4. There were 91 patients with mild/no obstruction and 48 patients with moderate/severe obstruction. For the entire cohort, there was no change in lung function in relation to performance of FESS. For patients in the moderate/severe category FEV1 declined pre-surgery by 3.0%/year followed by a significant increase post-surgery of 3.3%/year (95% CI: 1.0%, 5.6%; p=0.005). No similar benefit was identified for patients with no/mild obstruction.
CONCLUSIONS: Among patients with moderate/severe obstruction, pulmonary function tests improved in the year following sinus surgery.
CLINICAL IMPLICATIONS: These findings suggest a potential benefit in pulmonary outcomes following FESS. Further investigation is needed to determine the effects of sinus surgery on other clinical outcomes.
DISCLOSURE: The following authors have nothing to disclose: Sabrina Khalfoun, Dmitry Tumin, Meredith Lind, Shahid Sheikh, Maroun Ghossein, Don Hayes, Jr., Steven Kirkby
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