Risk Factors Associated With Recurrence Of Chronic Rhinosinusitis With Nasal Polyps After Surgery:A Meta-analysis

Objective:To collect data from studies on risk factors associated with recurrence after surgery for chronic rhinosinusitis with nasal polyps,and to systematically evaluate risk factors for recurrence using meta-analysis,with a view to providing an evidence-based basis for predicting the risk of recurrence after surgery for chronic rhinosinusitis with nasal polyps and to assist in identifying populations at high risk of recurrence.Methods:The relevant literature published in Chinese and English from the date of establishment to 31 December 2022 was collected using computer searches of databases such as China National Knowledge Infrastructure,Chinese biomedical literature service system,Wanfang Database,VIP Database,Cochrane Library,Embase,Pub Med and Web of Science(SCIE).The retrieved literature was screened,quality evaluated and data extracted in strict accordance with the inclusion and exclusion criteria.Review Manager5.4 statistical software was applied to combine the data from the included studies for heterogeneity testing,effect size OR and 95%CI,and change the statistical model for calculating the combined effect size for sensitivity testing.Stata 14 statistical software was applied to test for publication bias for data from 10 or more included studies.Results:A total of 1031 papers were retrieved,and after screening,30 papers were included in the meta-analysis,with a total sample size of 6011 cases,of which 2099 were recurrent and 3912 were not recurrent.A total of 14 risk factors for recurrence were included in the meta-analysis,and 11 factors with statistically significant results were: smoking [OR=3.04,95%CI(2.47,3.75),P<0.00001],combined asthma [OR=2.48,95%CI(2.12,2.90),P<0.00001],combined allergic rhinitis [OR=3.04,95%CI(1.67,5.55),P=0.0003],history of endoscopic sinus surgery [OR=2.58,95%CI(2.05,3.26),P<0.00001],high Lund-Kennedy score[OR=1.25,95%CI(1.17,1.34),P<0.00001],obstruction of ostiometal complex[OR=2.15,95% CI(1.59,2.93),P<0.00001],high Lund-Mackay score [OR=1.24,95%CI(1.06,1.46),P=0.008],high peripheral eosinophil(EOS)counts [OR=2.27,95%CI(1.68,3.08),P<0.00001],high peripheral EOS percentage [OR=1.35,95%CI(1.11,1.65),P=0.003],high tissue EOS percentage [OR=1.41,95% CI(1.26,1.58),P<0.00001],and postoperative infection [OR=3.59,95%CI(1.66,7.80),P=0.001];three factors with statistically insignificant results were: high visual analogue scale(VAS)score for olfactory impairment [OR=1.29,95%CI(0.96,1.72),P=0.09],high tissue EOS counts[OR=1.07,95%CI(1.00,1.15),P=0.07] and low tissue lymphocyte percentage [OR=1.24,95%CI(0.84,1.84),P=0.27].Sensitivity analyses was performed to find that the results were altered after changing the statistical model for three risk factors: high VAS score for olfactory impairment,high peripheral EOS percentage and high tissue EOS counts,and the results obtained were unstable.Publication bias analysis was performed to find publication bias for high tissue EOS percentage because of poor symmetry of the funnel plot scatter distribution and the Egger’s test P<0.05.The cut-and-patch method correction suggested a small effect of bias and more robust results.Conclusion:The meta-analysis shows that risk factors for recurrence after surgery for chronic sinusitis with nasal polyps include smoking,combined asthma,combined allergic rhinitis,history of endoscopic sinus surgery,high Lund-Kennedy score,obstruction of ostiometal complex,high Lund-Mackay score,high peripheral EOS counts,high tissue EOS percentage,and postoperative infection.Low tissue lymphocyte percentage was not significantly associated with postoperative recurrence.The association of three factors,high VAS score for olfactory impairment,high peripheral EOS percentage,and high tissue EOS counts,with postoperative recurrence could not be determined.