Medical Professional Publications

Is Endoscopic Sinus Surgery Safe for Children With Cystic Fibrosis?

Columbus, OH — September 2017

In what appears to be the largest study of its kind, researchers from Nationwide Children’s Hospital have found endoscopic sinus surgery poses no additional risk to children with cystic fibrosis (CF).

Their review of a multi-institutional surgical outcomes registry found that while CF patients were more likely than non-CF patients to require a prolonged hospital stay following the procedure, both groups had similar rates of readmission and reoperation. Among readmissions, only one CF patient returned to the hospital for reasons related to endoscopic sinus surgery (ESS) while non-CF patients were readmitted for ESS-related pain and bleeding and recurrence of sinusitis.

Hospitals report that more than 90 percent of CF patients suffer from chronic sinusitis. When medical treatments fail, ESS is an alternative that children's hospitals turn to in widely varying numbers. Small and preliminary studies indicate the procedure provides benefits, but there are conflicting reports as well.

"The procedure involves some controversy about the need for repeat surgeries, the correct age to start, the choice of technique and how to consistently measure outcomes and improvements in quality of life," says Dmitry Tumin, PhD, director of research in the Department of Anesthesiology and Pain Management at Nationwide Children's and lead author of the study. But, "Children with cystic fibrosis are living longer, so learning how they respond to surgical procedures is increasingly important."

Anecdotally, CF patients who have undergone ESS at Nationwide Children's have reported they suffer fewer sinus headaches, have improved senses of smell and taste and an overall feeling of well-being, says Don Hayes Jr. MD, a pulmonologist, medical director of Heart-Lung Transplant Programs at Nationwide Children's and study author.

"To understand how safe the procedure is for this patient population, we looked across surgical centers," says Dr. Hayes, who is also a professor of Pediatrics, Internal Medicine, and Surgery at The Ohio State College of Medicine. "Sometimes you have center-specific effects and this study goes beyond that."

The researchers reviewed 30-day outcomes of 213 children with cystic fibrosis and 821 without from the American College of Surgeons' National Surgical Quality Improvement Program-Pediatrics database. The study is published in the International Journal of Pediatric Otorhinolaryngology.

The authors found that 30 percent of CF patients required a prolonged hospital stay (longer than one day) compared to 9 percent of non-CF patients. The longer stay may be due to planned use of intravenous antibiotics as an adjunct to surgery, the researchers say. In any case, the longer stay appears to have no association with specific complications recorded in this registry.

The readmission rate for the CF patients was 6 percent and the most common reason was for pulmonary exacerbation. The readmission rate for non-CF patients was 4 percent, not significantly different. No CF patients and only 1 percent of non-CF patients returned for an unplanned reoperation.

"We're continuing to do the procedure here and continuing to collect more data for future studies to hopefully help not only the quality of life but potentially the long-term outcomes of the patient population," Dr. Hayes says.

Preliminary results of a follow-up study at Nationwide Children's show that patients with CF who had an initial deficit in lung function experienced improvement in lung function following the surgical procedure, says Dr. Tumin, who is also a research assistant professor of Pediatrics at The Ohio State University College of Medicine.

Dr. Hayes says future studies may include how sinusitis in CF patients may be a contributing factor in pulmonary exacerbations and whether the accompanying headaches and stuffed head are a factor in depression in this population.

Reference:
Tumin D, Hayes D Jr, Kirkby SE, Tobias JD, McKee C. Safety of endoscopic sinus surgery in children with cystic fibrosis.. International Journal of Pediatric Otorhinolaryngology. 2017 Jul; 98: 25-28.

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