Impact of Early Versus Delayed Functional Endoscopic Sinus Surgery for Chronic Rhinosinusitis With Nasal Polyps

OBJECTIVE: Previous studies have suggested a benefit to early functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis (CRS). With the approval of T2 biologics for CRS with nasal polyps (CRSwNP), it is important to re-evaluate FESS timing in relation to T2 biologic utilization. In this study, we aimed to understand the impact of FESS timing on CRSwNP disease control. STUDY DESIGN: Retrospective database study. SETTING: Patients diagnosed with CRSwNP in the TriNetX platform. METHODS: The TriNetX platform was queried to identify adult patients with one or more encounter diagnoses of CRSwNP. Among this cohort, we identified subgroups of individuals who underwent early (within 1 year) or delayed (1-2, 2-3, 3-4, 4-5, or >5 years after initial encounter) FESS, based on CPT codes. Pertinent outcomes, including the need for revision FESS and first-time T2 biologic prescription, were compared. RESULTS: After 1:1 propensity matching, we included a range of 264 to 1419 patients in each cohort. When followed for 2 and 5 years postoperatively, the delayed FESS (>5 years) cohort had 96% and 83% greater odds of new T2 biologic prescription (OR 1.96, 95% CI 1.40-2.73 and OR 1.83, 95% CI 1.40-2.40), but had no significant difference in the odds of revision FESS (2 year OR 1.03, 95% CI 0.73-1.47 and 5 year OR 1.23, 95% CI 0.93-1.63). CONCLUSIONS: Our findings demonstrate that the delayed FESS cohort had a higher T2 biologic prescription rate. Additional investigations are necessary to determine if this is due to the recent introduction of T2 biologics or a consequence of heightened disease severity necessitating long-term biologic use when surgery is delayed.