Comparison of endoscopic sinus surgery timing in lung transplant patients with cystic fibrosis

Abstract

No studies have investigated when endoscopic sinus surgery (ESS) is best performed in lung transplant patients with cystic fibrosis (CF). We sought to examine the effects of ESS timing on pulmonary health in this population. A retrospective review of all adult lung transplant patients with CF who underwent ESS at our academic medical center over a near 25-year period was performed. Patients were split into two groups based on median time from lung transplantation to ESS. Twenty-three patients were included (12 ESS early and 11 ESS delayed). Outcomes included changes in pulmonary function tests (PFTs) from baseline, preoperative to postoperative measurements, the number and duration of hospitalizations for pulmonary exacerbations, and the number of antibiotic courses used specifically to treat pulmonary exacerbations during the 12 months before and after ESS. Baseline demographics, operative history, and pulmonary function characteristics were similar between groups. While the ESS early group saw significant improvement from preoperative percent-predicted FEV1 (ppFEV1 ) at 12months postoperatively (confidence interval [CI]: 0.729-11.452, p=0.030), there were no significant postoperative PFT changes for the ESS delayed group. Postoperative improvement in FEV1 and ppFEV1 at 12months was significantly higher for the ESS early group relative to the ESS delayed group (CI: 0.010-0.583, p=0.043; CI: 1.240-16.692, p=0.025; respectively). The ESS early group had a significant reduction in the need for total antibiotic courses compared with the ESS delayed group (ESS early median: -1, interquartile range [IQR]: -1.5 to -0.5vs. ESS delayed median: 0, IQR: 0 to 0; p=0.027). Earlier ESS interventions following lung transplantation may improve pulmonary function and attenuate pulmonary exacerbations in CF patients.