Effect of Sinus Surgery on Bodily Pain: A Meta-analysis

Abstract

Objective To determine by systematic review and metaanalysis if (1) bodily pain as measured by the 36-Item Short Form Health Survey (SF-36) is consistently increased in patient populations with chronic rhinosinusitis (CRS); and (2) if SF-36 bodily pain scores significantly and consistently improve following endoscopic sinus surgery (ESS). Methods Studies published in any language reporting SF-36 results before and after ESS were retrieved by searching MEDLINE, EMBASE, Web of Science, Cochrane databases, and additional Web-based sources (from 1980 to January 2008); by examining bibliographies of retrieved articles; and by contacting investigators in the field. Two authors independently evaluated studies for inclusion. Results After excluding 1 study reporting results as medians rather than as means, the remaining 10 observational ESS studies (909 patients) reported preoperative SF-36 bodily pain scores 0.95 SDs below the general population mean (more bodily pain) in average weighted by sample size. Using a repeated-measures design, all studies noted an improvement in SF-36 bodily pain domain scores following surgery, with a moderate-sized combined effect of 0.54 (95% confidence interval [CI], 040–0.69) and moderate heterogeneity (I2 = 50%). This pooled effect corresponds to a clinically and statistically significant mean improvement of 11.7 (95% CI, 7.1–16.3) units in the SF-36 bodily pain domain. Conclusions Bodily pain is consistently increased in patient populations with CRS. Using within-subject comparisons, a clinically and statistically significant improvement in bodily pain is noted after ESS, an improvement similar in size to that previously described for fatigue and other CRS symptoms.