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Efficacy of steroid‐eluting stents in management of chronic rhinosinusitis after endoscopic sinus surgery: updated meta‐analysis
Author(s) -
Goshtasbi Khodayar,
Abouzari Mehdi,
Abiri Arash,
Yasaka Tyler,
Sahyouni Ronald,
Bitner Benjamin,
Tajudeen Bobby A.,
Kuan Edward C.
Publication year - 2019
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.22443
Subject(s) - medicine , confidence interval , odds ratio , chronic rhinosinusitis , meta analysis , endoscopic sinus surgery , randomized controlled trial , surgery
Background Recently, there has been mounting evidence suggesting the efficacy of steroid‐eluting stents (SES) for management of chronic rhinosinusitis after endoscopic sinus surgery (ESS). This meta‐analysis serves to evaluate the efficacy of SES in improving postoperative outcomes after ESS. Methods A systematic literature search was performed of PubMed for articles published between 1985 and 2018. The outcome variables were reported at, on average, 30 days postintervention. Results Seven of the 76 published studies, all of which were industry‐sponsored, were included for a collective cohort of 444 SES and 444 control sinuses. In patients who received SES vs controls, collective odds ratios (ORs) for postoperative need for intervention, surgery, and oral steroid were 0.45 (95% confidence interval [CI], 0.33‐0.62; p < 0.001), 0.30 (95% CI, 0.18‐0.52; p < 0.001), and 0.58 (95% CI, 0.40‐0.84; p = 0.004), respectively. In addition, collective ORs for frontal sinus ostia (FSO) patency, moderate‐to‐severe adhesion/scarring, and increase in polyp score were 2.53 (95% CI, 1.61‐3.97; p < 0.001), 0.28 (95% CI, 0.13‐0.59; p < 0.001), and 0.42 (95% CI, 0.25‐0.74; p = 0.002), respectively. Collective mean differences for FSO/ethmoid inflammation and FSO diameter were −10.86 mm ( p < 0.001) and +1.34 mm ( p < 0.001), respectively. Conclusion Aggregate evidence suggests that SES can improve ESS outcomes by reducing rates of postoperative intervention and recurrent polyposis and inflammation, while promoting FSO patency. All included and analyzed studies were industry‐sponsored and ruling‐out publication bias was not possible. Future independent and nonsponsored studies to further evaluate SES's long‐term efficacy are warranted.