The Impact of Acute Peri-operative Particulate Matter Exposure on Endoscopic Sinus Surgery Outcomes: A Preliminary Multi-site Investigation

Benton Tullis; Jess C Mace; Robert Hagedorn; Cassidy Nguyen; Ryan Stockard; Conner Massey; Vijay R Ramakrishnan; Daniel M Beswick; Zachary M Soler; Timothy L Smith; Jeremiah A Alt; Amarbir S Gill

doi:10.1177/19458924241246371

The Impact of Acute Peri-operative Particulate Matter Exposure on Endoscopic Sinus Surgery Outcomes: A Preliminary Multi-site Investigation

Am J Rhinol Allergy. 2024 Apr 16:19458924241246371. doi: 10.1177/19458924241246371. Online ahead of print.

Affiliations

¹ Department of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA.
² Division of Rhinology and Sinus Surgery/Oregon Sinus Center, Department of Otolaryngology - Head and Neck Surgery, Oregon Health & Science University (OHSU), Portland, OR, USA.
³ Department of Otolaryngology - Head and Neck Surgery, University of Indiana, Indianapolis, IN, USA.
⁴ Department of Otolaryngology - Head and Neck Surgery, University of California, Los Angeles, CA, USA.
⁵ Department of Otolaryngology -Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
⁶ Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.

PMID: 38623645
DOI: 10.1177/19458924241246371

Abstract

Background: Environmental exposures have been postulated to play an important role in the pathophysiology of chronic rhinosinusitis (CRS). Particulate matter (PM) is one of the most widely studied ambient air pollutants, but its peri-operative impact on CRS is unknown.

Objective: To determine the effect of acute, peri-operative PM exposure on outcomes after endoscopic sinus surgery (ESS).

Methods: Participants with CRS who self-selected ESS were prospectively enrolled. The 22-item SinoNasal Outcome Test (SNOT-22) and Medical Outcomes Study Questionnaire Short-Form 6-D (SF-6D) health utility values scores were recorded. Using residence zip codes, a secondary analysis of patient exposure to PM <2.5 μm and <10 μm (PM2.5 and PM10, respectively) was performed for the month of surgery utilizing data from Environmental Protection Agency air quality monitors. Spearman's correlation coefficients (ρ), 95% confidence intervals (CIs), and effect estimates (β) were used to determine the magnitudes of association. Simple, multivariate regression analysis was also completed.

Results: One hundred and seven patients from four geographically unique institutions across the US were enrolled with a follow-up of 6 months. Patients with higher peri-operative PM2.5 exposure had less improvement in their SNOT-22 scores after ESS compared to those with less exposure using both univariate analysis (ρ = 0.26, 95% CI: 0.08, 0.43; P = .01) and after covariate adjustment with multivariate analysis (B = 1.06, 95% CI: 0.001, 2.14, P = .05). Similar associations were not found with SF-6D outcomes or with PM10 as an exposure of interest. No significant correlations were found between peri-operative PM levels and Lund-Kennedy endoscopy scores post-operatively.

Conclusion: Preliminary data from this pilot study reveal that PM exposure at the time of ESS may negatively associate with post-operative improvement in sinonasal quality-of-life. Larger, population-based studies with more standardized PM exposure windows are needed to confirm the clinical significance of the present findings.

Keywords: SNOT-22; chronic rhinosinusitis; endoscopic sinus surgery; environment; multi-institution; particulate matter; peri-operative exposure; pollution; quality of life; surgical outcomes.