Smoking and endoscopic sinus surgery: Does smoking volume contribute to clinical outcome?

Background: The effect of tobacco smoking on chronic rhinosinusitis (CRS) is not yet well-delineated. The purpose of this investigation was to evaluate the overall effect of smoking on postoperative outcomes (endoscopic score and health-related quality-of-life [HRQoL]) after endoscopic sinus surgery (ESS) for CRS and to determine if volume of daily smoking impacts outcomes. Methods: A total of 784 patients with CRS were prospectively enrolled between January 2001 and April 2009 after electing ESS from 1 of 3 academic tertiary care centers. Follow-up longer than 6 months was available on 39 smoking patients. Smoking volume (cigarettes/day) analysis was performed by dichotomizing patients into either of 2 subgroups: light smokers (<20 cigarettes per day) or heavy smokers (≥20 cigarettes per day). Primary outcomes were Lund-Kennedy endoscopy scores and 2 disease-specific HRQoL instruments: the Rhinosinusitis Disability Index (RSDI) and Chronic Sinusitis Survey (CSS). Results: Smokers and nonsmokers experienced similar improvement in HRQoL following surgery (RSDI: p = 0.792 and CSS: p = 0.117). No difference in HRQoL improvements between light smokers and heavy smokers was identified. While overall changes in endoscopy scores did not differ between smokers and nonsmokers, there was a significant difference in the prevalence of worsening postoperative endoscopy scores between heavy smokers, light smokers, and nonsmokers (100%, 33%, and 20%, respectively; p = 0.002). Conclusion: Active smoking status does not alter postoperative improvement in HRQoL after ESS. Although limited by a small sample size, increasing smoking volume may contribute to worse postoperative endoscopy scores.