The effect of diabetes mellitus on chronic rhinosinusitis and sinus surgery outcome

Authors

  • Zi Zhang MD, MSCE,

    Corresponding author
    1. Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
    • Correspondence to: Zi Zhang, MD, MSCE, 8th Floor, Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104–6021; e-mail: zizhang@mail.med.upenn.edu

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  • Nithin D. Adappa MD,

    1. Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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  • Ebbing Lautenbach MD, MPH, MSCE,

    1. Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
    2. Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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  • Alexander G. Chiu MD,

    1. Department of Surgery, University of Arizona, Tucson, AZ
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  • Laurel Doghramji RN, BSN,

    1. Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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  • Timothy J. Howland BS,

    1. Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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  • Noam A. Cohen MD, PhD,

    1. Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
    2. Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
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  • James N. Palmer MD

    1. Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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  • Funding sources for the study: National Institutes of Health, National Institute of Allergy and Infectious Diseases (NIAID) (K24 AI080942/AI/NIAID NIH HHS/United States).

  • Potential conflict of interest: E.L. received research grant support from Merck, AstraZeneca, and 3M. None of the other authors report any conflicts of interest.

Abstract

Background

Patients with diabetes mellitus (DM) are known to be prone to infection. However, the association between diabetes and chronic rhinosinusitis (CRS) has not been well studied. We sought to determine the effects of DM on CRS culture results and quality of life (QOL) after functional endoscopic sinus surgery (FESS).

Methods

We conducted a retrospective cohort study. Adult CRS patients undergoing FESS were recruited from October 1, 2007 to December 31, 2011. Patient demographics, comorbidities, medication use, and Lund-Mackay CT scores were collected prior to FESS. Intraoperative culture was obtained. Preoperative and 1-month, 3-month, and 6-month postoperative QOL was measured by scores on the 22-item Sinonasal Outcome Test (SNOT-22). A mixed effects model was performed for analysis.

Results

Among the 376 CRS patients included, 19 patients (5.05%) had DM. Compared to non-DM patients, DM patients were significantly more likely to have Pseudomonas aeruginosa (26.32% vs 7.56%; p = 0.004) and Gram-negative rods (26.32% vs 8.96%; p = 0.013), but there was no significant difference in the prevalence of Staphylococcus aureus; DM patients were also significantly more likely to have nasal polyps and gastroesophageal reflux disease. Additionally, DM patients had significantly less improvement of postoperative SNOT-22 scores from baseline to 6-month follow-up than non-DM patients (adjusted mean = 11.14, 95% CI (0.14, 22.15), p = 0.047) after adjusting for all the other risk factors for CRS.

Conclusion

DM patients may be prone to Gram-negative bacterial sinus infections, and have significantly worse short-term postoperative QOL. Special postoperative care may need to be considered in CRS patients with DM.

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