BackgroundEnvironmental 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.ObjectiveTo determine the effect of acute, peri-operative PM exposure on outcomes after endoscopic sinus surgery (ESS).MethodsParticipants 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.ResultsOne 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.ConclusionPreliminary 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.

中文翻译：

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围手术期急性颗粒物暴露对内窥镜鼻窦手术结果的影响：初步多部位调查


背景环境暴露被认为在慢性鼻窦炎（CRS）的病理生理学中发挥重要作用。颗粒物 (PM) 是研究最广泛的环境空气污染物之一，但其对 CRS 的围手术期影响尚不清楚。目的确定围手术期 PM 急性接触对内窥镜鼻窦手术 (ESS) 后结果的影响。方法参与者自我选择 ESS 的 CRS 患者被前瞻性纳入。记录了 22 项鼻腔结果测试 (SNOT-22) 和医疗结果研究问卷简式 6-D (SF-6D) 健康效用值分数。使用居住邮政编码，利用环境保护局空气质量监测器的数据，对手术当月患者接触 PM <2.5 μm 和 <10 μm（分别为 PM2.5 和 PM10）的情况进行了二次分析。 Spearman 相关系数 (ρ)、95% 置信区间 (CI) 和效应估计 (β) 用于确定关联程度。还完成了简单的多变量回归分析。结果来自美国四个地理位置独特的机构的 107 名患者入组，并进行了 6 个月的随访。使用单变量分析（ρ = 0.26，95% CI：0.08，0.43；P = .01）和通过多变量分析进行协变量调整后（B = 1.06，95% CI：0.001, 2.14，P = .05）。未发现 SF-6D 结果或与作为感兴趣暴露的 PM10 存在类似关联。围手术期 PM 水平与术后 Lund-Kennedy 内窥镜评分之间没有发现显着相关性。结论 这项试点研究的初步数据表明，ESS 时的 PM 暴露可能与术后鼻窦生活质量的改善呈负相关。需要进行更大规模、基于人群的研究以及更标准化的 PM 暴露窗口，以证实目前研究结果的临床意义。