Perioperative Steroids’ Effect on Surgery for Chronic Rhinosinusitis: the POSE Scoring System

I believe that this is important since objective endoscopic findings have been shown to be a significant predictor of recidivism and will precede a worsening of symptoms, he said.

Design of the Study

Patients selected for the study had failed maximal medical therapy and were scheduled to undergo ESS. They were randomized to receive either 30 mg of prednisone or placebo for five days preoperatively and nine days postoperatively. In addition to using the Lund-McKay staging system to collect operative and baseline clinical data, both the LKES and Dr. Wright’s POSE scale were used to collect data regarding mucosal health, the technical difficulty of surgery, and endoscopic readings. Data were collected at two weeks, one month, three months, and six months postoperatively.

A sample size of 24 was calculated to detect a clinically relevant difference between groups of 40 percent, Dr. Wright said, noting that routine statistical comparisons were performed as well as repeated measures analysis of variance with Bonferroni adjustment due to the multiple comparisons performed.

To address the study’s secondary objective of POSE validation, comparisons were performed between the POSE and LKES including assessment of sensitivity to change, correlation between the two scales, and correlation with symptoms scores.

Operative data demonstrated a significantly higher percentage of severely inflamed sinonasal mucosa in patients not pretreated with systemic steroids, which was associated with technically more difficult surgery in the estimation of the operating surgeon, Dr. Wright said.

Support for Systemic Steroids

In presenting his conclusions on the study, Dr. Wright told the COSM audience that in addition to supporting the practice of administering preoperative systemic steroids to patients, in the practice of surgeons who provide intensive postoperative care post-ESS including debridement and medical therapy based on the endoscopic findings, there is evidence to support administering systemic steroids in the postoperative period.

About the Awardee

Dr. Wright traveled to COSM from his new position at the University of Alberta. He said the emphases of his new sinus center are clinical (comprehensive care of the sinus patient, minimally invasive anterior skull base surgery); educational (training of residents and fellows); and research. His future career plans resolve around development of the centre into a world-class, multifaceted entity where we provide top-notch clinical care and education, as well as make the discoveries that will lead to enhancements in both, he said.

My main focus has previously been clinical work and clinical research, Dr. Wright continued. I spend about 70 percent of my time in my clinical work and about 30 percent in academic pursuits, including research. I enjoy the variety and the excitement of potential discovery and would not want to spend less time than that on the research.