{"doi":"10.1002/lary.32456","title":"Immunodeficiency and Surgical Outcomes in Chronic Rhinosinusitis","abstract":"Immune deficiencies are more prevalent among patients with chronic rhinosinusitis (CRS) [1-7]. Given the recalcitrant nature of CRS in this population, many eventually require endoscopic sinus surgery (ESS). Although prior studies have demonstrated objective and patient-reported improvement following ESS in patients with immune dysfunction, large-scale data on associated complications and healthcare burden remain limited [8-12]. This study aims to evaluate postoperative outcomes and healthcare utilization among immunocompromised patients with CRS undergoing ESS utilizing a large multicenter database. This retrospective cohort study utilizing TriNetX analyzed adults diagnosed with CRS who underwent ESS, identified using procedural codes from prior studies (Table S1) [13]. Patients were included if they met inclusion criteria within 20 years of analysis and were followed for five years postoperatively. Cohorts were stratified by immunocompromised status, defined as receipt of immunomodulatory therapy or diagnosis of primary immunodeficiency (PID), autoimmune disease, or hematologic malignancy prior to ESS. Patients with sinonasal malignancy were excluded. Patients were matched on age, sex, race, and nasal polyp diagnosis. A sensitivity analysis was conducted using mutually exclusive subgroups assigned hierarchically: (1) Patients who received immunomodulatory therapy within six months of ESS regardless of diagnosis, (2) patients with PID and no recent immunomodulatory therapy, and (3) patients with autoimmune disease and neither PID nor recent immunomodulatory therapy. This study was deemed IRB-exempt by the University of Southern California due to the use of de-identified data. Demographic characteristics are summarized in Table S2. In the week following ESS, immunocompromised patients had higher odds of hospital admission (OR 1.20, 95% CI 1.16–1.24), cerebrospinal fluid (CSF) leak (OR 1.24, 95% CI 1.03–1.50), meningitis (OR 1.95, 95% CI 1.33–2.86), and blood transfusion (OR 2.19, 95% CI 1.68–2.85). They also demonstrated increased risk of acute sinusitis (OR 1.26, 95% CI 1.19–1.34), antibiotic use (OR 1.21, 95% CI 1.17–1.25), and oral steroid use (OR 1.11, 95% CI 1.07–1.16) in that timeframe. Within one month, immunocompromised patients were more likely to present to the emergency department (ED) (OR 1.48, 95% CI 1.35–1.63), and over five years, they had an increased likelihood of revision ESS (OR 1.16, 95% CI 1.10–1.23) (Table 1). Subgroup analysis revealed that patients receiving immunomodulatory therapy exhibited elevated risk across all outcomes, with significantly higher odds of hospital admission, CSF leak, and meningitis. These associations were not significant in the PID or autoimmune disease groups. Sensitivity analysis similarly revealed elevated risk of hospital admission, CSF leak, and meningitis limited to the immunomodulatory therapy group. The risk of revision ESS, however, remained elevated across all subgroups (Table S3). Immunocompromised patients with CRS who underwent ESS had an increased risk of postoperative complications and healthcare utilization, an association consistent across subgroup analyses. Elevated risk of acute sinusitis and antibiotic and steroid use may reflect greater susceptibility to postoperative infection and inflammation in this population; for example, patients with PID have been reported to require more frequent, longer, or culture-directed antibiotic courses, likely due to refractory disease driven by immune dysfunction [5, 7]. The increased risk of ED visits highlights the importance of close postoperative monitoring to enable earlier identification and management of complications, potentially reducing reliance on emergency care. The increased risk of revision ESS suggests that standard surgical approaches may yield less durable outcomes in this group, reinforcing the need for tailored perioperative management strategies, potentially including more extensive surgery or postoperativ","journal":"The Laryngoscope","year":2025,"id":545717,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9673,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1437449,"name":"Corey Karp","orcid":null,"position":1,"is_corresponding":false},{"id":246813,"name":"Kevin Hur","orcid":"0000-0001-7016-4375","position":2,"is_corresponding":false},{"id":1328537,"name":"Jaynelle Gao","orcid":"0000-0002-1853-4460","position":0,"is_corresponding":true}],"reference_count":18,"raw_metadata":null,"created_at":"2026-07-19T02:53:27.751050Z","pmid":"40747720","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}