The Completeness of Surgery Index Predicts Success in CRSwNP With Asthma by SNOT‐22 and Asthma Control Test

BACKGROUND: More extensive endoscopic sinus surgery (ESS) has been shown to correlate with better disease control for chronic rhinosinusitis with nasal polyps (CRSwNP). The Completion of Surgery Index (CoSI) is a recently developed radiologic scoring system that assesses the extent of surgery, where CoSI <70 (previous incomplete surgery) correlated with greater sino-nasal outcome test (SNOT-22) improvement after revision surgery. However, the benefit of complete surgery on asthma outcomes has not been defined. Here, we evaluated the impact of CoSI on SNOT-22 and Asthma Control Test (ACT) improvements after surgery in CRSwNP with asthma. METHODS: CRSwNP patients with asthma who underwent ESS between January 2018 and December 2023 were identified. Subjects were placed into two groups based on the preoperative CT scans: CoSI <70 (previous incomplete surgery) and CoSI 70 or greater (previous complete surgery). SNOT-22 and ACT data were collected at baseline and over 2 years postoperatively. RESULTS: Seventy CRSwNP patients with comorbid asthma underwent revision surgery, of which 49 (70.0%) patients had a preoperative CoSI <70. The CoSI <70 group had a greater average SNOT-22 improvement than the CoSI 70 or greater group from baseline to 2 years postoperatively (30.8 ± 20.5 vs. 20.4 ± 14.9, p = 0.042). In uncontrolled asthma, the average ACT improvement was significantly greater for the CoSI <70 group than the CoSI 70 or greater group (3.9 ± 2.2 vs. 0.88 ± 1.4, p = 0.029). CONCLUSION: Preoperative CoSI <70 was associated with significantly greater long-term improvements in SNOT-22 and ACT after revision surgery than CoSI 70 or greater group, supporting the need for complete surgery in CRSwNP with asthma.