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Keywords

Modified Lund-Kennedy score, Endoscopic sinus surgery, Pre-operative evaluation, Surgical outcome, Prediction, Success, Quality of life

Abstract

Background: Currently, there is no pre-operative parameters which can predict operative outcome of endoscopic sinus surgery. In this study, we evaluated the efficacy of the Modified Lund-Kennedy (MLK) endoscopic score as a predictor for significant symptom
improvement (SSI) after surgery.
Method: We performed retrospective review of 293 patients who underwent endoscopic sinus surgery for chronic rhinosinusitis at the Stanford Sinus Center from 2015 to 2018. Demographic data, duration of disease, and pre- and post-operative SNOT-22 scores were reviewed. Pre-operative MLK endoscopic score, and Lund-Mackay CT score were also collected. We defined SSI after surgery as a postoperative improvement > 9 in the SNOT-22 score, the MCID.
Result: The median MLK score in the SSI group was 4 versus 2 in the non-SSI group. On average, for every one point increase in the MLK, there was a 2% increase in rate of achieving SSI (P < 0.05). The likelihood of achieving SSI varied differentially within subsets of MLK scores. For MLK scores ≤ 2, each one point increase in MLK score was associated with a nonsignificant 0.2% decrease in the SSI rate. The greatest improvement in SSI rate was observed between MLK scores of 2 and 3, with a 14.62% increase in the SSI rate. For every one point increase in the MLK scores ≥ 3, there was a 1.11% increase in SSI rate (P < 0.05).
Conclusion: Pre-operative MLK score correlates with SSI after ESS. A MLK score of 3 appears to be an important breakpoint for higher rates of achieving SSI after ESS.

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