Advanced Age in Sinus Surgery: Diminished Symptom Gains but Enhanced Surgical Durability in Chronic Rhinosinusitis
Bibliographic record
Abstract
OBJECTIVE: To assess whether patients of advanced age with chronic rhinosinusitis (CRS) experience comparable symptom improvement and disease control following endoscopic sinus surgery (ESS) compared to younger patients. DATA SOURCES: Systematic searches were performed across PubMed, Embase, Web of Science, Scopus, and CENTRAL to May 2024. REVIEW METHODS: Following PRISMA guidelines, we included comparative studies with age-stratified cohorts reporting outcomes for CRS patients undergoing ESS. The primary outcome was symptom improvement measured by the 22-item Sinonasal Outcome Test (SNOT-22). Secondary outcomes were disease recurrence and revision rates. Meta-regression examined the influence of sex, preoperative symptom severity, nasal polyps, and prior ESS. RESULTS: Across the included studies, data from 3161 patients were analyzed. Advanced-age patients demonstrated significantly less SNOT-22 improvement than younger counterparts (SMD -0.36; 95% confidence interval [CI], -0.61 to -0.10; P = .01). Nevertheless, recurrence and revision rates were lower in the advanced-age group-12% and 3%, respectively-corresponding to a 50% reduction in combined risk (RR 0.50; 95% CI, 0.33-0.75; P < .001). Meta-regression identified male sex as a predictor of greater symptom improvement in advanced-age patients (β = 0.06, P = .03), whereas prior ESS was associated with diminished improvement (β = -0.05, P < .01). CONCLUSION: Patients of advanced age may experience less pronounced symptomatic improvement but lower recurrence and revision rates after ESS. These differences should be interpreted with caution, as they may reflect both surgical outcomes and other factors such as comorbidities or reoperation thresholds. Age alone should not preclude ESS, which remains an effective option when tailored to individual patient characteristics.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.016 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.004 | 0.006 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".