# Impact of biologicals on revision ESS numbers in CRSwNP in a tertiary care rhinology center

## TL;DR

Biologics have reduced the number of revision sinus surgeries for severe chronic rhinosinusitis with nasal polyps in a Belgian hospital since 2022.

## Contribution

This study provides the first data on how biologics impact revision endoscopic sinus surgery rates in patients with severe uncontrolled CRSwNP.

## Key findings

- The number of revision ESS procedures decreased from 66 in 2019 to 48 in 2023.
- The percentage of patients undergoing revision ESS dropped from 52% in 2019 to 30% in 2023.
- Primary ESS procedures remained stable despite the introduction of biologics.

## Abstract

Since 2022, several biologics are indicated and reimbursed for Belgian patients with severe uncontrolled CRSwNP despite previous endoscopic sinus surgery (ESS). Data on the impact of biologics on the number of patients undergoing revision ESS are lacking.

We analyzed the trend in numbers and percentages of patients with severe uncontrolled CRSwNP being offered primary ESS, revision ESS or biologics according to both academic- and reimbursement criteria at a tertiary care Rhinology center (University Hospitals Leuven) in Belgium, from 2019 until 2023.

A total of 641 patients with severe uncontrolled CRSwNP had been offered primary/revision ESS or biologics in the past 5 years. In contrast to the overall increase in annual numbers of CRSwNP patients treated for uncontrolled CRSwNP from 2019 (n = 128) until 2023 (n = 160) by ESS or biologics, the absolute number of patients undergoing revision surgery is reduced by the advent of biologics since 2022. Patient numbers undergoing revision ESS were 66 and 59 in 2019 and 2020 respectively, and 48 in 2023. Moreover, the percentage of patients undergoing revision surgery dropped from 52% and 56% in 2019 and 2020, respectively to 34% and 30% in 2022 and 2023, respectively. The percentage of primary ESS procedures remained stable.

The advent of biologics reduced the number and percentage of severe uncontrolled CRSwNP patients undergoing revision ESS, in contrast to number and percentage of primary ESS.