Modeling Time-to-Recurrence of Chronic Rhinosinusitis Following Endoscopic Sinus Surgery Using Cox Proportional Hazards Regression at Abubakar Tafawa Balewa University Teaching Hospital, Bauchi State, Nigeria

Author

Adamu Ali, A. Abdulkadir, M. Bawa, A. Abubakar, S. Abdullahi, Z. Bala

Abstract

 This retrospective cohort study examined CRS recurrence following endoscopic sinus surgery (ESS) in 46 patients at ATBUTH, Bauchi State, Nigeria, over five years. Recurrence occurred in 13 patients (28.26%; 95% CI 17.32%–42.55%). Among 41 patients with complete survival data, recurrence-free survival declined from 100% at 6 months to 65.36% at 36 months and remained at that level through 60 months; median recurrence-free survival was not reached. No demographic, clinical, radiological, or laboratory factor was a statistically significant predictor of recurrence in univariate or multivariable Cox models (all p > 0.05). AERD (adjusted HR 2.497), smoking (adjusted HR 2.239), and IgE (adjusted HR 2.257; p = 0.059 in the parametric model) showed non-significant elevated hazard estimates. With 10 covariates and only 13 events (~1.3 events per variable), the model was substantially underpowered, so the null findings reflect limited statistical precision rather than evidence of no effect. The Cox model performed marginally better than the flexible parametric model (MSE 0.1791 vs 0.2004; lower AIC and BIC), and the proportional hazards assumption was not violated. The authors conclude that ESS yields favourable outcomes for most patients but recurrence affects roughly three in ten, and that AERD, smoking, and IgE warrant investigation in larger, adequately powered multicentre studies.

Keywords

Chronic Rhinosinusitis, Endoscopic Sinus Surgery, Recurrence, Survival Analysis, Cox Proportional Hazards

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