Postoperative Recurrence in Allergic Fungal Rhinosinusitis: A Single Center Experience

Background Allergic fungal rhinosinusitis (AFRS) is a chronic inflammatory condition of the sinonasal mucosa with a propensity for postoperative recurrence despite surgical intervention. Understanding the factors contributing to recurrence is crucial for optimizing treatment outcomes. Study aim This retrospective cohort study aimed to assess demographic, clinical, pathological, and procedural factors associated with postoperative recurrence in AFRS patients undergoing functional endoscopic sinus surgery (FESS). Methodology Medical charts of 76 AFRS patients who underwent FESS between January 2008 and August 2021 at Prince Sultan Military Medical City in Riyadh, Saudi Arabia, were reviewed. Demographic data, clinical characteristics, comorbidities, surgical complications, histopathological findings, and postoperative outcomes were analyzed. Statistical analysis included the chi-square test and t-test. Results Relapse was observed in 42 (55.3%) patients. Significant predictors of relapse included younger age (24 ± 9 years in relapsing patients vs. 37 ± 17 years in non-relapsing patients, p < 0.001*), shorter time from presentation to surgery (229.8 ± 303.3 days in relapsing patients vs. 883.9 ± 1145.9 days in non-relapsing patients, p = 0.001*), and certain presenting symptoms such as facial swelling (p < 0.001*). Positive intraoperative cultures were more common in relapsing patients (73.3% vs. 36.4%, p = 0.029), and orbital extension was significantly associated with relapse (73.1% vs. 26.9%, p = 0.024). Surgical complications were more frequent among relapsing patients, although not statistically significant (85.7% vs. 52.2%, p = 0.089). Conclusions Our study highlights the multifactorial nature of postoperative recurrence in AFRS. Younger age, shorter time from presentation to surgery, specific severe presenting symptoms, positive intraoperative cultures, and orbital extension are significantly associated with higher relapse rates in AFRS patients. These findings highlight the need for tailored management strategies to reduce relapse rates, including aggressive and prolonged medical therapy, comprehensive preoperative assessments, and meticulous surgical and postoperative care.