Obesity and Its Impact on Endoscopic Sinus Surgery Outcomes in Patients With Chronic Rhinosinusitis With Nasal Polyps

Purpose: The rising prevalence of obesity introduces challenges in surgical contexts, including endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP). However, the impact of obesity on ESS outcomes remains underexplored. This study aims to evaluate the association between obesity and surgical complexity, operative duration, postoperative quality of life (QOL), in patients with CRSwNP undergoing ESS. Methods: A retrospective analysis was conducted on 310 adult patients who underwent ESS for CRSwNP at a tertiary medical center between 2013 and 2023. Patients were categorized into two groups: Nonobese (BMI < 30 kg/m²) and obese (BMI ≥ 30 kg/m²). Outcomes assessed included operative time, postoperative complications, and QOL using the Sinonasal Outcome Test (SNOT-22). Results: Of the 310 patients, 62 (20%) were obese. Obese patients had significantly higher preoperative Lund–Mackay scores (18.5 ± 4.7 vs. 16 ± 5.5, p = 0.036), longer operative durations (179 ± 61 vs. 162 ± 59 min, p = 0.034), and worse postoperative SNOT-22 scores (38 ± 26 vs. 24 ± 22, p = 0.041) compared to nonobese patients. However, only six obese patients completed paired pre- and postoperative snot-22 data. They were also more likely to require prolonged oral steroid use (> 3 months) (37% vs. 21%, p = 0.013) and biological treatments (21% vs. 8%, p = 0.01). No significant differences were observed in immediate postoperative complications or hospital stays. Conclusion: Obesity was not associated with increased surgical risk or delayed recovery following ESS for CRSwNP. However, obese patients had more severe disease and achieved less symptom improvement, highlighting the need for tailored postoperative care and adjunct therapies to optimize outcomes.