International Rhinologic Society Rhinology 0300-0729 2026 06 04 Assessment of the extent of previous endoscopic sinus surgery using the ACCESS score in patients with chronic rhinosinusitis referred to tertiary care rhinologic clinics EN M. LazzeroniDepartment of Otorhinolaryngology and Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy R. Hoven Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands E. de Corso Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy C. Montuori Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy A.R. Sedaghat Department of Otolaryngology – Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA A. Sarafidou Department of Otorhinolaryngology, Head and Neck Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece J. Constantinidis Department of Otorhinolaryngology, Head and Neck Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece C. Hopkins Department of Otolaryngology-Head and Neck Surgery, Guy’s and St. Thomas’ Hospitals, London, United Kingdom B.R. Castro Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, CA, USA Z. Patel Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, CA, USA P. Capaccio Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy W.J. Fokkens Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands S. Reitsma Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands Journal Article 3418 10.4193/Rhin25.236 BACKGROUND: Despite optimal medical and surgical therapy, many patients suffering from chronic rhinosinusitis (CRS) experience continuous inflammation for which revision surgery can be indicated. The present work was set out to investigate the extent of prior endoscopic sinus surgery (ESS) performed in CRS patients referred to tertiary rhinologic centers for revision surgery in Western countries. METHODS: A retrospective multicenter study was conducted including patients with any (pheno)type of diffuse CRS, who had undergone at least one prior ESS. All patients had a sinus computed tomography (CT) scan performed before their revision surgery which was used to retrieve the Amsterdam classification of completeness of ESS (ACCESS) scores, which range from 0 (sinuses functionally opened) to 24 (no sinus opening). RESULTS: 114 patients from 6 different centers were included. The median ACCESS score was 12 (7-17). Most patients had only one previous ESS (70/114, 61%), while 24 (21%) had 2 previous surgeries, 13 (11.4%) patients had three, and 7 (6%) patients had four or more. Median ACCESS scores by number of previous ESS were: 13 (6-16) for one prior surgery, 12 (7-18) for two, 10 (8-13) for three, and 6 (3-13) for four or more surgeries. Multivariate linear regression analysis showed small changes in the patient’s ACCESS score in relation to their number of previous surgeries. CONCLUSIONS: Our study underscores a large heterogeneity in extent of prior ESS among patients referred to tertiary rhinologic centers for diffuse CRS, regardless of the number of previous surgeries