Twenty-eight studies were included in the review (n=3,427, range 19 to 1,240), although three were excluded from the analysis due to disproportionately large effect sizes. Most were prospective cohort studies of consecutive patients.
There was a significant improvement in fatigue following endoscopic sinus surgery 0.77 (95% confidence interval (CI): 0.59, 0.95, p<0.001) (25 studies), but there was a high level of between-study heterogeneity (I2=90%).
Subgroup analyses for 11 studies yielded a moderate combined effect change in vitality scores of 0.47 (95% CI: 0.38, 0.56) with no heterogeneity (I2=0%). No publication bias was evident. Sensitivity analysis showed that the combined effect size for these studies was robust. Subgroup analyses for studies reporting by symptom rating yielded a combined effect of 0.97 (95% CI: 0.65, 1.29) with substantial heterogeneity (I2=95%). Results by visual analog scale (VAS) scores yielded a combined effect of 0.82 (95% CI: 0.68, 0.96) with low heterogeneity (I2=36%).