Approximately 25% of patients with chronic rhinosinusitis (CRS) have recurrence after endoscopic sinus surgery (ESS). The goal is to analyze and integrate research on individual and genetic factors of recurrence in CRS patients following ESS. A systematic review and meta-analysis were performed using PRISMA criteria. Various databases were searched from January 2008 to May 2025. ESS studies with adults with CRS reported results based on clinical or genetic factors. The Newcastle–Ottawa Scale and five dimensions of bias were examined study quality. Pooled odds ratios with 95% confidence intervals were estimated using a random-effects DerSimonian–Laird model. Heterogeneity was assessed using I 2 , publication bias using funnel plots and Egger test, and evidentiary certainty using GRADE. A total of 17 trials with 40,059 individuals were examined. Asthma, non-steroidal antiinflammatory drug (NSAID) intolerance, allergy, and higher Lund–Mackay scores (LMSs) were significant clinical predictors of recurrence. TAS2R38 polymorphisms had poorer outcomes, but only 4 trials were included. Asthma, NSAID intolerance, allergy, higher LMS, and TAS2R38 polymorphisms are significant predictors of recurrence in CRS following ESS. These results support the use of comorbidities, radiologic severity, and genetic biomarkers in preoperative risk classification, emphasizing the need for larger, standardized, and multi-ethnic research.