R. Dhamija1, N. Das1, P. Ding2 1Case Western Reserve University School Of Medicine, Cleveland, OH, USA 2Cleveland Clinic, Head And Neck Institute, Cleveland, OH, USA
Introduction:
Endoscopic Sinus Surgery (ESS) is a minimally invasive procedure indicated for patients with chronic sinusitis when other medical treatments, such as medications and nasal irrigation, have not provided sufficient relief. The primary goal of endoscopic sinus surgery is to remove blockages and improve the drainage of the sinuses. As with any surgical procedure, there are potential risks and complications. The purpose of this study is to report skull base, orbital, and hemorrhagic-associated complication rates following ESS.
Methods:
The study was performed using the TriNetX platform – a health research network containing real-time data from 59 U.S. healthcare organizations – which was queried using diagnostic and procedural codes to identify patients who have undergone ESS or Functional ESS following diagnosis of chronic sinusitis since 2003. Outcomes analyses were performed to determine incidence of skull base (CSF rhinorrhea, bacterial meningitis, dural tear), orbital (diplopia, optic nerve injury, blindness, epiphora, orbital hemorrhage, canthotomy/canthoplasty), and hemorrhagic (epistaxis, carotid artery injury, blood transfusion) complications within 30 days postoperatively. Kaplan-Meier Analysis was performed to assess survival probability following each type of postoperative complication.
Results:
105,716 patients from 52 healthcare organizations matched the search criteria. The average age at surgery was 48.8 ± 17.9 years. The gender distribution of the cohort was balanced at 51% female and 49% male. 1,111 patients experienced skull base complications, corresponding to a 1.05% risk. 1,439 patients experienced orbital complications, corresponding to a 1.36% risk. 3,318 patients experienced hemorrhagic complications, corresponding to a 3.14% risk. Kaplan-Meier Analysis revealed that survival probability was 98.9%, 98.6%, and 96.7% for patients who experienced skull base, orbital, and hemorrhagic postoperative complications, respectively.
Conclusions:
Overall, this study supports the existing consensus that ESS is a safe alternative for medical management of chronic sinusitis. Though complications following ESS on chronic sinusitis patients are rare, we found that hemorrhagic complications are more common than orbital and skull base complications. The findings of this study may inform otolaryngologists in counseling chronic sinusitis patients about the risks and benefits of Endoscopic Sinus Surgery.