Avoiding Complications in Endoscopic Sinus Surgery

Humphreys, Ian; Hwang, Peter H.

doi:10.1016/j.otc.2015.05.013

Cited by 19 publications

(19 citation statements)

References 42 publications

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“…The current overall rate of complications in ESS is thought to be 3% to 5%. 26 When compared with this expected frequency, the adverse event rate for our total patient sample is quite high at 19.0%. A number of factors could account for this.…”

Section: Discussionmentioning

confidence: 74%

Implications of Obesity on Endoscopic Sinus Surgery Postoperative Complications: An Analysis of the NSQIP Database

Wardlow

Bernstein

Orlov

et al. 2020

Otolaryngol.--head neck surg.

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Objective To evaluate the influence of body mass index on postoperative adverse events in adult patients undergoing endoscopic sinus surgery. Study Design Retrospective cohort study. Setting Database of the American College of Surgeons NSQIP (National Surgical Quality Improvement Program) from 2006 to 2018. Methods The NSQIP database was queried for adult patients undergoing endoscopic sinus surgery. The total sample (N = 1546) was stratified by nonobese (18.5 kg/m2≤ body mass index <30 kg/m2) and obese (≥30 kg/m2). Demographics, comorbidities, intraoperative variables, and postoperative adverse events were compared via chi-square analysis and multivariable logistic regression. Results Obese patients accounted for 49.7% (n = 768) of the cohort. Obese patients had a higher American Society of Anesthesiologists classification (class III, 45.1% vs 29.5%; P < .001), rate of diabetes (18.2% vs 7.2%, P < .001), and rate of hypertension requiring medication (43.1% vs 23.0%, P < .001). Nonobese patients were more likely to be >58 years of age (23.4% vs 29.0%, P = .02) and have disseminated cancer (<1% vs 3.2%, P < .001). The obese cohort had a lower frequency of surgical complications (3.0% vs 5.4%, P = .027), driven by frequency of perioperative bleeding (1.8% vs 3.7%, P = .022). There was no statistical difference in medical complications ( P = .775), unplanned readmissions ( P = .286), unplanned reoperations ( P = .053), or 30-day mortality ( P > .999). After multivariable adjustment, obese subjects had decreased odds of any surgical complication (adjusted odds ratio [aOR], 0.567; 95% CI, 0.329-0.979), perioperative bleeding (aOR, 0.474; 95% CI, 0.239-0.942), and any adverse postoperative event (aOR, 0.740; 95% CI, 0.566-0.968). Conclusion Obesity does not increase the risk of 30-day adverse outcomes following endoscopic sinus surgery and may even be protective against perioperative bleeding.

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Section: Discussionmentioning

confidence: 74%

Implications of Obesity on Endoscopic Sinus Surgery Postoperative Complications: An Analysis of the NSQIP Database

Wardlow

Bernstein

Orlov

et al. 2020

Otolaryngol.--head neck surg.

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“…Some patients described unbearable pain, while others experienced little to no discomfort. Demonstrations of post-operative care were problematic, at times including practices contrary to typical medical advice, including frequent nose-blowing, 16 application of external ice packs as a primary method for controlling epistaxis, and use of tap rather than distilled water in high volume saline irrigations. 17 As there is a rare but serious risk of fatal Naegleria fowleri infection related to sinonasal irrigation with tap or well water, 18 such inaccuracies, while easily overlooked by patients, could have potentially devastating consequences.…”

Section: Discussionmentioning

confidence: 99%

Sinus Surgery: Analysis of Videos Available Online

Uyesugi

Moldowan

Bradbrook

et al. 2021

Allergy�Rhinol (Providence)

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Objectives YouTube is the second most visited website in the world and can be a useful resource for patients to gain insight into surgical procedures. A multitude of studies have evaluated the quality of otolaryngology-specific healthcare information available on the YouTube platform, but to our knowledge, the online content regarding functional endoscopic sinus surgery available on this site has not been systematically evaluated. Study Design Cross sectional study. Setting Online. Methods YouTube was searched using the keywords “sinus surgery.” Variables including video length, total number of views, authorship (academic, private practice physician, patient, or third party), objective (advertisement, informative, or patient perspective), inclusion of intra-operative footage, and discussion of balloon sinuplasty were recorded and analyzed by a single reviewer. Results Two-hundred twenty-two videos met inclusion criteria, with a median length of 4 minutes, and a median of 3349 views. The majority of videos were informative (n = 145, 65%), narrated (n = 151, 68%), and did not mention balloon sinuplasty (n = 189, 85%) nor contain intra-operative footage (n = 116, 52%). Private practice physicians were the most common authors (n = 113, 51%), followed by patients (n = 70, 32%), third parties (n = 28, 13%) and academics (n = 11, 5%). Conclusions Sinus surgery is one of the most common ambulatory procedures performed. Online resources such as YouTube can be useful for improving health literacy and patient comfort with medical topics such as functional endoscopic sinus surgery, but it is important for clinicians and patients to understand that there is a spectrum in the authorship, content, and quality of sinus surgery related videos posted online.

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“…[1][2][3] One of the core tenets of postoperative care after ESS has been to restrict patients from nose blowing in the days or weeks following ESS. 3 Concerns regarding nose blowing after surgery often relate to its potential to instigate bleeding or cause air to transgress into the skull base or orbit. A casual review of institutional websites suggests that most surgeons advise patients to refrain from nose blowing for periods ranging from 3 days to 2 weeks following ESS.…”

Section: Introductionmentioning

confidence: 99%

“…Since endoscopic sinus surgery (ESS) was first described, a number of technical innovations have transformed the capabilities of sinus surgeons, yet recommendations regarding optimal postoperative care have remained relatively static . One of the core tenets of postoperative care after ESS has been to restrict patients from nose blowing in the days or weeks following ESS . Concerns regarding nose blowing after surgery often relate to its potential to instigate bleeding or cause air to transgress into the skull base or orbit.…”

Section: Introductionmentioning

confidence: 99%