Complications of primary and revision functional endoscopic sinus surgery for chronic rhinosinusitis

Abstract

Objective The goal of this study was to determine the incidence of major complications following primary and revision functional endoscopic sinus surgery (FESS). Additionally, this study aimed to determine factors associated with the occurrence of complications including patient and provider characteristics and the use of image guidance system (IGS) technology. Study Design Retrospective cohort analysis of California and Florida all-payer databases from 2005–2008. Methods The rates of major surgical complications (skull base, orbital, and hemorrhagic) after primary and revision FESS were calculated, and bivariate analyses were performed to investigate relationships of complications with demographic and clinical characteristics. A multivariate model was used to determine risk factors for the occurrence of major complications. Results Among 78,944 primary FESS cases, 288 major complications were identified representing a complication rate of 0.36% (95% CI 0.32%–0.40%). The major complication rate following revision cases (n = 19; 0.46%) and primary cases (n = 288; 0.36%) was similar (OR=1.26; 95% CI 0.79–2.00). Multivariate analysis showed that patients who were >40 years old, had a primary payer of Medicaid, had surgery involving the frontal sinus, or had image guidance during surgery were at higher risk for major complications. Conclusion The rate of major complications (0.36%) associated with primary FESS is lower than earlier reports. The rate of major complications following revision FESS (0.46%) was found to be similar to primary cases. IGS, insurance status, age, and extent of surgery were found to be associated with an increased risk of major complications following FESS.

Assessment of depth of olfactory fossa in pre-functional endoscopic sinus surgery computed tomography scan of paranasal sinuses

“…They include cerebrospinal fluid leak, ocular injury (herniation of orbital fat, extra-ocular muscle injury, ocular motility dysfunction, optic nerve injury, and periorbital hematoma or periorbital emphysema) and intracranial injury (brain or major blood vessels injury). 12 Hence an understanding of the anatomy of the paranasal sinuses and the common variants in this region is necessary. Among all the surgical complications that occur with endoscopic sinus surgery, ethmoidectomy was the most hazardous procedure in a study done by Dessi et al 13 Several studies, highlight the relevance of the evaluation of the ethmoidal roof and its value in the prevention of endoscopic surgery complications.…”

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

“…Similarly, Krings et al 1359 used a larger set of healthcare data to determine the rates of complications in 78,944 patients undergoing primary ESS as well as 4151 patients undergoing revision ESS during the years 2005 to 2008. The overall complication rates in patients undergoing primary ESS and revision ESS were 0.36% (288/78,944) and 0.46% (19/4151), respectively.…”

Age-Related Increased Prevalence of Asthma and Nasal Polyps in Chronic Rhinosinusitis and Its Association with Altered IL-6 Trans-Signaling

“…CRSwNP also affects quality of life in elderly patients and age may be one of the risk factors for major complications of endoscopic sinus surgery (6,7). Moreover, elderly patients with CRS usually have an age-related physiological impairment of olfaction and upper and lower respiratory function, often accompanied by other chronic illness, requiring additional therapies to be added to the numerous daily medications.…”