Oral steroids and intraoperative bleeding during endoscopic sinus surgery

Our main objective was to investigate the effect of preoperative oral steroids on intraoperative bleeding and quality of the surgical field during endoscopic sinus surgery (ESS). Our second objective was to determine whether the osteitis score could be used to predict the volume of intraoperative bleeding.

This double-blinded, randomized trial included 65 patients with chronic rhinosinusitis with nasal polyps. The corticosteroid group received oral prednisolone (1 mg/kg), administered to patients once daily for 2 days and then tapered down, with treatment completed on the day 10. The control group received placebo before the operation. Endoscopic exams were recorded, and preoperative sinus computed tomography scans were scored. Intraoperative blood loss was recorded. Quality of the surgical field was assessed by the surgeon, using a linear scale from 1 to 10.

The mean bleeding volume was 239 ml in the corticosteroid group and 203 ml in control group. There was no significant difference between the groups (p = 0.495). Surgical field quality scores were higher in the corticosteroid group than in the control group, but the difference was not significant (p = 0.36). There was no statistically significant relationship between the bleeding volume and Kennedy Osteitis Scores in corticosteroid group (r = 0.225, p = 0.186) and control group (r = 0.084, p = 0.663).

Our findings suggest that using oral corticosteroids, which have rare but serious side effects, is not necessary in the preoperative period. Furthermore, we found that the radiological osteitis score was not a suitable marker for predicting intraoperative bleeding volumes.