Oral steroids and intraoperative bleeding during endoscopic sinus surgery

Area of Science:

• Otolaryngology
• Surgical Innovation
• Pharmacology

Background:

• Chronic rhinosinusitis with nasal polyps (CRSwNP) often requires endoscopic sinus surgery (ESS).
• Optimizing intraoperative conditions, such as minimizing bleeding and improving surgical field quality, is crucial for successful ESS outcomes.
• The role of preoperative systemic corticosteroids in modifying intraoperative bleeding and surgical field quality in ESS remains debated.

Purpose of the Study:

• To evaluate the efficacy of preoperative oral corticosteroids in reducing intraoperative bleeding during ESS.
• To assess the impact of preoperative oral steroids on the quality of the surgical field in ESS.
• To determine if the osteitis score on computed tomography (CT) scans can predict intraoperative bleeding volume in ESS patients.

Main Methods:

• A double-blinded, randomized controlled trial involving 65 patients with CRSwNP.
• Patients received either oral prednisolone or a placebo for 2 days preoperatively.
• Intraoperative bleeding volume and surgical field quality (1-10 scale) were recorded; preoperative CT scans were scored for osteitis.

Main Results:

• No significant difference in mean bleeding volume between the corticosteroid group (239 ml) and the placebo group (203 ml) (p = 0.495).
• Surgical field quality scores were numerically higher in the corticosteroid group, but the difference was not statistically significant (p = 0.36).
• No significant correlation was found between osteitis scores and intraoperative bleeding volume in either group.

Conclusions:

• Preoperative oral corticosteroids are not indicated for reducing intraoperative bleeding or improving surgical field quality in ESS.
• The radiological osteitis score is not a reliable predictor of intraoperative bleeding volume in patients undergoing ESS.
• The potential for serious side effects associated with oral corticosteroids outweighs any perceived benefits in this context.