Incidence and Risk Factors for Toxic Shock Syndrome After Endoscopic Sinus Surgery: A Systematic Review

Area of Science:

• Otolaryngology
• Infectious Diseases
• Surgical Complications

Background:

• Toxic shock syndrome (TSS) is a rare but serious complication following sinonasal surgery.
• Previous reports on TSS after sinonasal surgery are primarily limited to case studies or small patient series.
• Nasal packing and prophylactic antibiotics are often considered in preventing TSS after sinonasal procedures.

Purpose of the Study:

• To systematically review and describe the incidence, risk factors, and clinical course of TSS following endoscopic sinus surgery (ESS) and/or septoplasty.
• To provide a comprehensive overview of TSS as a complication in sinonasal surgery.
• To identify potential risk factors and patient outcomes associated with TSS after ESS and/or septoplasty.

Main Methods:

• A systematic review of relevant literature was conducted using multiple major scientific databases (MEDLINE, EMBASE, CINAHL, Web of Science, Cochrane Library).
• Eligibility criteria included patients of any age who developed TSS as a complication of ESS and/or septoplasty.
• Data extraction focused on incidence, patient demographics, surgical details, management, and outcomes.

Main Results:

• The pooled incidence of TSS after sinonasal surgery was found to be 0.0003 (30 per 100,000 persons) over a 38-year period (1982-2020), with 70 identified cases.
• Among patients with available data, nasal packing was present in 51.5%, stents in 9.1%, and 42.4% had nonabsorbable packing.
• Prophylactic peri-operative antibiotics were administered to 48% of patients, and 97% of patients experienced full recovery.

Conclusions:

• The incidence of TSS following sinonasal surgery is exceedingly rare.
• TSS can occur irrespective of nasal packing, and prophylactic antibiotics were not found to be protective against its development.
• Early recognition and appropriate management of TSS lead to favorable patient outcomes, though further research is needed to identify high-risk individuals.