Are Endoscopic Sinus Surgery Complication Rates Improving Over Time and With the Adoption of Image Guidance?

Area of Science:

• Otolaryngology
• Surgical Innovation
• Patient Safety

Background:

• Endoscopic sinus surgery (ESS) is a common treatment for chronic rhinosinusitis (CRS).
• Established complication rates for ESS are often cited in literature and patient counseling.
• Advancements in surgical techniques and technology may influence modern complication rates.

Purpose of the Study:

• To evaluate contemporary complication rates following ESS.
• To assess trends in complications and intraoperative navigation system (IGS) use over time.
• To compare complication rates across different age groups.

Main Methods:

• A retrospective analysis of the TriNetX Research Network (2010-2023) was performed.
• Data included ESS complications such as CSF leak, orbital injury, and epistaxis.
• Complication rates and IGS trends were analyzed across two time periods (2010-2016 vs. 2017-2023) and age groups (pediatric, adolescent, adult).

Main Results:

• Major complications (CSF leak, orbital injury) rates were similar or improved compared to prior reports.
• Epistaxis and other perioperative complications exceeded 1%, indicating a need for attention.
• IGS use increased over time and was associated with lower CSF leak rates (0.8% vs. 0.95%) but higher epistaxis rates (2.5% vs. 2.1%).
• CSF leak rates were higher in patients under 18, while adults experienced higher epistaxis rates.

Conclusions:

• ESS complications remain low, but rising epistaxis rates warrant attention.
• Increased perioperative complications may be linked to worsening population health.
• IGS use is associated with a decreased risk of CSF leak.