Effectiveness of surgical management of epistaxis at a tertiary care center

A retrospective review is presented of 44 consecutive patients requiring hospitalization for epistaxis at a tertiary care center. The study had the following objectives: 1. to identify predictors of surgical treatment, and 2. to compare the effectiveness of different surgical treatments. Length of stay, complications, and cost analysis are also presented. Eighteen patients were successfully treated nonsurgically, whereas 26 patients received surgical treatment. Posterior epistaxis (P<0.05) and an admission hematocrit less than 38% (P<0.05) were significant predictors of surgical treatment. The rebleed rate after first surgical therapy was 33% for embolization, 33% for endoscopic cautery, and 20% for ligation. Since embolization, ligation, and endoscopic cautery may have nearly equivalent failure rates, other factors, such as cost and institutional expertise, should guide the selection of surgical treatment.