Sinus surgery complications unaffected by surgical experience
MedWire News: Endoscopic sinus surgery (ESS) can be performed with comparable complication rates by surgical residents and senior surgeons, suggest study findings.
The study also showed that extensive surgeries, revision surgery, and presence and grade of polyposis are associated with an increased rate of complications.
To estimate the incidence of complications in ESS in a surgical center with 20 years' experience, Ricardo Ribeiro (Santo Antonio Hospital, Porto, Portugal) and colleagues reviewed clinical data of 667 patients treated during 2006 to 2009. Perioperative and postoperative complications were evaluated with a minimum follow-up period of 3 months.
Patients had an average symptom duration of 3.62 years, with the average time between the first consultation and surgery 15.52 months. The most common symptom at presentation was nasal obstruction, which was observed in 89.2% of patients.
Nasal neoformations were present in 30.6% of patients, with the remaining 470 patients showing simple chronic rhinosinusitis. Inflammatory polyposis was present in 178 patients, as were antrochoanal polyps in 16 patients, and inverted nasal papilloma in 13 patients.
Major and minor complications were seen in 1.48% and 5.91% of patients, with 1.62% reported as orbital complications, 0.44% intracranial complications, 2.51% bleeding complications, and 2.81% as "other."
No significant association was seen between surgical experience and the presence and type of complications. In surgeries performed by residents (average 1.55 years' experience) and nonresidents (average 7.62 years' experience), minor complication rates were 4.60% and 6.36%, respectively, and major complication rates were 1.72% and 1.39%.
Analysis of surgical characteristics and complications showed that the more extensive the polyposis, the higher the complication rate was. Furthermore, the rate of complications was greater in revision cases relative to primary cases for both minor (10.00 vs 5.34%) and major (2.86 vs 1.39%) complications. A higher rate of complications was observed when a greater number of procedures were performed.
"A careful and systematic preoperative evaluation, based on information obtained by radiological examinations is always mandatory and in the most difficult cases, mainly in surgical revision, ESS image-guided can be an important tool, minimizing the surgical risks," conclude the researchers in Auris Nasus Larynx.
By Ingrid Grasmo