Postoperative Infection Rate and Associated Factors Following Endoscopic Sinus Surgery

Objectives: There is a paucity of data on postoperative infections after endoscopic sinus surgery and associated risk factors. Our objective was to evaluate a cohort of patients undergoing endoscopic sinus surgery (ESS) for chronic rhinosinusitis to determine which perioperative factors may be associated with infection in the 30-day postoperative period. Methods: A retrospective cohort study of adults who underwent ESS at a tertiary academic medical center from 2015 to 2018 was performed. The primary outcome was incidence of postoperative infection, defined by identification of sinus purulence on nasal endoscopy necessitating antibiotics within 30 days of surgery. Independent variables collated included the result of postoperative cultures and use of perioperative antibiotics, oral corticosteroids, packing, and steroid-eluting stents. Statistical analysis involved bivariate analysis to identify variables that correlated with postoperative infection and subsequent multivariate logistic regression to identify independent risk factors. Results: Three hundred seventy-eight unique ESS cases performed in 356 patients were reviewed. The mean age was 46 years (range, 18-87). The most common indication for surgery was chronic rhinosinusitis without nasal polyposis. The postoperative infection rate was 10.1%. The most commonly cultured pathogen was Staphylococcus aureus. Multivariate logistic regression analysis showed that postoperative systemic corticosteroid use was the only risk factor independently associated with infection (OR 3.47 [95% CI 1.23-9.76], P = .018). Conclusion: The incidence of postoperative infection following ESS was 10.1%. The use of postoperative systemic corticosteroids independently increased the risk of infection by 3.47-fold.

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Risk factors for postoperative bleeding after endoscopic sinus surgery to treat chronic rhinosinusitis

Acta Oto-Laryngologica ◽

10.1080/00016489.2021.1878276 ◽

2021 ◽

Vol 141 (4) ◽

pp. 392-396

Author(s):

Xuemei Qin ◽

Qing Sun ◽

Guohui Chen ◽

Jian Liu ◽

Tianle Gao ◽

...

Keyword(s):

Risk Factors ◽

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Postoperative Bleeding ◽

Sinus Surgery

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Risk factors of recurrent chronic rhinosinusitis after functional endoscopic sinus surgery

Saudi Journal of Otorhinolaryngology Head and Neck Surgery ◽

10.4103/sjoh.sjoh_4_19 ◽

2019 ◽

Vol 21 (2) ◽

pp. 33

Author(s):

WaleedAbdullah Mohsenh ◽

RaneemAbdulaziz Aljthalin ◽

RaseelAbdulaziz Aljthalin ◽

Sameer Al-Bahkaly

Keyword(s):

Risk Factors ◽

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery

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Office-Based Sinus Surgery for Cystic Fibrosis Chronic Rhinosinusitis

ORL ◽

10.1159/000512495 ◽

2020 ◽

pp. 1-4

Author(s):

Daniel B. Spielman ◽

David A. Gudis

Keyword(s):

Cystic Fibrosis ◽

Mechanical Ventilation ◽

Chronic Rhinosinusitis ◽

Local Anesthesia ◽

Endoscopic Sinus Surgery ◽

Care Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Sinus Surgery ◽

Office Setting

Objective: Chronic rhinosinusitis (CRS) is nearly ubiquitous in the cystic fibrosis (CF) population, and many patients require multiple endoscopic sinus surgeries throughout their lifetime. Recent studies have demonstrated the profound pulmonary and systemic health benefits of comprehensive CRS treatment. Both endotracheal intubation with mechanical ventilation and inpatient hospital care represent significant risks for CF patients. The goal of this study is to evaluate the safety and feasibility of performing revision endoscopic sinus surgery for CF patients in the outpatient office setting using only local anesthesia to decrease the need for mechanical ventilation and inpatient hospitalization. Methods: This is a prospective cohort study conducted at a tertiary care academic medical center with a CF Foundation-accredited care center. Patients with CF and refractory CRS despite prior surgery and medical therapy were eligible for inclusion. Comprehensive revision ESS was performed in the office using only local anesthesia. Results: Five patients were enrolled and underwent revision endoscopic sinus surgery without complication. The average preoperative Sinonasal-Outcome Test-22 score was 52.0 ± 12.1 and the average preoperative Lund-Mackay score was 15.2 ± 3.8. No patients requested aborting the procedure early due to pain, discomfort, or any other reason. No subjects required prolonged observation or postoperative hospital admission. Conclusion: This prospective pilot study is the first to demonstrate the safety and feasibility of performing comprehensive revision endoscopic sinus surgery for CF patients in the outpatient office setting using only local anesthesia.

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Risk Factors for Complications of Endoscopic Sinus Surgery for Chronic Rhinosinusitis

American Journal of Rhinology and Allergy ◽

10.2500/ajra.2012.26.3711 ◽

2012 ◽

Vol 26 (1) ◽

pp. 61-64 ◽

Cited By ~ 26

Author(s):

Daiya Asaka ◽

Tsuguhisa Nakayama ◽

Takanori Hama ◽

Tetsushi Okushi ◽

Yoshinori Matsuwaki ◽

...

Keyword(s):

Risk Factors ◽

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Sinus Surgery

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Risk factors for complications of endoscopic sinus surgery for Chronic rhinosinusitis

Sleep Medicine ◽

10.1016/j.sleep.2019.11.1099 ◽

2019 ◽

Vol 64 ◽

pp. S395

Author(s):

A. Uzokov ◽

X. Shayhova

Keyword(s):

Risk Factors ◽

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Sinus Surgery

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Chronic Rhinosinusitis: Risk Factors for the Recurrence of Chronic Rhinosinusitis Based on 5-Year Follow-Up after Endoscopic Sinus Surgery

International Archives of Allergy and Immunology ◽

10.1159/000126066 ◽

2008 ◽

Vol 146 (1) ◽

pp. 77-81 ◽

Cited By ~ 97

Author(s):

Yoshinori Matsuwaki ◽

Tetsushi Ookushi ◽

Daiya Asaka ◽

Eri Mori ◽

Tsuneya Nakajima ◽

...

Keyword(s):

Risk Factors ◽

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Sinus Surgery

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Risk Factors of Chronic Rhinosinusitis After Functional Endoscopic Sinus Surgery

Medical Science Monitor ◽

10.12659/msm.900421 ◽

2017 ◽

Vol 23 ◽

pp. 1064-1068 ◽

Cited By ~ 4

Author(s):

Feng Juan ◽

Qukuerhan Ayiheng ◽

Fan Yuqin ◽

Zhang Hua ◽

Yong Jun ◽

...

Keyword(s):

Risk Factors ◽

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery

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What is the optimal outcome after endoscopic sinus surgery in the treatment of chronic rhinosinusitis? A consultation of Canadian experts

Journal of Otolaryngology - Head and Neck Surgery ◽

10.1186/s40463-021-00519-9 ◽

2021 ◽

Vol 50 (1) ◽

Author(s):

Nadim Saydy ◽

Sami P. Moubayed ◽

Marie Bussières ◽

Arif Janjua ◽

Shaun Kilty ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Patient Reported Outcome ◽

Sinus Surgery ◽

Structured Interviews ◽

Subjective Data ◽

Operative Outcomes ◽

Patient Reported ◽

Definition Of Success ◽

Reported Data

Abstract Objectives Many experts feel that in the absence of well-defined goals for success, they have an easier time identifying failure. As success ought to not be defined only by absence of failure, we aimed to define optimal outcomes for endoscopic sinus surgery (ESS) in chronic rhinosinusitis (CRS) by obtaining expert surgeon perspectives. Methods A total of 12 surgeons participated in this targeted consultation. Face to face semi-structured interviews were performed with expert surgeons in the field of CRS and ESS. General impressions and personal definitions of acceptable operative success and optimal operative outcomes were compiled and summarized. Results According to an expert survey, patients’ main objectives are an improvement in their chief complain, a general improvement in quality of life (QoL), and a better overall symptomatic control. The most important aspects of endoscopy for defining a successful intervention were an adequate mucus circulation, a healthy mucosa, minimal edema, and patency of all explored cavities or ostia. In the assessment of surgical outcomes, it was determined that both objective and patient reported data must be carefully examined, with more attention given to subjective outcomes. Conclusions According to data gathered from a Canadian expert consultation, a definition of success must be based on both subjective data and nasal endoscopy. We propose to define an acceptable outcome as either a subjective improvement of at least the minimal clinically improvement difference of a validated patient reported outcome questionnaire, along with a satisfactory endoscopic result (1) or a complete subjective resolution with a sub-optimal endoscopy (2). Graphical abstract

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Desmopressin effects on bleeding during functional endoscopic sinus surgery on patients with chronic rhinosinusitis

American Journal of Otolaryngology ◽

10.1016/j.amjoto.2021.103024 ◽

2021 ◽

pp. 103024

Author(s):

Fatemeh Hajimohamadi ◽

Jawad Hosseini ◽

Farrokh Heidari ◽

Sepideh Alvandi ◽

Shahin Bastaninezhad ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery

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Short-Term Outcomes Following Removal of Infected Hernia Mesh

The American Surgeon ◽

10.1177/00031348211024189 ◽

2021 ◽

pp. 000313482110241

Author(s):

Christine Tung ◽

Junko Ozao-Choy ◽

Dennis Y. Kim ◽

Christian de Virgilio ◽

Ashkan Moazzez

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Logistic Regression ◽

Body Mass ◽

Smoking History ◽

Multivariate Logistic Regression ◽

Short Term ◽

Mesh Removal ◽

Mesh Placement ◽

Infected Mesh

There are limited studies regarding outcomes of replacing an infected mesh with another mesh. We reviewed short-term outcomes following infected mesh removal and whether placement of new mesh is associated with worse outcomes. Patients who underwent hernia repair with infected mesh removal were identified from 2005 to 2018 American College of Surgeons-National Surgical Quality Improvement Program database. They were divided into new mesh (Mesh+) or no mesh (Mesh-) groups. Bivariate and multivariate logistic regression analyses were used to compare morbidity between the two groups and to identify associated risk factors. Of 1660 patients, 49.3% received new mesh, with higher morbidity in the Mesh+ (35.9% vs. 30.3%; P = .016), but without higher rates of surgical site infection (SSI) (21.3% vs. 19.7%; P = .465). Mesh+ had higher rates of acute kidney injury (1.3% vs. .4%; P = .028), UTI (3.1% vs. 1.3%, P = .014), ventilator dependence (4.9% vs. 2.4%; P = .006), and longer LOS (8.6 vs. 7 days, P < .001). Multivariate logistic regression showed new mesh placement (OR: 1.41; 95% CI: 1.07-1.85; P = .014), body mass index (OR: 1.02; 95% CI: 1.00-1.03; P = .022), and smoking (OR: 1.43; 95% CI: 1.05-1.95; P = .025) as risk factors independently associated with increased morbidity. New mesh placement at time of infected mesh removal is associated with increased morbidity but not with SSI. Body mass index and smoking history continue to contribute to postoperative morbidity during subsequent operations for complications.

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