Postoperative evaluation and efficiency of functional sinus surgery: a meta-analysis

Background Previous studies and meta analyses have led to incongruent and incomplete results respectively when total intravenous anesthesia (TIVA) and inhalational anesthesia (IA) are compared in endoscopic sinus surgeries in regards to intraoperative bleeding and visibility. Objective To perform a more comprehensive meta-analysis on randomized controlled trial (RCTs) comparing TIVA with IA in endoscopic sinus surgery to evaluate their effects on intraoperative bleeding and visibility. Methods A systematic review and meta-analysis of studies comparing TIVA and IA in endoscopic sinus surgery for chronic rhinosinusitis was completed in May 2020. Utilizing databases, articles were systematically screened for analysis and 19 studies met our inclusion criteria. The primary outcome included intraoperative visibility scores combining Boezaart, Wormald and Visual Analogue Scale (VAS). Secondary outcomes included rate of blood loss (mL/kg/min), estimated total blood loss (mL), Boezaart, Wormald scores, VAS, heart rate, and mean arterial pressure (MAP). Results 19 RCTs with 1,010 patients were analyzed. TIVA had a significantly lower intraoperative bleeding score indicating better endoscopic visibility (Boezaart, VAS, and Wormald) than IA (−0.514, p = 0.020). IA had a significantly higher average rate of blood loss than TIVA by 0.563 mL/kg/min (p = 0.016). Estimated total blood loss was significantly lower in TIVA than IA (−0.853 mL, p = 0.002). There were no significant differences between TIVA and IA in the mean heart rate (−0.225, p = 0.63) and MAP values (−0.126, p = 0.634). The subgroup analyses revealed no significant difference between TIVA and IA when remifentanil was not utilized and whenever desflurane was the IA agent. Conclusion TIVA seemed to have superior intraoperative visibility scores and blood loss during endoscopic sinus surgery when compared to IA. However, the results are not consistent when stratifying the results based on the use of remifentanil and different inhaled anesthetics. Therefore, the conclusion cannot be made that one approach is superior to the other.

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Endoscopic Sinus Surgery Improves Sleep Quality in Chronic Rhinosinusitis: A Systematic Review and Meta-analysis

Otolaryngology ◽

10.1177/0194599817737977 ◽

2017 ◽

Vol 158 (2) ◽

pp. 249-256 ◽

Cited By ~ 12

Author(s):

Daniel C. Sukato ◽

Jason M. Abramowitz ◽

Marina Boruk ◽

Nira A. Goldstein ◽

Richard M. Rosenfeld

Keyword(s):

Systematic Review ◽

Sleep Quality ◽

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Meta Analysis ◽

Research Direction ◽

Sinus Surgery ◽

Future Research ◽

Apnea Hypopnea Index ◽

Poor Sleep

Objective Up to 75% of patients with chronic rhinosinusitis (CRS) suffer with poor sleep quality and reduced quality of life. Endoscopic sinus surgery has demonstrated encouraging results in improving sleep function. The aim of this systematic review is to assess the change in sleep quality after surgery for CRS. Data Sources PubMed, Web of Science, EMBASE. Review Methods An electronic search was conducted with the keywords “sinusitis” or “rhinosinusitis” and “sleep.” Studies were included only when adults underwent endoscopic sinus surgery and were evaluated pre- and postoperatively by the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI), the Apnea-Hypopnea Index (AHI), the sleep domain of Sino-Nasal Outcome Test–22, or the sleep domain of Rhinosinusitis Disability Index. Results The database search yielded 1939 studies, of which 7 remained after dual-investigator screening. The standardized mean differences (95% CI) for the ESS, PSQI, and AHI were −0.94 (−1.63 to −0.26), −0.80 (−1.46 to −0.14), and −0.20 (−0.32 to −0.07), indicating large, moderate to large, and small improvements, respectively. All analyses displayed high heterogeneity ( I2 = 95%-99%). Conclusion Sleep quality, as measured by the ESS and PSQI surveys, shows substantial improvement after surgery for CRS, with smaller improvement seen for AHI. Generalizability of our results is limited by high heterogeneity among studies and by broad confidence intervals that cannot exclude small to trivial changes. The findings of this meta-analysis provide insight into the effect of CRS-related endoscopic sinus surgery on sleep quality, which should guide future research direction and counseling of patients in the clinical setting.

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Meta-analysis and literature review of techniques to achieve hemostasis in endoscopic sinus surgery

International Forum of Allergy & Rhinology ◽

10.1002/alr.21126 ◽

2012 ◽

Vol 3 (6) ◽

pp. 482-487 ◽

Cited By ~ 40

Author(s):

Akhil J. Khosla ◽

Francisco G. Pernas ◽

Patricia A. Maeso

Keyword(s):

Literature Review ◽

Endoscopic Sinus Surgery ◽

Meta Analysis ◽

Sinus Surgery

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Outcomes of Concurrent Functional Endoscopic Sinus Surgery and Rhinoplasty: A Meta-analysis

American Journal of Rhinology and Allergy ◽

10.1177/1945892420980673 ◽

2020 ◽

pp. 194589242098067

Author(s):

Benjamin F. Bitner ◽

Karthik R. Prasad ◽

Khodayar Goshtasbi ◽

Brandyn S. Dunn ◽

Edward C. Kuan

Keyword(s):

Patient Satisfaction ◽

Endoscopic Sinus Surgery ◽

Meta Analysis ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Complication Rates ◽

Medical Problems ◽

Random Effects Models ◽

Ovid Medline ◽

Significant Difference

Introduction Chronic rhinosinusitis (CRS) and functional nasal airway obstruction are common but distinct medical problems which affect quality of life. In certain instances, patients often benefit from concomitant functional septorhinoplasty, or elect for cosmetic rhinoplasty, in addition to functional endoscopic sinus surgery (FESS) and prefer combining procedures. Determining outcomes of combined surgery is important when discussing risks and benefits with patients. Methods A thorough literature search of articles published in PubMed, Ovid MEDLINE, and Cochrane databases. Patients were categorized as either having FESS or rhinoplasty alone or combined. Binary random-effects models were applied to calculate odds ratios (ORs) for outcomes including complications, recurrence, and satisfaction. Results Of the 55 screened articles, 6 were included in the analysis, and of these, 6 (405 patients), 2 (90 patients), 4 (290 patients), and 3 (190 patients) provided data for postoperative complications, recurrence of CRS symptoms, revision rates, and patient satisfaction, respectively. Major complications were observed in 11 (5.8%) total combined cases, 0 (0%) FESS cases, and 6 (3.5%) rhinoplasty cases with no statistical difference between combined cases and rhinoplasties (OR 1.37, 95% CI 0.45–4.16, p = 0.58). Recurrence of CRS symptoms was noted in 35.6% combined cases and 28.9% FESS cases (OR 1.42, 95% CI 0.55–3.64, p = 0.47). There was no observed difference in revision rates between combined and isolated rhinoplasties (OR 1.00, 95% CI 0.43–2.32, p = 1). Lastly, 91.6% of patients were satisfied with results of combined cases compared to 87.4% of patients in standalone cases (OR 1.57, 95% CI 0.61–4.03, p = 0.35). Conclusion Aggregate evidence demonstrates similar risk in complication rates in combined surgical cases compared to stand-alone rhinoplasty. There appears to be no significant difference in recurrence of symptoms, revision rates or patient satisfaction.

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Traditional endonasal and microscopic sinus surgery complications versus endoscopic sinus surgery complications: a meta-analysis

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-011-1744-2 ◽

2011 ◽

Vol 269 (3) ◽

pp. 721-729 ◽

Cited By ~ 12

Author(s):

Massimo Re ◽

Humbert Massegur ◽

Giuseppe Magliulo ◽

Luigi Ferrante ◽

Vittorio Sciarretta ◽

...

Keyword(s):

Endoscopic Sinus Surgery ◽

Meta Analysis ◽

Sinus Surgery ◽

Surgery Complications

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Stereotactic anatomical localization in complex sinus surgery: A systematic review and meta-analysis

The Laryngoscope ◽

10.1002/lary.25323 ◽

2015 ◽

Vol 126 (1) ◽

pp. 51-59 ◽

Cited By ~ 4

Author(s):

Thomas D. Vreugdenburg ◽

Robyn S. Lambert ◽

Yasoba N. Atukorale ◽

Alun L. Cameron

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Sinus Surgery ◽

Anatomical Localization

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Hyaluronic acid for post sinus surgery care: systematic review and meta-analysis

The Journal of Laryngology & Otology ◽

10.1017/s0022215116009269 ◽

2017 ◽

Vol 131 (S1) ◽

pp. S2-S11 ◽

Cited By ~ 8

Author(s):

E Fong ◽

M Garcia ◽

C M Woods ◽

E Ooi

Keyword(s):

Systematic Review ◽

Hyaluronic Acid ◽

Endoscopic Sinus Surgery ◽

Meta Analysis ◽

Adhesion Formation ◽

Sinus Surgery ◽

Current Evidence ◽

Secondary Outcome ◽

Control Group ◽

Patient Reported

AbstractBackground:Wound healing after endoscopic sinus surgery may result in adhesion formation. Hyaluronic acid may prevent synechiae development. A systematic review was performed to evaluate the current evidence on the clinical efficacy of hyaluronic acid applied to the nasal cavity after sinus surgery.Methods:Studies using hyaluronic acid as an adjunct treatment following endoscopic sinus surgery for chronic rhinosinusitis were identified. The primary outcome was adhesion formation rates. A meta-analysis was performed on adhesion event frequency. Secondary outcome measures included other endoscopic findings and patient-reported outcomes.Results:Thirteen studies (501 patients) met the selection criteria. A meta-analysis of adhesion formation frequency on endoscopy demonstrated a lower risk ratio in the hyaluronic acid intervention group (42 out of 283 cases) compared to the control group (81 out of 282) of 0.52 (95 per cent confidence interval = 0.37–0.72). Hyaluronic acid use was not associated with any significant adverse events.Conclusion:Hyaluronic acid appears to be clinically safe and well tolerated, and may be useful in the early stages after sinus surgery to limit adhesion rate. Further research, including larger randomised controlled trials, is required to evaluate patient- and clinician-reported outcomes of hyaluronic acid post sinus surgery.

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Post-operative corticosteroid irrigation for chronic rhinosinusitis after endoscopic sinus surgery: A meta-analysis

Clinical Otolaryngology ◽

10.1111/coa.13015 ◽

2017 ◽

Vol 43 (2) ◽

pp. 525-532 ◽

Cited By ~ 9

Author(s):

H.Y. Yoon ◽

H.S. Lee ◽

I.H. Kim ◽

S.H. Hwang

Keyword(s):

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Meta Analysis ◽

Sinus Surgery

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Endoscopic sinus surgery in patients with cystic fibrosis: a systematic review and meta-analysis of pulmonary function

Rhinology Journal ◽

10.4193/rhino11.271 ◽

2012 ◽

Vol 50 (4) ◽

pp. 360-369

Author(s):

K.I. Macdonald ◽

A. Gipsman ◽

A. Magit ◽

M. Fandino ◽

E. Massoud ◽

...

Keyword(s):

Systematic Review ◽

Cystic Fibrosis ◽

Pulmonary Function ◽

Endoscopic Sinus Surgery ◽

Meta Analysis ◽

Pulmonary Function Tests ◽

Sinus Surgery ◽

Intravenous Antibiotics

Introduction: The role of endoscopic sinus surgery (ESS) in patients with cystic fibrosis (CF) is not clearly defined. Objective: TO perform a systematic review of subjective and objective outcomes of ESS in CF. Methods: A systematic review was performed using the keywords 'sinusitis,' 'sinus surgery,' 'nasal polyps' and 'cystic fibrosis.' The quality of papers was assessed using the NICE scoring scale. Outcomes included safety, subjective symptoms, objective endoscopy scores, days spent in hospital, courses of antibiotics, and pulmonary function tests (PFTs). Results: Nineteen studies involving 586 patients were included in the review. There were four prospective cohort trials, and three were rated as good quality. There were no major complications attributable to ESS. There was consistent evidence in four cohort studies of improved sinonasal symptoms, including nasal obstruction, facial pain, headaches, rhinorrhea and olfaction. Three studies reported conflicting results in post-operative endoscopy scores. Three studies showed a decrease in days spent in hospital, and two showed a significant decrease in courses of intravenous antibiotics. A recent study, however, did not show a difference in either days spent in hospital or courses of antibiotics. Pulmonary function tests were not improved by ESS in six cohort trials, and one small study found significant improvement. A meta-analysis of FEV1 scores confirmed no significant difference. Conclusion: THE most consistent findings of this review were that ESS in patients with CF is safe, produces symptomatic benefit, and does not consistently improve PFTs. There were more conflicting results with regards to endoscopy scores, days spent in hospital, and courses of intravenous antibiotics. Future prospective studies, utilizing validated quality of life, symptom and endoscopy scales, are needed to further elucidate the role of ESS in the management of chronic rhinosinusitis in CF patients.

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