Complications of primary and revision functional endoscopic sinus surgery for chronic rhinosinusitis

Abstract

Objectives/hypothesis: The goal of this study was to determine the incidence of major complications following primary and revision functional endoscopic sinus surgery (FESS). In addition, this study aimed to determine factors associated with the occurrence of complications including patient and provider characteristics and the use of image guidance system (IGS) technology.

Study design: Retrospective cohort analysis of California and Florida all-payer databases from 2005 to 2008.

Methods: The rates of major surgical complications (skull base, orbital, and hemorrhagic) after primary and revision FESS were calculated, and bivariate analyses were performed to investigate relationships of complications with demographic and clinical characteristics. A multivariate model was used to determine risk factors for the occurrence of major complications.

Results: Among 78,944 primary FESS cases, 288 major complications were identified representing a complication rate of 0.36% (95% CI 0.32%-0.40%). The major complication rate following revision cases (n = 19; 0.46%) and primary cases (n = 288; 0.36%) was similar (OR = 1.26; 95% CI 0.79-2.00). Multivariate analysis showed that patients who were >40 years old, had a primary payer of Medicaid, had surgery involving the frontal sinus, or had image guidance during surgery were at higher risk for major complications.

Conclusion: The rate of major complications (0.36%) associated with primary FESS is lower than earlier reports. The rate of major complications following revision FESS (0.46%) was found to be similar to primary cases. IGS, insurance status, age, and extent of surgery were found to be associated with an increased risk of major complications following FESS.

Level of evidence: 2C.

Keywords: CSF leak; Chronic rhino sinusitis; complications; diplopia; endoscopic sinus surgery; epistaxis; hemorrhage; orbital.

Figure 1

Study flow diagram *Participants were considered to have a major complication if they had a diagnostic or procedural code for skull base injury, orbital injury, ICA injury, or other hemorrhagic injury that resulted in a blood transfusion.