title: Complications in endoscopic sinus surgery for chronic rhinosinusitis: a 25-year experience.
abstract: OBJECTIVE
  The aim of this study was to review complications occurring as a result of endoscopic sinus surgery by one surgeon in an academic practice during a 25-year period.
  
  
  METHODS
  Retrospective clinical study.
  
  
  METHODS
  A register of complications was tabulated during a period of 25 years for endoscopic sinus surgery performed for chronic rhinosinusitis in 3,402 patients (6,148 sides). All complications were reviewed as a whole and were not divided into major or minor categories.
  
  
  RESULTS
  A total of 105 patients were found to have complicated endoscopic sinus surgery, for an overall patient complication rate of 0.031, or 0.017 per operated side. The most common complications were hemorrhage (n = 41), orbital complications (n = 29), and CSF leak (n = 19). The following factors were noted to have increased risk for complications: age, revision surgery, nasal polyps, anatomic variation, extensive disease, overall health, medications, and underlying factors. Certain types of instrumentation such as powered instrumentation placed patients at greater risk. The use of image guidance or surgical experience did not eliminate complications from occurring.
  
  
  CONCLUSIONS
  Complications of endoscopic sinus surgery still occur 25 years after the initial introduction of the surgery in 1985. Many complications can be managed without a bad outcome. The key to prevention is knowledge of anatomy, preparation, anticipation, and experience. Even then, complications can occur in the most experienced hands. Patients most at risk for complications include those with revision surgery, extensive disease, skull base anatomic or radiologic variations or dehiscences related to disease or previous surgery, and the use of powered instrumentation.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois 60153, USA. jstank@lumc.edu
authors.forename: James A
authors.initials: JA
authors.lastname: Stankiewicz
authors.forename: Devyani
authors.initials: D
authors.lastname: Lal
authors.forename: Matthew
authors.initials: M
authors.lastname: Connor
authors.forename: Kevin
authors.initials: K
authors.lastname: Welch
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D015331:Cohort Studies; D004724:Endoscopy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D059747:Nasal Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D012220:Rhinitis / Q000175:diagnosis / Q000601:surgery*; D018570:Risk Assessment; D012852:Sinusitis / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult