title: Early postoperative care following endoscopic sinus surgery: an evidence-based review with recommendations.
abstract: BACKGROUND
  Early postoperative care following endoscopic sinus surgery (ESS) has been suggested to minimize avoidable complications and optimize long-term outcomes. Several postoperative care strategies have been proposed but a formal comprehensive evaluation of the evidence has never been performed. The purpose of this article is to provide an evidence-based approach to early postoperative care following ESS.
  
  
  METHODS
  A systematic review of the literature was performed and the Clinical Practice Guideline Manual, Conference on Guideline Standardization (COGS), and the Appraisal of Guidelines and Research Evaluation (AGREE) instrument recommendations were followed. Study inclusion criteria were: adult population >18 years old; chronic rhinosinusitis (CRS) based on published diagnostic criteria; ESS following failed medical therapy; primary study objective was to evaluate an ESS early postoperative care strategy; and clearly defined primary clinical end-point.
  
  
  RESULTS
  This review identified and evaluated the literature on 7 early postoperative care strategies following ESS: saline irrigations, sinus cavity debridements, systemic steroids, topical steroids, oral antibiotics, topical decongestants, and drug-eluting spacers/stents.
  
  
  CONCLUSIONS
  Based on the available evidence, use of nasal saline irrigation, sinus cavity debridement, and standard topical nasal steroid spray are recommended early postoperative care interventions. Postoperative antibiotic, systemic steroid, nonstandard topical nasal steroid solution, and/or drug-eluting spacers/stents are options in postoperative management. These evidence-based recommendations should not necessarily be applied to all postoperative patients and clinical judgment, in addition to evidence, is critical to determining the most appropriate care.
authors.affiliation: Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR 97239, USA.
authors.forename: Luke
authors.initials: L
authors.lastname: Rudmik
authors.forename: Zachary M
authors.initials: ZM
authors.lastname: Soler
authors.forename: Richard R
authors.initials: RR
authors.lastname: Orlandi
authors.forename: Michael G
authors.initials: MG
authors.lastname: Stewart
authors.forename: Neil
authors.initials: N
authors.lastname: Bhattacharyya
authors.forename: David W
authors.initials: DW
authors.lastname: Kennedy
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Smith
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003646:Debridement / Q000379:methods; D054855:Drug-Eluting Stents; D004724:Endoscopy / Q000379:methods*; D019317:Evidence-Based Medicine; D006801:Humans; D059085:Nasal Sprays; D010256:Paranasal Sinuses / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods*; D012852:Sinusitis / Q000601:surgery*; D012965:Sodium Chloride / Q000627:therapeutic use; D007507:Therapeutic Irrigation / Q000379:methods
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D059085:Nasal Sprays; D012965:Sodium Chloride