Nationwide incidence of major complications in endoscopic sinus surgery.
BACKGROUND
Endoscopic sinus surgery (ESS) is one of the most commonly performed procedures in otolaryngology. Major complications are estimated to occur in 1-3% of cases, based on early studies with relatively small patient cohorts in academic institutions. The aim of this study was to update data regarding major complication rates associated with ESS by analyzing a large patient database.


METHODS
Retrospective review of a nationwide database of patients who underwent ESS between 2003 and 2007. Major postoperative complications-cerebrospinal fluid (CSF) leak, orbital injury, and hemorrhage requiring blood transfusion-were identified by searching the database for related International Classification of Diseases, 9th edition (ICD-9) and Current Procedural Terminology (CPT) codes. Complication rates were examined and time to occurrence analyzed. Two-tailed test of proportions, global chi-square test, and logistical regression analysis were used for statistical comparison.


RESULTS
A total of 62,823 patients who met rigorous inclusion criteria were included. The overall major complication rate was 1.00% (CSF leak 0.17%; orbital injury 0.07%; hemorrhage requiring transfusion 0.76%). CSF leak was less likely to occur in the pediatric population (p = 0.05), whereas orbital injury was more likely to occur in children (p < 0.001). Examination of the impact of image guidance (IGS) was limited by study design.


CONCLUSIONS
The incidence of major complications associated with ESS appears to have decreased since early reports over 10 years ago. There may be different complication rates in the pediatric population. Study design limitations did not allow for comprehensive assessment of IGS in the development of these complications. These data help to educate otolaryngologists and patients about complication rates in ESS in a modern context.
Department of Otolaryngology, University of Colorado Denver, Aurora, CO 80045, USA. vijay.ramakrishnan@ucdenver.edu
Vijay R
VR
Ramakrishnan
Todd T
TT
Kingdom
Jayakar V
JV
Nayak
Peter H
PH
Hwang
Richard R
RR
Orlandi
D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000453:epidemiology / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy / Q000009:adverse effects*; D004844:Epistaxis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006406:Hematoma / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000293:injuries; D013517:Otorhinolaryngologic Surgical Procedures / Q000009:adverse effects*; D010254:Paranasal Sinus Diseases / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D014786:Vision Disorders / Q000453:epidemiology / Q000209:etiology; D055815:Young Adult