title: Image-guided surgery influences perioperative morbidity from endoscopic sinus surgery: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Although image-guided surgery (IGS) is considered a valuable tool, its impact on perioperative morbidity for endoscopic sinus surgery (ESS) remains unclear. The evidence from reported literature is systematically reviewed with meta-analysis.
  
  
  METHODS
  MEDLINE (1946 to September 14, 2012, week 2) and EMBASE (1974 to September 14, 2012, week 37).
  
  
  METHODS
  MEDLINE and EMBASE were searched using a search strategy for publications on IGS during ESS that reported original data on perioperative morbidity. PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines were followed. Both comparative cohort studies with non-IGS cases and case series were included. Primary outcome was major and total complications. Secondary outcomes were specific orbital and intracranial injury, major hemorrhage, ability to complete the operation, and revision surgery. The incidence of these events was defined as dichotomous variables and expressed as a risk ratio (RR) in a fixed-effects model.
  
  
  RESULTS
  In total, 2586 articles fulfilled the search, producing 55 included studies. Fourteen were comparative cohorts of IGS and non-IGS sinus surgical patient populations used for meta-analysis. Among the cohorts, major complications were more common in the non-IGS group (RR = 0.48; 95% confidence interval [CI], 0.28-0.82; P = .007). Total complications were greater in the non-IGS group (RR = 0.66; 95% CI, 0.47-0.94; P = .02). All other outcomes did not reach significance on meta-analysis.
  
  
  CONCLUSIONS
  Contrary to current review articles on the topic of IGS use during ESS, there is evidence from published studies that the use of IGS for sinus surgery, within selected populations, is associated with a lower risk of major and total complications compared with non-IGS sinus surgery.
authors.affiliation: Rhinology and Skull Base, Applied Medical Research Centre, St Vincent's Hospital, University of New South Wales and Macquarie University, Sydney, NSW, Australia. ddalgorf@gmail.com
authors.forename: Dustin M
authors.initials: DM
authors.lastname: Dalgorf
authors.forename: Raymond
authors.initials: R
authors.lastname: Sacks
authors.forename: Peter-John
authors.initials: PJ
authors.lastname: Wormald
authors.forename: Yuresh
authors.initials: Y
authors.lastname: Naidoo
authors.forename: Ben
authors.initials: B
authors.lastname: Panizza
authors.forename: Brent
authors.initials: B
authors.lastname: Uren
authors.forename: Chris
authors.initials: C
authors.lastname: Brown
authors.forename: John
authors.initials: J
authors.lastname: Curotta
authors.forename: Kornkiat
authors.initials: K
authors.lastname: Snidvongs
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Harvey
mesh_terms: D004724:Endoscopy / Q000009:adverse effects*; D006801:Humans; D059747:Nasal Surgical Procedures / Q000009:adverse effects*; D010254:Paranasal Sinus Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000009:adverse effects*
keywords: endoscopic sinus surgery; image-guided surgery; major complications; meta-analysis; patient reported outcome measures; perioperative morbidity; systematic review