title: Multiple analyses of factors related to complications in endoscopic sinus surgery.
abstract: BACKGROUND
  This study was undertaken to evaluate whether endoscopic sinus surgery (ESS) with a microdebrider had an impact on complication rates, and to facilitate the determination of factors associated with complications in patients who underwent ESS at a tertiary referral center in Taiwan.
  
  
  METHODS
  This investigation was a retrospective study and literature review. We analyzed 997 consecutive patients who underwent ESS at Mackay Memorial Hospital in Taipei, Taiwan from January 2006 through February 2010. All data including those of patient medical information, and peri- and postoperative complications were provided by the surgeons involved in patient medical care. We analyzed the complication rates using the following 10 variables by univariate analysis and multivariate logistic regression: sex, age, Lund-Mackay score, polyp grading, previous sinonasal surgery, surgeon skill, adjunctive sinonasal surgery, mesenteric type of anterior ethmoid artery, Keros skull base type, and the use of a microdebrider.
  
  
  RESULTS
  Of the 997 patients in our study, 78 (7.8%) had complications. Major complications occurred in five patients (0.5%): two with cerebrospinal fluid rhinorrhea, one with medial rectus muscle damage, and two with retrobulbar hematoma. Minor complications were found in 73 patients (7.3%), which included 32 patients with perioperative estimated blood loss > 15% of the total estimated blood volume, 26 with lamina papyracea damage, two with orbital cellulitis, and 13 with postoperative bleeding. Univariate analysis showed that risk factors related to complication rate were advanced Lund-Mackay scores (scores 19-24), advanced polyp grading (Grades 2 and 3), inexperienced surgeon (resident), and microdebrider usage. However, multivariate analysis revealed that complication rate was linked to advanced Lund-Mackay scores (Scores 19-24), mesenteric type of anterior ethmoid artery, and inexperienced surgeon.
  
  
  CONCLUSIONS
  Overall, the results of our study showed that the ESS complication rate was 7.8%, with risk factors including advanced Lund-Mackay scores (19-24, odds ratio 10.4) and inexperienced surgeon. It was also noted that ESS with a microdebrider had no impact on complication rates, although the presence of a mesenteric type of anterior ethmoid artery proved to be a protective factor.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan, ROC.
authors.forename: Tung-Wei
authors.initials: TW
authors.lastname: Chou
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan, ROC.
authors.forename: Pei-Shih
authors.initials: PS
authors.lastname: Chen
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan, ROC; Department of Audiology, Speech and Language Pathology, Mackay Medical College, Taipei, Taiwan, ROC.
authors.forename: Hung-Ching
authors.initials: HC
authors.lastname: Lin
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan, ROC; Department of Audiology, Speech and Language Pathology, Mackay Medical College, Taipei, Taiwan, ROC.
authors.forename: Kuo-Sheng
authors.initials: KS
authors.lastname: Lee
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan, ROC; Department of Audiology, Speech and Language Pathology, Mackay Medical College, Taipei, Taiwan, ROC.
authors.forename: Hsun-Tien
authors.initials: HT
authors.lastname: Tsai
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan, ROC.
authors.forename: Jehn-Chuan
authors.initials: JC
authors.lastname: Lee
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan, ROC; Mackay Medicine, Nursing and Management College, Taipei, Taiwan, ROC; National Defense Medical Center, Taipei, Taiwan, ROC.
authors.forename: Yi-Shing
authors.initials: YS
authors.lastname: Leu
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan, ROC; Department of Audiology, Speech and Language Pathology, Mackay Medical College, Taipei, Taiwan, ROC. Electronic address: carlsonwang@yahoo.com.tw.
authors.forename: Ying-Piao
authors.initials: YP
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010256:Paranasal Sinuses / Q000601:surgery*; D012189:Retrospective Studies
keywords: complications; endoscopic surgery; frontal sinus; rhinosinusitis