(A1139) Trends and Complications in Endoscopic Sinus Surgery: Impact of Image Guidance and Evolving Practices

Introduction: Endoscopic sinus surgery (ESS) is a common elective procedure, with an estimated overall complication rate of ~ 1% established from data over 15 years ago. Advances in surgical technique and increasing availability of intraoperative image guidance (IGS) warrant an update on ESS complications. Our objective is to update estimated incidence of major complications from ESS in the modern era.

Methods: The TriNetX US Global Collaborative network was queried for patients who underwent ESS for chronic rhinosinusitis (CRS) from 2010-2023. Major complications were ascertained by ICD and CPT within conservative postoperative timeframes. IGS use and propensity-score matching were used to evaluate risks of age, sex, race and other potential cofounders.

Results: Among 150,775 patients, IGS was utilized in 42.2% of cases. Overall major complication rate was 3.4% (Hemorrhage requiring transfusion within 90 days 2.3%, CSF Leak 0.9%, and orbital injury 0.2%). CSF leak occurred less frequently in ESS cases with IGS than without IGS (0.8% v 0.95%, p= < 0.009), while hemorrhage requiring transfusion was higher in those where IGS was used (2.5% v 2.1 %, p= < 0.001). IGS usage increased from 38% (2010-2016) to 43.8% (2017-2013, p < 0.001). CSF leak and orbital injury rates remained stable across time periods, whereas hemorrhage rates have increased in recent years (p < 0.001).

Conclusions: Major complications in ESS remains low, but postoperative hemorrhage appears to be an ongoing challenge. IGS use has become more widespread and across the two time periods examined and may be associated with decreased risk of CSF leak.