(A1113) Disparities in Postoperative Complications Following Endoscopic Sinus Surgery

Introduction: Surgical and diagnostic endoscopic sinus procedures can result in serious post-procedure complications. This study investigated the relationship between demographic factors and complication risk following sinus procedures to better understand and address potential inequalities.

Methods: Using the NIH’s All of Us database, this retrospective cohort study analyzed U.S. adults who underwent sinus procedures from 1993 to 2022. Patients were stratified by age, as well as self-reported race, ethnicity, sex, socioeconomic status (SES), and education to identify factors associated with higher complication incidence. The primary outcome was the development of one or more postprocedural complications categorized as hemorrhagic, infectious, visual disturbance, or cerebrospinal fluid (CSF) leak. Logistic regression was used to adjust the odds ratio.

Results: Among 7724 patients who underwent sinus procedures (65.7% White, 14.7% Black, 15.6% Other, 2.4% Asian, 1.5% Multiracial), 466 (6.0%) experienced complications: 287 (61.6%) infectious, 128 (27.5%) hemorrhagic, 28 (6.0%) visual disturbances, and 23 (4.9%) CSF leaks. Black patients, when compared to White patients, were more likely (OR 1.81, 95% CI [1.37-2.38], p < 0.0001) to develop complications, including hemorrhagic (2.04 [1.23-3.36], p = 0.005) and infectious (1.58 [1.11-2.23], p = 0.01). Hispanic/Latino patients, when compared to non-Hispanic/Latino patients, had increased infectious risks (2.16 [1.034-4.09], p = 0.028). Male patients, compared to female patients, had lower complication risk (0.78 [0.62-0.97], p = 0.025). No significant trends were noted for other racial groups, or by age, SES, or education.

Conclusions: These findings suggest higher complication risks for historically marginalized groups—Black, Hispanic/Latino, and Female patients—that are not explainable by common causes of demographic inequality. This highlights a need for targeted efforts to ensure equitable perioperative and postoperative care, and a need for further research to identify drivers of these disparities.