Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA.
Ann Otol Rhinol Laryngol. 2021 Aug;130(8):892-898. doi: 10.1177/0003489420987418. Epub 2021 Jan 8.
Understanding patient-specific risk factors for complications of functional endoscopic sinus surgery (ESS) is critical. Previous work has investigated such risk factors, but a population-based analysis has not been performed to date.
This study analyzes the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database to identify patient-specific risk factors associated with complications following ESS.
A retrospective cohort study of patients who underwent ESS was conducted using the NSQIP database from 2011 to 2017. Patients were identified using CPT-codes for ESS procedures. The primary outcome analyzed was any postoperative complication. Simultaneous procedures with ESS were controlled for with regression analysis. Post-operative complications and 30-day readmission were evaluated using multivariate logistic regression controlling for age, gender, race, comorbidities (diabetes mellitus, hypertension, chronic obstructive pulmonary disease, congestive heart failure, renal failure, steroid use, and cancer history), smoking history, and intraoperative factors.
A total of 1279 patients who underwent ESS were identified. The average age of patients was 46.1 (SD = 16.8). Most patients (58.2%) had no major comorbidities. 594 (46.4%) patients had a tonsillectomy, adenoidectomy, or uvulopharyngoplasty at the same time as ESS. 101 (7.9%) patients experienced a complication post-operatively. 46 (3.6%) patients experienced a readmission postoperatively. The most common complication was reoperation (N = 40, 3.1%). Regression analysis revealed that gender was the only demographic factor associated with risk of post-operative complications, with women having a significantly lower risk than men (OR = 0.61, 95% CI 0.37-0.99, = .046).
ESS is typically performed on a relatively young and healthy population. Women have a significantly lower risk of complications after controlling for comorbidities. Further analysis of gender-specific differences in surgical outcomes should be evaluated to understand this phenomenon.
了解功能性内窥镜鼻窦手术（ESS）并发症的患者特定风险因素至关重要。先前的研究已经调查了这些风险因素，但迄今为止尚未进行基于人群的分析。
本研究分析美国外科医师学会国家手术质量改进计划（NSQIP）数据库，以确定与 ESS 后并发症相关的患者特定风险因素。
使用 NSQIP 数据库对 2011 年至 2017 年期间接受 ESS 的患者进行回顾性队列研究。使用 ESS 手术的 CPT 代码识别患者。分析的主要结果是任何术后并发症。同时进行的手术与回归分析一起控制。使用多元逻辑回归控制年龄、性别、种族、合并症（糖尿病、高血压、慢性阻塞性肺疾病、充血性心力衰竭、肾衰竭、类固醇使用和癌症病史）、吸烟史和术中因素，评估术后并发症和 30 天再入院。
共确定了 1279 例接受 ESS 的患者。患者的平均年龄为 46.1（标准差=16.8）。大多数患者（58.2%）没有重大合并症。594 例（46.4%）患者在 ESS 同时进行了扁桃体切除术、腺样体切除术或悬雍垂腭咽成形术。101 例（7.9%）患者术后出现并发症。46 例（3.6%）患者术后再次入院。最常见的并发症是再次手术（N=40，3.1%）。回归分析显示，性别是唯一与术后并发症风险相关的人口统计学因素，女性的风险明显低于男性（OR=0.61，95%CI 0.37-0.99，P=0.046）。
ESS 通常在相对年轻和健康的人群中进行。在控制合并症后，女性发生并发症的风险明显降低。应进一步分析手术结果的性别特异性差异，以了解这一现象。
