Are Endoscopic Sinus Surgery Complication Rates Improving Over Time and With the Adoption of Image Guidance?

Background: Endoscopic sinus surgery (ESS) continues to be widely used as a treatment for refractory chronic rhinosinusitis (CRS). With advancements in technology and surgical technique, we might expect fewer surgical complications to occur in the modern era as compared to established rates that are often quoted in the literature and patient counseling. Methods: We queried the TriNetX Research Network (2010-2023) for ESS complications (cerebrospinal fluid (CSF) leak, orbital injury, epistaxis event, ER visit, stroke, MI, thromboembolic event, 30-day mortality) by ICD and CPT codes in timeframes consistent with prior literature. Complication rates and IGS trends were evaluated over time (2010-2016 vs 2017-2023) and age groups (pediatric <12, adolescent (12-17), and adult >18-<65). Results: Overall rate of major complications of CSF leak and orbital injury was similar or slightly better than prior reports, but epistaxis and other perioperative complications were higher than anticipated (>1%) and might deserve additional attention in preoperative counseling and perioperative care. IGS use increased over time and was associated with lower CSF leak rates (0.8 vs. 0.95%, p = 0.003), increased epistaxis rates (2.5 vs. 2.1%, p < 0.0001), and no significant difference in orbital injury. CSF leak was higher in patients under 18 (p <0.001), while adults had higher rates of epistaxis (p = 0.007). Conclusion: Complications from ESS remain low. But, increasing epistaxis and other perioperative complications are notable and may result from worsened overall population health. IGS use has increased with time and is associated with a decreased risk of CSF leak.