Validation of the Modena bleeding score in endoscopic sinus surgery

Alicandri‐Ciufelli, Matteo; Pingani, Luca; Maccarrone, Francesco; Anschuetz, Lukas; Mariano, Davide; Galeazzi, Gian Maria; Presutti, Livio; Molinari, Giulia

doi:10.1016/j.bjorl.2020.08.006

Cited by 4 publications

(5 citation statements)

References 20 publications

(20 reference statements)

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“…16,17 These scales show somewhat disparate outcomes within the context of surgical field visualization, limiting their technical utility and generalizability to all patients. 58 Our subgroup analysis found that TXA improved Boezaart grading in patients with CRSwNP and those with CRS of unspecified clinical subtype (Figure 7). When compared with CRSsNP, ESS for CRSwNP is associated with more extensive procedures, longer operative times, and possibly higher bleeding risk.…”

Section: Discussionmentioning

confidence: 77%

“…16 A novel scoring system, the validated Modena bleeding score in ESS, has been suggested as an alternative tool that can improve generalizability in evaluating intraoperative bleeding. 58 Our evidence is also somewhat limited by the number of studies and poor reporting quality, which did not permit all planned subgroup analyses. 60 Finally, these findings offer limited generalizability to pediatric or ESBS populations due to the lack of studies.…”

Section: Discussionmentioning

confidence: 82%

“…There are also methodological challenges associated with the use of the Boezaart and Wormald scales, including concerns for measurement bias and clinical generalizability 16 . A novel scoring system, the validated Modena bleeding score in ESS, has been suggested as an alternative tool that can improve generalizability in evaluating intraoperative bleeding 58 . Our evidence is also somewhat limited by the number of studies and poor reporting quality, which did not permit all planned subgroup analyses 60 .…”

Section: Discussionmentioning

confidence: 94%

“…When comparing these scales, it is important to note that the six‐point Boezaart scale assesses the frequency of intraoperative suctioning, while the 11‐point Wormald scale may be dependent on size, location, and orientation of the sphenoid ostium/sphenoid sinus to assess filling of the sphenoid sinus with blood 16,17 . These scales show somewhat disparate outcomes within the context of surgical field visualization, limiting their technical utility and generalizability to all patients 58 . Our subgroup analysis found that TXA improved Boezaart grading in patients with CRSwNP and those with CRS of unspecified clinical subtype (Figure 7).…”

Section: Discussionmentioning

confidence: 99%

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Tranexamic acid in endoscopic sinus and skull base surgery: A systematic review and meta‐analysis

Abdallah

Staibano

Zhou

et al. 2023

Int Forum Allergy Rhinol

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ObjectiveEndoscopic sinus surgery (ESS) and endoscopic skull base surgery (ESBS) approaches have revolutionized the management of sinonasal and intracranial pathology. Maintaining surgical hemostasis is essential as bleeding can obscure the visibility of the surgical field, thus increasing surgical duration, risk of complications, and procedural failure. Tranexamic acid (TXA) acts to reduce bleeding by inhibiting fibrin degradation. This review aims to assess whether TXA improves surgical field quality and reduces intraoperative blood loss compared with control.MethodsWe searched PubMed, MEDLINE, Embase, Web of Science, and Cochrane Library from inception until September 1, 2022. Two reviewers independently screened citations, extracted data, and assessed methodological quality using the Cochrane risk‐of‐bias tool for randomized trials. Data were pooled using a random‐effect model, with continuous data presented as mean differences and dichotomous data presented as odds ratios.ResultsSeventeen ESS randomized controlled trials (n = 1377) and one ESBS randomized controlled trial (n = 50) were reviewed. Significant improvement in surgical field quality was achieved with both systemic TXA (six studies, p < 0.00001) and topical TXA (six studies, p = 0.01) compared with the control. Systemic TXA (eight studies) and topical TXA (three studies) both achieved a significant reduction in intraoperative blood loss compared with the control (p < 0.00001). There were significant differences in operative times (p < 0.001) but no significant difference in perioperative outcomes (p = 0.30).ConclusionThis meta‐analysis demonstrated that the administration of TXA in ESS can improve surgical field quality and reduce intraoperative blood loss. TXA use did not result in increased perioperative complications including thrombotic events.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

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Tranexamic acid in endoscopic sinus and skull base surgery: A systematic review and meta‐analysis

Abdallah

Staibano

Zhou

et al. 2023

Int Forum Allergy Rhinol

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“…2 ). The Modena bleeding score ( Table 2 ) [ 7 ], another 5-point ordinal scale, was used to quantify the surgical field, ranging from 1 to 5. Scores 1 and 2 were combined into a “good surgical field” as they did not hinder the surgery.…”

Section: Methodsmentioning

confidence: 99%

A Novel Combined Anesthetic Technique to Improve the Surgical Working Conditions of Lumbar and Thoracolumbar Spine Surgery from a Spine Surgeon’s Perspective: A Prospective Randomized Controlled Study

et al. 2023

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Prospective randomized controlled study. Purpose: This study aimed to assess the effects of a different combination of anesthetic techniques in lumbar and thoracolumbar spinal surgeries in terms of muscle relaxation and surgical field in addition to hemodynamic parameters. Overview of Literature: Adequate relaxation of the erector spinae muscle and good surgical fields are preferred in lumbar spine surgeries. The effects of anesthetic techniques on these parameters have not been evaluated from a surgeon's perspective to date. We propose a novel combined anesthetic technique that improves the working conditions from a surgeon's perspective as we hypothesize that combining general anesthesia (GA) with regional anesthesia (RA) might provide benefits for both techniques. Methods: A prospective randomized study of 76 patients who underwent lumbar and thoracolumbar surgeries was conducted by randomly allocating patients into three anesthetic groups: GA alone, GA with spinal anesthesia (SA), and GA with erector spinae plane block (ESPB) by the allocation concealment method to avoid selection bias. The working conditions were assessed by the same operating surgeon who was blinded by the type of anesthesia to eliminate the assessment bias. Muscle relaxation and surgical field were compared among the three groups along with other hemodynamic parameters to identify any significant differences. Results: Significantly better muscle relaxation, surgeon satisfaction, postoperative analgesia, and blood pressure (BP) were observed in the GA+RA when compared to GA alone (p<0.01), whereas no difference was observed between the GA+SA and GA+ESPB groups (p>0.05). Complications were only observed in the GA+SA group (19%). Conclusions:The study results suggest that the addition of RA to GA may provide better working conditions and surgeon's satisfaction by improving relaxation of the erector spinae in addition to decreasing the BP and postoperative pain in contrast to the use of GA alone. The combined GA and ESPB techniques may be a viable anesthetic alternative to provide better working conditions for surgeons.

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A Comparison of Tranexamic Acid in Nasal Versus Sinus Surgeries: a Systematic Review and Meta-Analysis

Teng,

Chia,

Gan

et al. 2024

Indian J Otolaryngol Head Neck Surg

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Validation of the Modena bleeding score in endoscopic sinus surgery

Cited by 4 publications

References 20 publications

Tranexamic acid in endoscopic sinus and skull base surgery: A systematic review and meta‐analysis

Tranexamic acid in endoscopic sinus and skull base surgery: A systematic review and meta‐analysis

A Novel Combined Anesthetic Technique to Improve the Surgical Working Conditions of Lumbar and Thoracolumbar Spine Surgery from a Spine Surgeon’s Perspective: A Prospective Randomized Controlled Study

A Comparison of Tranexamic Acid in Nasal Versus Sinus Surgeries: a Systematic Review and Meta-Analysis

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