Anemia and blood transfusion requirements in endoscopic sinus surgery: A propensity‐matched analysis

Abstract

Objective: Massive bleeding requiring blood transfusion is a feared complication of endoscopic sinus surgery (ESS). In an effort to improve healthcare quality and outcomes, research is focused on identifying the risk factors for complications following surgical procedures. Blood transfusions have been linked to increased complication rates, but their role has not been extensively studied in ESS.Methods: The American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP) participant user files 2005 to 2014 were queried for all cases of ESS. Patients were divided into cohorts based on anemia (hematocrit <39.00 in men and <36.00 in women) and hematocrit levels. Univariate analyses and a propensity score-matching algorithm were employed.Results: Of 630 cases of ESS, 117 (18.6%) had preexisting anemia. Anemic patients were more likely to be black (19.8% vs. 6.7%, P ≤ 0.001), undergo longer operation times (117.50 minutes AE155.73 vs. 129.85 minutes AE36.03, P = 0.005), have diabetes (28.2% vs. 10.9%, P ≤ 0.001), and have hypertension (46.2% vs. 33.1%, P = 0.010). Following propensity score matching, 109 cases were selected for each cohort, with no significant differences in demographics, comorbidities, operation time, or outpatient status. The anemic cohort was independently associated with an increase in overall postoperative complications (17.4% vs. 7.3%, P = 0.038). Transfusion use was significantly associated with preoperative hematocrit levels <30 (30.0% vs. 4.5%, P = 0.001) and between 30 and 34.99 (13.9% vs. 2.5%, P = 0.011).Conclusion: Preoperative anemia is a significant predictor of overall complications and bleeding requiring transfusion for patients undergoing ESS. These results highlight the need for careful preoperative assessment and management of anemia in this population.

Dural Bleeding After Endoscopic Sinus Surgery

“…Although blood transfusions are rare in endoscopic sinus surgery, transfusions are usually required in preoperative anemic patients and in trauma cases. 2 The deep religious convictions of Jehovah's Witness are against accepting homologous or autologous whole blood, packed red blood cells, or platelets. However, the religious understanding does not prohibit the use of albumin, immune globulins, and factor replacement for hemophilia treatment.…”

MELD-Na Score as a Predictor of Postoperative Complications in Ventral Skull Base Surgery

“…Similar to other studies investigating NSQIP, demographics assessed included age (divided into cohorts of ≤40, 41-60, 61-80, and 81 years), sex, and race (white, Black, other, or unknown). 34 Comorbidities assessed included obesity (BMI>30), diabetes mellitus, cigarette use within the past year, alcohol consumption (>2 drinks/day in 2 weeks prior to admission), dyspnea…”

Endoscopic Sinus Surgery in Older Patients With Significant Medical Comorbidities

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“…For example, diabetes, baseline anemia, and smoking status have been implicated as risk factors for medical complications following ESS. [3][4][5] Therefore, it is important to weigh each patient's risk against expected improvements in sinonasal QOL.…”