Cost Analysis of Computer-Aided Endoscopic Sinus Surgery

Gibbons, M. David; Gunn, Christopher; Niwas, Santosh; Sillers, Michael J.

doi:10.2500/105065801781543709

Cited by 37 publications

(59 citation statements)

References 4 publications

(1 reference statement)

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“…8,9 The most commonly mentioned drawbacks of computer-assisted surgery are increased cost and increased time demands (during both installation and the surgery itself). 4,10,11 In addition, the computer-assisted surgical systems in use today have an accuracy of 0.5 to 2 mm. 8,12 -14 This slight inaccuracy, potentially compounded by errors in image generation and referencing procedures, implies that, although it may serve as an affirming guide, computer-assisted surgery cannot replace a combination of surgical experience and thorough knowledge of the complex paranasal sinus anatomy.…”

Section: Introductionmentioning

confidence: 99%

Outcome of computer-assisted surgery in patients with chronic rhinosinusitis

Mueller

Caversaccio

2009

J. Laryngol. Otol.

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Objective: To compare the complication rates and outcome of computer-assisted versus non-computer-assisted functional endoscopic sinus surgery.Methods: We reviewed retrospectively the medical records of 276 patients who had undergone sinus surgery for chronic rhinosinusitis with (n ¼ 108) or without (n ¼ 168) computer assistance, from 1996 to 2004, to determine the incidence of complications and need for revision surgery.Results: The incidence of complications was 6.5 per cent in the computer-assisted group and 6.0 per cent in the non-computer-assisted group ( p ¼ 1.00). In the computer-assisted group, 9.2 per cent needed revision surgery, compared with 10.7 per cent in the non-assisted group ( p ¼ 0.84).Conclusions: Although our study found no significant difference in complications or revision rates, computer-assisted surgery serves as an important orientation aid during functional endoscopic sinus surgery.

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Section: Introductionmentioning

confidence: 99%

Outcome of computer-assisted surgery in patients with chronic rhinosinusitis

Mueller

Caversaccio

2009

J. Laryngol. Otol.

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“…Of the 15 controlled cohort studies identified, 14 were used for meta-analysis. [7][8][9][10][11][12][13][14][15][16][17][18][19][20] One cohort study was excluded from the meta-analysis as it was a cadaveric study that compared the use of IGS, transillumination, sinus probing, and 6-foot Caldwell radiography for mapping frontal sinus margins during osteoplastic flap. 21 One cohort study was a randomized single-blinded clinical trial.…”

Section: Description Of Studiesmentioning

confidence: 99%

“…For total complications, data on 13 studies were collected for meta-analysis. [7][8][9][10][11][12][13][14][15][16][17][18][19] A total of 1119 patients were allocated to the IGS group and 1282 allocated to the non-IGS group. Overall, there were 44 and 81 total complications in the IGS and non-IGS groups, respectively.…”

Section: Perioperative Morbidity For Igs Vs Non-igs Essmentioning

confidence: 99%

Image‐Guided Surgery Influences Perioperative Morbidity from Endoscopic Sinus Surgery: A Systematic Review and Meta‐Analysis

Dalgorf

Sacks

Wormald³

et al. 2013

Otolaryngol.--head neck surg.

119

136

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Objective. Although image-guided surgery (IGS) is considered a valuable tool, its impact on perioperative morbidity for endoscopic sinus surgery (ESS) remains unclear. The evidence from reported literature is systematically reviewed with meta-analysis.Data Sources. MEDLINE (1946 to September 14, 2012 and EMBASE (1974 to September 14, 2012.Review Methods. MEDLINE and EMBASE were searched using a search strategy for publications on IGS during ESS that reported original data on perioperative morbidity. PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines were followed. Both comparative cohort studies with non-IGS cases and case series were included. Primary outcome was major and total complications. Secondary outcomes were specific orbital and intracranial injury, major hemorrhage, ability to complete the operation, and revision surgery. The incidence of these events was defined as dichotomous variables and expressed as a risk ratio (RR) in a fixed-effects model.Results. In total, 2586 articles fulfilled the search, producing 55 included studies. Fourteen were comparative cohorts of IGS and non-IGS sinus surgical patient populations used for meta-analysis. Among the cohorts, major complications were more common in the non-IGS group (RR = 0.48; 95% confidence interval [CI], 0.28-0.82; P = .007). Total complications were greater in the non-IGS group (RR = 0.66; 95% CI, 0.47-0.94; P = .02). All other outcomes did not reach significance on meta-analysis.Conclusion. Contrary to current review articles on the topic of IGS use during ESS, there is evidence from published studies that the use of IGS for sinus surgery, within selected populations, is associated with a lower risk of major and total complications compared with non-IGS sinus surgery. Although IGS is considered a valuable tool, its impact on perioperative morbidity and patient-reported outcome measures (PROMs) for ESS remains unclear. Current evidence based on a small number of individual cohort studies and case series has not consistently demonstrated a significant advantage of IGS over non-IGS ESS. Given the low incidence of complications, a large sample size in both the IGS and non-IGS study group arms is required. Several evidencebased reviews have recently evaluated the impact of IGS during ESS on complications and clinical outcomes. 3,4 However, while these studies attempt to be systematic, they provide a qualitative and opinion-based recommendation for the indications of IGS for ESS. This meta-analysis is performed using pooled data from published studies to address the impact of IGS on perioperative morbidity and PROMs. MethodsA systematic review of the published literature was undertaken to collate studies providing original data on the patient outcomes following IGS-based sinus surgery. A metaanalysis was performed on the studies that were randomized controlled trials, retrospective cohorts, or prospective cohorts that had a control population. PRISMA (Preferred Reporting Items for Systematic reviews and Meta-...

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“…However, a similarly designed study with 203 subjects had contradicting findings. 11 More recently, 2 separate meta-analyses found no significant difference in subsequent revision rates with or without the initial use of IGS. 4,14…”

Section: Revision Ratementioning

confidence: 98%

“…Four of the 6 studies showed no statistically significant difference in complication rates with IGS, 11,[15][16][17] whereas 2 studies did show a significant difference in major complications with IGS use. One of these studies showed fewer major complications with IGS use (intracranial injury, orbital injury, major hemorrhage, and aborted procedure) but no difference in minor complications (not specifically defined), 10 whereas the other actually showed an increased rate of orbital injuries with the use of IGS but no other significant differences.…”

Section: Utility Of Image Guidance In Endoscopic Sinus Surgerymentioning

confidence: 99%