Endoscopic Sinus Surgery in Patients with Cystic Fibrosis: An Analysis of Complications

Abstract

The application of endoscopic sinus surgery (ESS) for the management of paranasal sinus disease in patients with cystic fibrosis (CF) has been well described. Due to underlying medical issues such as acquired coagulopathies and advanced pulmonary disease, perioperative morbidity is assumed to be higher in this group. The incidence and type of complications associated with CF patients undergoing ESS has not been previously described. We reviewed 52 consecutive endoscopic procedures in 41 patients with CF performed by a single surgeon over a 34-month period. This review focused on perioperative and postoperative complications. Additional clinical data gathered included estimated blood loss, length of procedure, coagulation laboratory studies, the presence of nasal polyposis, the use of nasal packing, pulmonary function status, and average hospitalization time. A total of six complications were identified--four immediate and two delayed. The perioperative or immediate complications included two cases of epistaxis, one case of periorbital ecchymosis, and one case of pulmonary hemorrhage. Delayed complications include one case of epistaxis and one case of intranasal scarring. In two of these six patients, length of hospitalization was prolonged for management of the associated complications. No study has specifically addressed complications of ESS in the CF patient. Our review demonstrates a complication rate of 11.5%, which compares favorably with the non-CF ESS complication rates of 0-17% reported in the literature. Critical to successful management of these patients is coordinated care delivered by the pediatrician or internist, the pulmonary specialist, the anesthesia team, and the otolaryngologist. In addition to a review of current literature, we discuss the overall management approach adopted at our institution and highlight elements thought to minimize morbidity.

Sinonasal Manifestations in Cystic Fibrosis

“…However, a previous study by Albritton and Kingdom demonstrated a low complication rate for ESS in this patient group, compared to non-CF ESS complication rates reported in the literature [38]. Another previous study did not show association of ESS or open sinus surgery with increased rates of pulmonary complications or postoperative bleeding in CF patients [39].…”

“…Studies on the effect of sinus surgery on pulmonary function have shown improvement of pulmonary symptoms and a reduced need for hositalization, but no differences in pulmonary function test outcomes (grade C evidence) [55–58]. No association has been found between sinus surgery and increased rates of postoperative complications, including hemorrhage (grade C evidence) [38, 39]. Surgical revision rates in patients with nasal polyps are much higher than in patients without polyps (grade C evidence) [53].…”

Functional endoscopic sinus surgery—A retrospective analysis of 115 children and adolescents with chronic rhinosinusitis

“…In CF improvement after FESS is less good than in non-CF children, but still significant with 50% after 2 years [1]. FESS is associated with a lower incidence of tracheobronchitis and pneumonia in CF-patients with a transplanted lung [22].…”

Cystic Fibrosis Chronic Rhinosinusitis: A Comprehensive Review

“…Multiple studies have been conducted to report on the safety and effectiveness of FESS in CF patients. 9,[119][120][121][122][123] Complication rate after FESS in CF patients (11.5%) was found to be similar to the rate of non-CF FESS complications (0-17%). 121 Khalid et al reported on the outcomes of sinus surgery in adult patients both with and without CF.…”

“…9,[119][120][121][122][123] Complication rate after FESS in CF patients (11.5%) was found to be similar to the rate of non-CF FESS complications (0-17%). 121 Khalid et al reported on the outcomes of sinus surgery in adult patients both with and without CF. 114 Although baseline CT and endoscopy scores were significantly worse in CF patients, the overall quality of life improvements as well as the degree of endoscopic improvement was similar between the two groups.…”