Multiple analyses of factors related to complications in endoscopic sinus surgery

Chou, Tung-Wei; Chen, Pei–Shih; Lin, Hung-Ching; Lee, Kuo‐Sheng; Tsai, Hsun-Tien; Lee, Jehn-Chuan; Leu, Yi-Shing; Wang, Ying‐Piao

doi:10.1016/j.jcma.2015.11.001

Cited by 20 publications

(14 citation statements)

References 15 publications

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“…[1,2,19] Patients with severe uncontrolled chronic rhinosinusitis are required standard-dose MDCT following sinus surgeries. [1,2,6,22,25] In consideration of the risk of complications, the trial suggested, the adaptation of standard-dose protocols of MDCT for sinus surgeries when severe complications have found by nasal endoscopy and olfactory function test.…”

Section: Discussionmentioning

confidence: 99%

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Standard-dose versus low-dose multidetector computed tomography examinations in patients with uncontrolled chronic rhinosinusitis

Huang

Ye²,

Guan³

2018

Medicine

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Background:Multidetector computed tomography (MDCT) images for rhinosinusitis may have a risk of radiation hazards. Reduction in radiation dose may lead to a compromise in quality of MDCT images and have chances of postoperative complications.Objective:The aim of the study was to test the applicability of low-dose MDCT protocols for decision-making of sinus surgeries of patients with uncontrolled chronic rhinosinusitis.Design:Randomized, double-blind (patients and evaluators blind), controlled, trial.Setting:People's Hospital of Guanghan, China.Patients:A total of 288 patients with clinically confirmed uncontrolled chronic rhinosinusitis were subjected to randomization (1:1 ratio).Interventions:Patients were subjected to low-dose preoperative protocols of MDCT (n = 144; ldMDCT group) or standard-dose preoperative protocols of MDCT (n = 144; sdMDCT group).Outcome measures:Image analysis was performed by the workstation. Lund-Mackay score, modified Lund-Mackay score, estimated radiation exposure, and surgical complications were evaluated for each patient. The χ2 independent test or 2-tailed paired t test were performed for statistical analysis.Results:The preoperative MDCT images for standard-dose protocol had better quality than low-dose protocol (P < .001, q = 4.57). The area of images that give confidence for sinus surgery at one time was higher for standard-dose MDCT protocol technique than low-dose MDCT protocol method. Patients of ldMDCT group with large growth of nasal polyps (P = .03, q = 5.35) and complete opacification of sinuses (P = .03, q = 7.94) had complications after sinus surgeries. Either low-dose or standard-dose MDCT protocol was performed, the experience of otolaryngologist had decreased complication after surgeries.Conclusion:Preoperative low-dose MDCT should be used for diagnosis of uncontrolled chronic rhinosinusitis for decision making of sinus surgeries.Level of Evidence:III.Trial registration:researchregistry4264 dated 1 March 2016 (www.researchregistry.com).

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Section: Discussionmentioning

confidence: 99%

“…[5] Postoperative complications affected by the other factors like the experience of surgeons, length of surgeries, and the demographic characters of patients. [6]…”

Section: Introductionmentioning

confidence: 99%

Standard-dose versus low-dose multidetector computed tomography examinations in patients with uncontrolled chronic rhinosinusitis

Huang

Ye²,

Guan³

2018

Medicine

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“…Chou et al per 997 patients, there is a direct relationship between the experience of the ENT doctor and the probability of iatrogenic maneuver (a resident doctor has a risk of 12.67% vs. an experienced doctor who has a risk of only 2.4%) 15 .…”

Section: The Role Of the Keros Classification In Endoscopic Sinus Surmentioning

confidence: 99%

The role of the Keros classification in endoscopic sinus surgery

Lupoi

2020

Romanian Journal of Rhinology

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“…It could be suspected that using dose reduction CT protocol in chronic rhinosinusitis patients with initially higher risk for perioperative complications, like those with bronchial asthma, after previous sinus surgery and with enhanced nasal polyposis, may potentially further increase the risk of complications [ 5 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

Investigation of sinonasal anatomy via low-dose multidetector CT examination in chronic rhinosinusitis patients with higher risk for perioperative complications

Frączek

Guziński

Morawska-Kochman

et al. 2016

Eur Arch Otorhinolaryngol

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The aim of the study was to compare visualisation of the surgically relevant anatomical structures via low- and standard-dose multidetector CT protocol in patients with chronic rhinosinusitis (CRS) and higher risk for perioperative complications (i.e. presence of bronchial asthma, history of sinus surgery and advanced nasal polyposis). 135 adult CRS patients were divided randomly into standard-dose (120 kVp, 100 mAs) or low-dose CT groups (120 kVp, 45 mAs). The detectability of the vital anatomical structures (anterior ethmoid artery, optic nerve, cribriform plate and lamina papyracea) was scored using a five-point scale (from excellent to unacceptable) by a radiologist and sinus surgeon. Polyp sizes were quantified endoscopically according to the Lildholdt’s scale (LS). Olfactory function was tested with the “Sniffin’ Sticks” test. On the low-dose CT images, detectability ranged from 2.42 (better than poor) for cribriform plate among anosmic cases to 4.11 (better than good) for lamina papyracea in cases without nasal polyps. Identification of lamina papyracea on low-dose scans was significantly worse in each group and the same was the case with cribriform plates in patients with advanced polyposis and anosmia. Cribriform plates were the most poorly identified (between poor and average) among all the structures on low-dose images. Identification of anterior ethmoid artery (AEA) with reduced dose was insignificantly worse than with standard-dose examination. The AEA was scored as an average-defined structure and was the second weakest visualised. In conclusion, preoperatively, low-dose protocols may not sufficiently visualise the surgically relevant anatomical structures in patients with CRS and bronchial asthma, advanced nasal polyps (LS > 2) and history of sinus surgery. Low mAs value enables comparable detectability of sinonasal landmarks with standard-dose protocols in patients without analysed risk factors. In the context of planned surgery, the current preferences of the tube should be carefully evaluated for different patient constitutions to minimise the risk of complications.

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Multiple analyses of factors related to complications in endoscopic sinus surgery

Cited by 20 publications

References 15 publications

Standard-dose versus low-dose multidetector computed tomography examinations in patients with uncontrolled chronic rhinosinusitis

Standard-dose versus low-dose multidetector computed tomography examinations in patients with uncontrolled chronic rhinosinusitis

The role of the Keros classification in endoscopic sinus surgery

Investigation of sinonasal anatomy via low-dose multidetector CT examination in chronic rhinosinusitis patients with higher risk for perioperative complications

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