Complication rates after functional endoscopic sinus surgery: analysis of 50,734 Japanese patients.

OBJECTIVE The complication rates associated with different types of functional endoscopic sinus surgery (FESS) remain to be fully examined. STUDY DESIGN Retrospective cohort study. METHODS We extracted data from the Japanese Diagnosis Procedure Combination database on 50,734 patients (aged ≥ 16 years) who underwent FESS for chronic rhinosinusitis between 2007 and 2013. We focused on specific types of surgery and stratified the patients into three groups: group 1 (single sinus surgery), group 2 (multiple sinus surgery), and group 3 (whole sinus surgery). Patient characteristics and early postoperative complications including cerebrospinal fluid (CSF) leakage, orbital injury, severe hemorrhage, and toxic shock syndrome (TSS) that occurred during 1 to 2 weeks of each hospitalization were compared. Multivariable logistic regression analysis was performed to assess the association between overall complication rate and background characteristics, with adjustment for within-hospital clustering. RESULTS The overall complication rate was 0.50%; the rates of CSF leakage, orbital injury, hemorrhage requiring surgery, blood transfusion, and TSS were 0.09%, 0.09%, 0.10%, 0.18%, and 0.02%, respectively. Ethmoidectomy combined with sphenoidotomy was associated with higher overall complication rates (1.40%). The rate of orbital injury was highest in group 2, whereas that of other complications did not differ significantly among the groups. Extent of FESS showed no significant association with overall complication rate. CONCLUSION More extensive FESS was not associated with increased rates of postoperative CSF leakage, hemorrhage, or TSS. Multiple sinus surgery was associated with a higher rate of orbital injury. The extent of surgery did not significantly affect the overall complication rate. LEVEL OF EVIDENCE 2b.