Geriatric Sinus Surgery: A Review of Demographic Variables, Surgical Success and Complications in Elderly Surgical Patients

Samuel N Helman; Daniel Carlton; Brian Deutsch; Robert Choake; Varun Patel; Satish Govindaraj; Alfred M C Iloreta; Anthony Del Signore

doi:10.1177/21526567211010736

Geriatric Sinus Surgery: A Review of Demographic Variables, Surgical Success and Complications in Elderly Surgical Patients

Allergy Rhinol (Providence). 2021 Jun 3:12:21526567211010736. doi: 10.1177/21526567211010736. eCollection 2021 Jan-Dec.

Authors

Samuel N Helman¹, Daniel Carlton², Brian Deutsch², Robert Choake², Varun Patel³, Satish Govindaraj², Alfred M C Iloreta², Anthony Del Signore²

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York.
² Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital-New York Eye and Ear Infirmary of Mount Sinai, New York, New York.
³ Department of Otolaryngology-Head and Neck Surgery, Albany Medical Center, Albany, New York.

Abstract

Objective: Demonstrate feasibility, safety and outcome metrics of geriatric sinus surgery (GESS).

Study design: Retrospective review of patients undergoing sinus surgery for indication of chronic rhinosinusitis with and without nasal polyposis.

Setting: Tertiary referral center.

Participants: Patients who underwent FESS from 2008-2017; excluding skull base, craniofacial, or oncologic surgery. Primary study group were patients aged 65 years and older. Patients aged 40-64 years of age were included for comparison.Main Outcomes and Measures: Multivariate analysis was performed to identify independently associated patient characteristics and perioperative variables. Preoperative medical and treatment history, revision and primary surgery, preoperative and post-operative SNOT-22 and NOSE scores, Lund-McKay scores were recorded when available. Post-operative data was assessed at a minimum of two months after the index procedure. Post-operative complications were included.

Results: Ninety-one (91) patients met criteria. 21.2% of the geriatric patients were taking systemic anticoagulation prior to surgery, and underwent treatment with nasal steroids (25.0%), oral antibiotics (67.7%), nasal irrigations (48.4%), and systemic steroids (37.5%) over an average of 7.3 months prior to surgery. There was an average post-operative reduction of 15.0 points (p < 0.0001) and 42.5 points (p = 0.0008) for SNOT-22 and NOSE scores, respectively. Average operative time was 117.4 minutes in geriatric patients compared to 183.4 minutes in younger patients (p = 0.004), with an average estimated blood loss of 55.6 milliliters (mL) compared to younger patients (111.8 mL) (p = 0.04). Linear regression identified revision surgery as associated with reductions in Sinonasal Outcome Test (SNOT-22) scores (p = 0.011). Geriatric patients had a shorter operative time (p = 0.011) while male sex was associated with a longer operative time (p = 0.014). Patients over 65 had fewer minor complications (p = 0.01), and there were no major complications in either group.

Conclusions and relevance: Geriatric sinus surgery is effective and safe in this cohort of patients.

Keywords: geriatric surgery; sinus surgery; surgical complications; surgical outcomes.