Gender as a Predictor of Complications in Endoscopic Sinus Surgery

Abstract

Background: Understanding patient-specific risk factors for complications of functional endoscopic sinus surgery (ESS) is critical. Previous work has investigated such risk factors, but a population-based analysis has not been performed to date. Objectives: This study analyzes the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database to identify patient-specific risk factors associated with complications following ESS. Methods: A retrospective cohort study of patients who underwent ESS was conducted using the NSQIP database from 2011 to 2017. Patients were identified using CPT-codes for ESS procedures. The primary outcome analyzed was any postoperative complication. Simultaneous procedures with ESS were controlled for with regression analysis. Post-operative complications and 30-day readmission were evaluated using multivariate logistic regression controlling for age, gender, race, comorbidities (diabetes mellitus, hypertension, chronic obstructive pulmonary disease, congestive heart failure, renal failure, steroid use, and cancer history), smoking history, and intraoperative factors. Results: A total of 1279 patients who underwent ESS were identified. The average age of patients was 46.1 (SD = 16.8). Most patients (58.2%) had no major comorbidities. 594 (46.4%) patients had a tonsillectomy, adenoidectomy, or uvulopharyngoplasty at the same time as ESS. 101 (7.9%) patients experienced a complication post-operatively. 46 (3.6%) patients experienced a readmission postoperatively. The most common complication was reoperation (N = 40, 3.1%). Regression analysis revealed that gender was the only demographic factor associated with risk of post-operative complications, with women having a significantly lower risk than men (OR = 0.61, 95% CI 0.37-0.99, P = .046). Conclusions: ESS is typically performed on a relatively young and healthy population. Women have a significantly lower risk of complications after controlling for comorbidities. Further analysis of gender-specific differences in surgical outcomes should be evaluated to understand this phenomenon.

Biological sex as a modulator in rhinologic anatomy, physiology, and pathology: A scoping review

“…noted that female sex was associated with lower health‐related QoL improvement after ESS for the CRSsNP group but not the CRSwNP group 49 . Additionally, females had a significantly lower risk of any postoperative complications from ESS compared with males on regression analysis although the mechanism behind these results is still unknown 50 …”

“…49 Additionally, females had a significantly lower risk of any postoperative complications from ESS compared with males on regression analysis although the mechanism behind these results is still unknown. 50 A systematic review and meta-analysis on the role of depression in CRS found mixed results. A possible association of depression with female sex may be present and special attention should be paid to depressive symptoms in females in clinical management.…”

Gender Differences in Adults With Chronic Rhinosinusitis: A Scoping Review

“…Only 1 study (n = 1279) evaluated gender effects on complications after functional of endoscopic sinus surgery and found that women were less likely to experience complications after controlling for comorbidities 30 . This finding however has not been attested to in the rest of the literature.…”