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Postoperative Hemorrhage after Endoscopic Sinus Surgery
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Otolaryngology-Head and Neck Surgery, Vol 139, No 2S1, August 2008
rhinosinusitis (CRS). The relevance of this gene in CRS is also substantiated by previous biological studies 1) that stimulation of the gene product increases the innate immune responses in some inflammatory diseases, and 2) a reduced level of the gene transcript in patients with recalcitrant CRS with nasal polyposis. We explore whether single nucleotide polymorphisms (SNPs) in the IL22RA1 gene are associated with CRS. METHODS: DNA extracted from a population of 206 patients with severe CRS and 196 postal-code matched controls was used. The 23 tagging SNPs in the IL22RA1 gene were selected from positive results in the pGWAS and completed with tagging SNPs from the CEU HapMap dataset and genotyped in our population. The haploview software was used to determine association. RESULTS: 22 SNPs were genotyped successfully with a genotype distribution in agreement with the Hardy-Weinberg equilibrium. Seven (rs10751768, rs10794665, rs16829225, rs3936073, rs4292900, rs4648936, rs7418238) out of 22 genotyped-SNPs were significantly associated with CRS (p-value: 0.0009 to 0.0337; OR: 1.44 to 1.76). CONCLUSIONS: Polymorphisms in the IL22RA1 gene are associated with severe CRS. This may help better understand the pathophysiology of CRS and identify new targets for therapy. Replication in a second population with CRS is in progress to validate these findings. Postoperative Hemorrhage after Endoscopic Sinus Surgery Troy D. Woodard, MD (presenter); James A Stankiewicz, MD OBJECTIVE: 1) Identify complication rates of patients that underwent endoscopic sinus surgery and developed postoperative hemorrhage. 2) Determine if there is a correlation of preoperative variables with the development of this complication. METHODS: Retrospectively review patients who had functional endoscopic sinus surgery and developed postoperative hemorrhage from 1987 to 2007 in an university tertiary care facility. Analyze baseline characteristics and preoperative clinical variables for significant correlations. RESULTS: 29 of 5000 endoscopic cases resulted in postoperative hemorrhage (.58% complication rate). The mean age of the patients was 50 years old and there were equal proportions of male and female patients. While the extent of surgery demonstrated no significant difference among the patients, hemorrhage was most likely to occur in patients with previous surgery. An overwhelming majority of patients required a surgical procedure to control the bleeding. Hemorrhage was primarily isolated on the patient’s right side and involved the sphenopalatine or posterior septal arteries. CONCLUSIONS: Endoscopic sinus surgery has vastly increased in popularity. However, there still is a paucity of
information in the literature on complications associated with endoscopic sinus surgery, particularly postoperative hemorrhage. The results from this study provide identifying characteristics that predispose patients to develop this complication and what methods can be successfully utilized to treat this complication. Radiologic Staging System for Allergic Fungal Rhinosinusitis Gamwell A Rogers, MD (presenter); Sarah K Wise, MD; Mark D Ghegan, MD; Richard J Harvey, BSc(Med), MBBS, FRACS; John M DelGaudio, MD; Rodney J Schlosser, MD OBJECTIVE: (1) To develop an objective method for quantifying radiologic bone erosion in allergic fungal rhinosinusitis (AFRS). (2) To assess the utility of the newly developed AFRS CT staging system in differentiating AFRS patient groups. METHODS: Patients from two tertiary care rhinology practices with classic AFRS and available CTs (2001-2007) were included for retrospective review. CTs were scored by trained graders not involved in the patients’ care as the primary treating surgeon. The following novel assessment scale was used: Each paranasal sinus wall with expansion/erosion was scored 1 point, with a maximum of 3 points possible for each frontal sinus, 2 points for each ethmoid complex, 3 points for each sphenoid sinus, 3 points for each maxillary sinus, 1 point for the frontal intersinus septum, and 1 point for the sphenoid intersinus septum, yielding a maximum of 24 possible total points. RESULTS: 111 CTs were reviewed. Mean score across all patients was 7.8 (range 0-24). Males scored significantly higher than females (mean 9.3 vs 5.6, p ⬍ 0.001). African Americans scored significantly higher than Caucasians (mean 9.6 vs 5.0, p ⬍ 0.001). There was also a trend towards younger patients exhibiting higher scores (p ⫽ 0.07). CONCLUSIONS: A radiologic grading system for bone erosion/expansion in AFRS is presented, which is easy to apply and may objectively stratify disease severity. Males and African Americans with AFRS demonstrate significantly more bone erosion. Additional analysis of disease course will assess the potential utility of this staging system in predicting outcomes. Surgeon Radiation Exposure in ESS Using Balloon Catheters Ford D Albritton, IV, MD (presenter); Joseph L. Smith, II, MD; Fazlur R. Zahurullah, MD, MBA; Michael Armstrong, Jr, MD; Don A Duplan MD; James A Gershow, MD; Frederick A Kuhn, MD OBJECTIVE: Less invasive instruments such as balloon cath-
Otolaryngology-Head and Neck Surgery, Vol 139, No 2S1, August 2008
rhinosinusitis (CRS). The relevance of this gene in CRS is also substantiated by previous biological studies 1) that stimulation of the gene product increases the innate immune responses in some inflammatory diseases, and 2) a reduced level of the gene transcript in patients with recalcitrant CRS with nasal polyposis. We explore whether single nucleotide polymorphisms (SNPs) in the IL22RA1 gene are associated with CRS. METHODS: DNA extracted from a population of 206 patients with severe CRS and 196 postal-code matched controls was used. The 23 tagging SNPs in the IL22RA1 gene were selected from positive results in the pGWAS and completed with tagging SNPs from the CEU HapMap dataset and genotyped in our population. The haploview software was used to determine association. RESULTS: 22 SNPs were genotyped successfully with a genotype distribution in agreement with the Hardy-Weinberg equilibrium. Seven (rs10751768, rs10794665, rs16829225, rs3936073, rs4292900, rs4648936, rs7418238) out of 22 genotyped-SNPs were significantly associated with CRS (p-value: 0.0009 to 0.0337; OR: 1.44 to 1.76). CONCLUSIONS: Polymorphisms in the IL22RA1 gene are associated with severe CRS. This may help better understand the pathophysiology of CRS and identify new targets for therapy. Replication in a second population with CRS is in progress to validate these findings. Postoperative Hemorrhage after Endoscopic Sinus Surgery Troy D. Woodard, MD (presenter); James A Stankiewicz, MD OBJECTIVE: 1) Identify complication rates of patients that underwent endoscopic sinus surgery and developed postoperative hemorrhage. 2) Determine if there is a correlation of preoperative variables with the development of this complication. METHODS: Retrospectively review patients who had functional endoscopic sinus surgery and developed postoperative hemorrhage from 1987 to 2007 in an university tertiary care facility. Analyze baseline characteristics and preoperative clinical variables for significant correlations. RESULTS: 29 of 5000 endoscopic cases resulted in postoperative hemorrhage (.58% complication rate). The mean age of the patients was 50 years old and there were equal proportions of male and female patients. While the extent of surgery demonstrated no significant difference among the patients, hemorrhage was most likely to occur in patients with previous surgery. An overwhelming majority of patients required a surgical procedure to control the bleeding. Hemorrhage was primarily isolated on the patient’s right side and involved the sphenopalatine or posterior septal arteries. CONCLUSIONS: Endoscopic sinus surgery has vastly increased in popularity. However, there still is a paucity of
information in the literature on complications associated with endoscopic sinus surgery, particularly postoperative hemorrhage. The results from this study provide identifying characteristics that predispose patients to develop this complication and what methods can be successfully utilized to treat this complication. Radiologic Staging System for Allergic Fungal Rhinosinusitis Gamwell A Rogers, MD (presenter); Sarah K Wise, MD; Mark D Ghegan, MD; Richard J Harvey, BSc(Med), MBBS, FRACS; John M DelGaudio, MD; Rodney J Schlosser, MD OBJECTIVE: (1) To develop an objective method for quantifying radiologic bone erosion in allergic fungal rhinosinusitis (AFRS). (2) To assess the utility of the newly developed AFRS CT staging system in differentiating AFRS patient groups. METHODS: Patients from two tertiary care rhinology practices with classic AFRS and available CTs (2001-2007) were included for retrospective review. CTs were scored by trained graders not involved in the patients’ care as the primary treating surgeon. The following novel assessment scale was used: Each paranasal sinus wall with expansion/erosion was scored 1 point, with a maximum of 3 points possible for each frontal sinus, 2 points for each ethmoid complex, 3 points for each sphenoid sinus, 3 points for each maxillary sinus, 1 point for the frontal intersinus septum, and 1 point for the sphenoid intersinus septum, yielding a maximum of 24 possible total points. RESULTS: 111 CTs were reviewed. Mean score across all patients was 7.8 (range 0-24). Males scored significantly higher than females (mean 9.3 vs 5.6, p ⬍ 0.001). African Americans scored significantly higher than Caucasians (mean 9.6 vs 5.0, p ⬍ 0.001). There was also a trend towards younger patients exhibiting higher scores (p ⫽ 0.07). CONCLUSIONS: A radiologic grading system for bone erosion/expansion in AFRS is presented, which is easy to apply and may objectively stratify disease severity. Males and African Americans with AFRS demonstrate significantly more bone erosion. Additional analysis of disease course will assess the potential utility of this staging system in predicting outcomes. Surgeon Radiation Exposure in ESS Using Balloon Catheters Ford D Albritton, IV, MD (presenter); Joseph L. Smith, II, MD; Fazlur R. Zahurullah, MD, MBA; Michael Armstrong, Jr, MD; Don A Duplan MD; James A Gershow, MD; Frederick A Kuhn, MD OBJECTIVE: Less invasive instruments such as balloon cath-