Early postoperative care following endoscopic sinus surgery

An evidence-based review with recommendations

Luke Rudmik, Zachary M. Soler, Richard R. Orlandi, Michael G. Stewart, Neil Bhattacharyya, David W. Kennedy, Timothy Smith

Research output: Contribution to journalArticle

85 Citations (Scopus)

Abstract

Background: Early postoperative care following endoscopic sinus surgery (ESS) has been suggested to minimize avoidable complications and optimize long-term outcomes. Several postoperative care strategies have been proposed but a formal comprehensive evaluation of the evidence has never been performed. The purpose of this article is to provide an evidence-based approach to early postoperative care following ESS. Methods: A systematic review of the literature was performed and the Clinical Practice Guideline Manual, Conference on Guideline Standardization (COGS), and the Appraisal of Guidelines and Research Evaluation (AGREE) instrument recommendations were followed. Study inclusion criteria were: adult population >18 years old; chronic rhinosinusitis (CRS) based on published diagnostic criteria; ESS following failed medical therapy; primary study objective was to evaluate an ESS early postoperative care strategy; and clearly defined primary clinical end-point. Results: This review identified and evaluated the literature on 7 early postoperative care strategies following ESS: saline irrigations, sinus cavity debridements, systemic steroids, topical steroids, oral antibiotics, topical decongestants, and drug-eluting spacers/stents. Conclusion: Based on the available evidence, use of nasal saline irrigation, sinus cavity debridement, and standard topical nasal steroid spray are recommended early postoperative care interventions. Postoperative antibiotic, systemic steroid, nonstandard topical nasal steroid solution, and/or drug-eluting spacers/stents are options in postoperative management. These evidence-based recommendations should not necessarily be applied to all postoperative patients and clinical judgment, in addition to evidence, is critical to determining the most appropriate care.

Original languageEnglish (US)
Pages (from-to)417-430
Number of pages14
JournalInternational Forum of Allergy and Rhinology
Volume1
Issue number6
DOIs
StatePublished - Nov 2011

Fingerprint

Postoperative Care
Steroids
Drug-Eluting Stents
Debridement
Nasal Lavage
Guidelines
Nasal Decongestants
Anti-Bacterial Agents
Nasal Sprays
Nose
Practice Guidelines
Population

Keywords

  • Endoscopy
  • Evidence-based medicine
  • Postoperative care
  • Sinusitis
  • Surgery

ASJC Scopus subject areas

  • Immunology and Allergy
  • Otorhinolaryngology

Cite this

Early postoperative care following endoscopic sinus surgery : An evidence-based review with recommendations. / Rudmik, Luke; Soler, Zachary M.; Orlandi, Richard R.; Stewart, Michael G.; Bhattacharyya, Neil; Kennedy, David W.; Smith, Timothy.

In: International Forum of Allergy and Rhinology, Vol. 1, No. 6, 11.2011, p. 417-430.

Research output: Contribution to journalArticle

Rudmik, Luke ; Soler, Zachary M. ; Orlandi, Richard R. ; Stewart, Michael G. ; Bhattacharyya, Neil ; Kennedy, David W. ; Smith, Timothy. / Early postoperative care following endoscopic sinus surgery : An evidence-based review with recommendations. In: International Forum of Allergy and Rhinology. 2011 ; Vol. 1, No. 6. pp. 417-430.
@article{72307c44d95e49e4b09c068ca5193bd9,
title = "Early postoperative care following endoscopic sinus surgery: An evidence-based review with recommendations",
abstract = "Background: Early postoperative care following endoscopic sinus surgery (ESS) has been suggested to minimize avoidable complications and optimize long-term outcomes. Several postoperative care strategies have been proposed but a formal comprehensive evaluation of the evidence has never been performed. The purpose of this article is to provide an evidence-based approach to early postoperative care following ESS. Methods: A systematic review of the literature was performed and the Clinical Practice Guideline Manual, Conference on Guideline Standardization (COGS), and the Appraisal of Guidelines and Research Evaluation (AGREE) instrument recommendations were followed. Study inclusion criteria were: adult population >18 years old; chronic rhinosinusitis (CRS) based on published diagnostic criteria; ESS following failed medical therapy; primary study objective was to evaluate an ESS early postoperative care strategy; and clearly defined primary clinical end-point. Results: This review identified and evaluated the literature on 7 early postoperative care strategies following ESS: saline irrigations, sinus cavity debridements, systemic steroids, topical steroids, oral antibiotics, topical decongestants, and drug-eluting spacers/stents. Conclusion: Based on the available evidence, use of nasal saline irrigation, sinus cavity debridement, and standard topical nasal steroid spray are recommended early postoperative care interventions. Postoperative antibiotic, systemic steroid, nonstandard topical nasal steroid solution, and/or drug-eluting spacers/stents are options in postoperative management. These evidence-based recommendations should not necessarily be applied to all postoperative patients and clinical judgment, in addition to evidence, is critical to determining the most appropriate care.",
keywords = "Endoscopy, Evidence-based medicine, Postoperative care, Sinusitis, Surgery",
author = "Luke Rudmik and Soler, {Zachary M.} and Orlandi, {Richard R.} and Stewart, {Michael G.} and Neil Bhattacharyya and Kennedy, {David W.} and Timothy Smith",
year = "2011",
month = "11",
doi = "10.1002/alr.20072",
language = "English (US)",
volume = "1",
pages = "417--430",
journal = "International Forum of Allergy and Rhinology",
issn = "2042-6976",
publisher = "Wiley-Blackwell",
number = "6",

}

TY - JOUR

T1 - Early postoperative care following endoscopic sinus surgery

T2 - An evidence-based review with recommendations

AU - Rudmik, Luke

AU - Soler, Zachary M.

AU - Orlandi, Richard R.

AU - Stewart, Michael G.

AU - Bhattacharyya, Neil

AU - Kennedy, David W.

AU - Smith, Timothy

PY - 2011/11

Y1 - 2011/11

N2 - Background: Early postoperative care following endoscopic sinus surgery (ESS) has been suggested to minimize avoidable complications and optimize long-term outcomes. Several postoperative care strategies have been proposed but a formal comprehensive evaluation of the evidence has never been performed. The purpose of this article is to provide an evidence-based approach to early postoperative care following ESS. Methods: A systematic review of the literature was performed and the Clinical Practice Guideline Manual, Conference on Guideline Standardization (COGS), and the Appraisal of Guidelines and Research Evaluation (AGREE) instrument recommendations were followed. Study inclusion criteria were: adult population >18 years old; chronic rhinosinusitis (CRS) based on published diagnostic criteria; ESS following failed medical therapy; primary study objective was to evaluate an ESS early postoperative care strategy; and clearly defined primary clinical end-point. Results: This review identified and evaluated the literature on 7 early postoperative care strategies following ESS: saline irrigations, sinus cavity debridements, systemic steroids, topical steroids, oral antibiotics, topical decongestants, and drug-eluting spacers/stents. Conclusion: Based on the available evidence, use of nasal saline irrigation, sinus cavity debridement, and standard topical nasal steroid spray are recommended early postoperative care interventions. Postoperative antibiotic, systemic steroid, nonstandard topical nasal steroid solution, and/or drug-eluting spacers/stents are options in postoperative management. These evidence-based recommendations should not necessarily be applied to all postoperative patients and clinical judgment, in addition to evidence, is critical to determining the most appropriate care.

AB - Background: Early postoperative care following endoscopic sinus surgery (ESS) has been suggested to minimize avoidable complications and optimize long-term outcomes. Several postoperative care strategies have been proposed but a formal comprehensive evaluation of the evidence has never been performed. The purpose of this article is to provide an evidence-based approach to early postoperative care following ESS. Methods: A systematic review of the literature was performed and the Clinical Practice Guideline Manual, Conference on Guideline Standardization (COGS), and the Appraisal of Guidelines and Research Evaluation (AGREE) instrument recommendations were followed. Study inclusion criteria were: adult population >18 years old; chronic rhinosinusitis (CRS) based on published diagnostic criteria; ESS following failed medical therapy; primary study objective was to evaluate an ESS early postoperative care strategy; and clearly defined primary clinical end-point. Results: This review identified and evaluated the literature on 7 early postoperative care strategies following ESS: saline irrigations, sinus cavity debridements, systemic steroids, topical steroids, oral antibiotics, topical decongestants, and drug-eluting spacers/stents. Conclusion: Based on the available evidence, use of nasal saline irrigation, sinus cavity debridement, and standard topical nasal steroid spray are recommended early postoperative care interventions. Postoperative antibiotic, systemic steroid, nonstandard topical nasal steroid solution, and/or drug-eluting spacers/stents are options in postoperative management. These evidence-based recommendations should not necessarily be applied to all postoperative patients and clinical judgment, in addition to evidence, is critical to determining the most appropriate care.

KW - Endoscopy

KW - Evidence-based medicine

KW - Postoperative care

KW - Sinusitis

KW - Surgery

UR - http://www.scopus.com/inward/record.url?scp=84861409772&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84861409772&partnerID=8YFLogxK

U2 - 10.1002/alr.20072

DO - 10.1002/alr.20072

M3 - Article

VL - 1

SP - 417

EP - 430

JO - International Forum of Allergy and Rhinology

JF - International Forum of Allergy and Rhinology

SN - 2042-6976

IS - 6

ER -