Objectives:Enhanced recovery after surgery(ERAS)protocols for endoscopic sinus surgery(ESS)have not been widely implemented,and a critical review of ERAS recommendations and a comprehensive analysis of the supporting ...Objectives:Enhanced recovery after surgery(ERAS)protocols for endoscopic sinus surgery(ESS)have not been widely implemented,and a critical review of ERAS recommendations and a comprehensive analysis of the supporting literature has not been undertaken.We describe an ESS ERAS protocol including key perioperative interventions for patients undergoing ESS and assess the available evidence.Data Sources:A search was conducted of all relevant ERAS literature in otorhinolaryngology,anesthesia,and surgery using Medline(via PubMed),and Scopus.Keywords included“endoscopic sinus surgery,”“sinus surgery,”“FESS,”and“ESS”for each area of intervention.Where applicable,the authors considered highlevel evidence for recommendations devised for patient cohorts in otorhinolaryngology not undergoing ESS,as well as cohorts undergoing surgical procedures for which ERAS protocols have been extensively evaluated.Methods:Studies received grades of“low,”“moderate,”or“high”quality evidence based on the Oxford Centre for Evidence-Based Medicine criteria.Each intervention was subsequently assigned a grade of“strong,”“weak,”or“conditional”based on the available evidence.Results:Strong recommendations include comprehensive patient education and counseling,minimization of preoperative fasting,application of topical/local anesthetics and vasoconstrictors,use of total intravenous anesthesia,avoidance of pharyngeal packing,and use of postoperative nasal irrigation and multimodal analgesia.Conditional recommendations include antibiotic prophylaxis.Weak recommendations include perioperative venous thromboembolism prophylaxis,controlled hypotension,and use of postoperative nasal packing/dressing.Conclusion:A comprehensive ERAS protocol for ESS can include a variety of high yield,evidence-based interventions that would likely improve surgical outcomes and patient satisfaction.展开更多
Background:Aspirin-exacerbated respiratory disease(AERD)is an aggressive inflammatory disorder of the upper and lower respiratory tract.Corticosteroids,leukotriene modifiers,endoscopic sinus surgery(ESS),aspirin(ASA)d...Background:Aspirin-exacerbated respiratory disease(AERD)is an aggressive inflammatory disorder of the upper and lower respiratory tract.Corticosteroids,leukotriene modifiers,endoscopic sinus surgery(ESS),aspirin(ASA)desensitization,and biological immu-nomodulators are currently used to treat the disorder.Objective:The objective of this study was to determine the psychosocial impact of ESS and ASA desensitization on AERD patients.Methods:All AERD patients who underwent complete ESS were divided into two cohorts based on ASA desensitization status.The psychosocial metrics of the SNOT-22 were collected and analyzed at the following time points:pre-operative,1-month,3-month,6-month,and 12-month after ESS.Results:One hundred and eighty-four AERD patients underwent ESS from November 2009 to November 2018.From this group,130 patients underwent ASA desensitization(AD cohort)and 54 patients remained non-desensitized(ND cohort).AD patients showed a significantly greater reduction in total SNOT-22 scores over the study period compared to ND patients(p=0.0446).Analysis of SNOT-22 psychosocial metrics showed a significantly greater improvement in patient productivity in the AD cohort when compared to the ND cohort(p=0.0214).Further,a sub-group analysis accounting for subject attrition showed a significantly greater improvement in both productivity and concentration in AD patients when compared to the ND cohort(productivity:p=0.0068;concentration:p=0.0428).Conclusions:ESS followed by ASA desensitization decreases the overall psychosocial burden in AERD patients with a significant improvement in perceived productivity and concentration.This has significant implications given the psychosocial impact of chronic diseases.展开更多
文摘Objectives:Enhanced recovery after surgery(ERAS)protocols for endoscopic sinus surgery(ESS)have not been widely implemented,and a critical review of ERAS recommendations and a comprehensive analysis of the supporting literature has not been undertaken.We describe an ESS ERAS protocol including key perioperative interventions for patients undergoing ESS and assess the available evidence.Data Sources:A search was conducted of all relevant ERAS literature in otorhinolaryngology,anesthesia,and surgery using Medline(via PubMed),and Scopus.Keywords included“endoscopic sinus surgery,”“sinus surgery,”“FESS,”and“ESS”for each area of intervention.Where applicable,the authors considered highlevel evidence for recommendations devised for patient cohorts in otorhinolaryngology not undergoing ESS,as well as cohorts undergoing surgical procedures for which ERAS protocols have been extensively evaluated.Methods:Studies received grades of“low,”“moderate,”or“high”quality evidence based on the Oxford Centre for Evidence-Based Medicine criteria.Each intervention was subsequently assigned a grade of“strong,”“weak,”or“conditional”based on the available evidence.Results:Strong recommendations include comprehensive patient education and counseling,minimization of preoperative fasting,application of topical/local anesthetics and vasoconstrictors,use of total intravenous anesthesia,avoidance of pharyngeal packing,and use of postoperative nasal irrigation and multimodal analgesia.Conditional recommendations include antibiotic prophylaxis.Weak recommendations include perioperative venous thromboembolism prophylaxis,controlled hypotension,and use of postoperative nasal packing/dressing.Conclusion:A comprehensive ERAS protocol for ESS can include a variety of high yield,evidence-based interventions that would likely improve surgical outcomes and patient satisfaction.
文摘Background:Aspirin-exacerbated respiratory disease(AERD)is an aggressive inflammatory disorder of the upper and lower respiratory tract.Corticosteroids,leukotriene modifiers,endoscopic sinus surgery(ESS),aspirin(ASA)desensitization,and biological immu-nomodulators are currently used to treat the disorder.Objective:The objective of this study was to determine the psychosocial impact of ESS and ASA desensitization on AERD patients.Methods:All AERD patients who underwent complete ESS were divided into two cohorts based on ASA desensitization status.The psychosocial metrics of the SNOT-22 were collected and analyzed at the following time points:pre-operative,1-month,3-month,6-month,and 12-month after ESS.Results:One hundred and eighty-four AERD patients underwent ESS from November 2009 to November 2018.From this group,130 patients underwent ASA desensitization(AD cohort)and 54 patients remained non-desensitized(ND cohort).AD patients showed a significantly greater reduction in total SNOT-22 scores over the study period compared to ND patients(p=0.0446).Analysis of SNOT-22 psychosocial metrics showed a significantly greater improvement in patient productivity in the AD cohort when compared to the ND cohort(p=0.0214).Further,a sub-group analysis accounting for subject attrition showed a significantly greater improvement in both productivity and concentration in AD patients when compared to the ND cohort(productivity:p=0.0068;concentration:p=0.0428).Conclusions:ESS followed by ASA desensitization decreases the overall psychosocial burden in AERD patients with a significant improvement in perceived productivity and concentration.This has significant implications given the psychosocial impact of chronic diseases.
