Operative and postoperative outcomes in elderly patients undergoing endoscopic sinus surgery
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RHINOLOGY
Operative and postoperative outcomes in elderly patients undergoing endoscopic sinus surgery J. Reed Gardner1 · Jessica B. Campbell1 · Olivia Daigle1 · Deanne King1 · Alissa Kanaan1 Received: 20 August 2020 / Accepted: 21 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Chronic rhinosinusitis (CRS) is increasingly common in the elderly population (≥ 65 years old). Compared to their younger counterparts, differences exist in the etiology of CRS and outcomes of Endoscopic Sinus Surgery (ESS) for elderly patients. The aim of this study is to determine if differences in surgical outcomes are present between these two patient populations to facilitate patient pre-operative counseling by their healthcare providers. Methods Retrospective chart review conducted at a single tertiary care center for patients undergoing ESS between June 2014 and June 2019. Patients were classified into two cohorts (adult and elderly) based on age ( 12 weeks, antimicrobial therapies are generally only used for acute exacerbations, though EPOS 2020 does not strongly support it due to conflicting findings in the literature [3, 4]. These treatments are not without risks, especially in the elderly population that already suffers from polypharmacy. Intranasal steroids, while having fewer side effects than systemic steroids, have been shown to increase the risk for epistaxis, headaches, and nasal dryness [9]. Elderly sinus patients are already predisposed to nasal dryness because of atrophy of the nasal mucosae that occur with aging, which leads to thicker mucus compared to younger populations. This agerelated pathophysiology leads to the common complaints of nasal drainage, cough, globus sensation, and increased sneezing [11]. This population is also more likely to be on anticoagulation therapy, which in the setting of additional of nasal drying can lead to epistaxis, which can be difficult to manage. Antibiotic treatments can also prove problematic for elderly patients [3]. Arrhythmias and electrolyte abnormalities can be exacerbated by their use. Additionally, the risk of fluoroquinolone-associated tendon rupture is higher for elderly patients [10, 12]. Endoscopic sinus surgery (ESS) is one of the most commonly performed procedures in adults with CRS, which has been shown to be both safe and effective; [13, 14] leading to decreased symptomatology, regardless of patient age [15]. However, patient age and preoperative SNOT-22 scores have been shown to be predictors for the degree of improvement in quality of life (QOL) after sinus surgery [2]. Despite the efficacy, elderly patients have been demonstrated to have greater incidence of all cause complications compared with adult ESS patients, and even paediatric ESS patients [14, 16]. In addition, a study by Krings et al. showed increasing age to be a predictor for major complications of ESS [17]. The analysis of risks and benefits of surgical therapy must also take into account that QOL increases are not as pronounced for the elderly population
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