Perioperative management of the sinus patient: a Canadian perspective.

OBJECTIVE: To survey the current practices and opinions of Canadian otolaryngologists with regard to the perioperative management of the sinus patient and to explore practice variations and examine the preferred methods of experts.

DESIGN: A mailed survey was designed and sent to all members of the Canadian Society of Otolaryngology-Head and Neck Surgery who practice in Canada. The multiple-choice questionnaire addressed issues including diagnostic evaluation; routine preoperative, intraoperative, and postoperative methods; and practice demographics.

RESULTS: A total of 242 questionnaires were returned, for an overall response rate of 72%. Preoperatively, the majority of surgeons obtained a computed tomographic scan (70%) and administered inhaled steroids (83%). Half of those surveyed performed endoscopic sinus surgery (ESS) using the image on the video monitor, and close to 70% routinely used postoperative nasal packing. There were significant variations in practice habits between the general respondents and a subgroup of self-defined "experts" in the field, defined as those who spent greater than 40% of their clinical time managing sinonasal disease. Analysis uncovered that the experts were statistically more likely to use preoperative systemic steroids (p = .008), use the video monitor (p = .045), and perform surgery under neuroleptic anaesthesia (p = .045). As a group, they were also less likely to routinely use postoperative place nasal packing (p = .004).

CONCLUSIONS: Considerable variations in clinical practices were identified among Canadian surgeons. Continued efforts aimed at diminishing these variations through the establishment of evidence-based practice guidelines will assist in standardizing the care of these patients.