Relationship between the frequency of postoperative debridement and patient discomfort, healing period, surgical outcomes, and compliance after endoscopic sinus surgery

Jae Yong Lee, Jang Yul Byun
Laryngoscope 2008, 118 (10): 1868-72

OBJECTIVES/HYPOTHESIS: To determine the optimal frequency of postoperative care after endoscopic sinus surgery, we evaluated the relationship between the frequency of postoperative debridement and patient discomfort, healing period, surgical outcomes, and compliance.

STUDY DESIGN: A prospective randomized study.

METHODS: Patients diagnosed with chronic rhinosinusitis with or without nasal polyposis were randomly allocated to three groups (N = 10 each group), according to the frequency of office visits for postoperative debridement during a 4-week postoperative period. Group 1 underwent debridement twice a week, group 2 once a week, and group 3 once every 2 weeks. Four weeks after the procedure, the patients in each group were asked about discomfort between visits for postoperative debridement, including nasal obstruction, nasal discharge, foul odor, postnasal drip, and headache. Responses were scored using the visual analogue scale (VAS). Six months after surgery, the healing period was evaluated and both subjective and objective surgical outcomes were assessed using the Sinonasal Outcome test 20 and endoscopic findings. Patient compliance to postoperative debridement was also evaluated using the VAS. We compared the statistical significance of these parameters among the three groups.

RESULTS: In groups 1, 2, and 3, nasal polyposis was present in eight, eight, and six patients, respectively, and five, one, and four patients had unilateral sinusitis. The VAS scores for four of the five main symptoms regarding patient discomfort differed significantly among the groups; group 3 reported the worst scores. However, healing periods, Sinonasal Outcome test-20 scores, and objective endoscopic findings did not show statistical differences among the groups. Patient compliance to the frequency of postoperative debridement differed significantly among the groups. Patients in group 1 reported the greatest disturbance in academic and socioeconomic activities, whereas the patients in groups 2 and 3 demonstrated similar scores.

CONCLUSIONS: One-week intervals seem to be the optimal frequency for postoperative debridement during the healing period after endoscopic sinus surgery. However, patient individualization should be taken into account depending on the extent of surgery and healing progress.

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