Preoperative risk assessment for ambulatory sinonasal surgery

Objectives An increasing proportion of patients who are candidates for endoscopic sinus surgery can be treated as an outpatient. A preoperative risk assessment is needed to evaluate eligibility for day surgery. This study analyses the effectiveness of a risk assessment scoring system which examines medical, procedure-related, and socioeconomic factors. Design Prospective multicenter study. Setting Three center study including Klinik Hirslanden, Zurich, Switzerland, Luzerner Kantonsspital, Lucerne, Switzerland and HNO-Klinik Munchen-Bogenhausen, Munich, Germany. Ethical considerations The study was approved by the Ethics Committee of the Canton Zurich, Switzerland. Study design and patients In a prospective multicentric interventional study, patients where endoscopic sinus procedures were planned at the Center for Otorhinolaryngology, Head and Neck Surgery, Klinik Hirslanden, Zurich, the Department of Otolaryngology, Head & Neck Surgery, Luzerner Kantonsspital, Lucerne and HNO-Klinik Munchen-Bogenhausen, Munich, in the period between January 1st 2017 and December 31st 2018 were evaluated. Due to the structure of the health care system in these centers, patients were admitted with a minimal hospital stay of 24 hours. Patients below the age of 18 were excluded. Patient specific data (patient age, gender), the type of the procedure, the preoperative risk score or day surgery risk score, postoperative complications during the first 14 days and the length of hospital stay were analyzed. Data collection was performed using ENTstatistics software (ENTstatistics, Innoforce, LI-9491 Ruggel, Liechtenstein). Participants Patients with endoscopic sinus procedures between January 1st, 2017 and December 31st, 2018. Main outcome measures The day surgery risk score consisted of three subgroups with medical, procedure-related and socioeconomic risk factors were assessed to determine if these predicted the severity of postoperative complications. Results Three-hundred and one patients who underwent endoscopic sinus surgery were included. The score resulted in a median value of 5 [5, 5]. In the Receiver-Operating Curve (ROC-the true-positive rate against the false-positive rate), the Area Under the Curve (AUC) was 0.59 with 95% confidence interval from 0.49 to 0.69, indicating that the day surgery risk score may be no better at predicting the likelihood of a complication than a random classification model. Conclusions The day surgery risk score is a straightforward risk assessment which combines medical, procedure-related, and socioeconomic factors. The score is easy to use but in trying to decide whether a patient is eligible for ambulatory endoscopic sinus surgery it did not predict whether a complication was more likely to occur.

Automated summary

This study analyzed the effectiveness of a risk assessment scoring system for determining eligibility for day surgery, taking into account medical, procedure-related, and socioeconomic factors. The results showed that the day surgery risk score may not be more accurate than a random classification model in predicting postoperative complications after endoscopic sinus surgery.