Image-Guided Surgery Influences Perioperative Morbidity from Endoscopic Sinus Surgery A Systematic Review and Meta-Analysis

Dustin Dalgorf, Raymond Sacks, Peter Wormald, Yuresh Naidoo, Ben Panizza, Brent Uren, Chris Brown, John Curotta, Kornkiat Snidvongs, Richard Harvey

    Research output: Contribution to journalReview articlepeer-review

    94 Citations (Scopus)


    Objective. Although image-guided surgery (IGS) is considered a valuable tool, its impact on perioperative morbidity for endoscopic sinus surgery (ESS) remains unclear. The evidence from reported literature is systematically reviewed with meta-analysis. Data Sources. MEDLINE (1946 to September 14, 2012, week 2) and EMBASE (1974 to September 14, 2012, week 37). Review Methods. MEDLINE and EMBASE were searched using a search strategy for publications on IGS during ESS that reported original data on perioperative morbidity. PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines were followed. Both comparative cohort studies with non-IGS cases and case series were included. Primary outcome was major and total complications. Secondary outcomes were specific orbital and intracranial injury, major hemorrhage, ability to complete the operation, and revision surgery. The incidence of these events was defined as dichotomous variables and expressed as a risk ratio (RR) in a fixed-effects model. Results. In total, 2586 articles fulfilled the search, producing 55 included studies. Fourteen were comparative cohorts of IGS and non-IGS sinus surgical patient populations used for meta-analysis. Among the cohorts, major complications were more common in the non-IGS group (RR = 0.48; 95% confidence interval [CI], 0.28-0.82; P = .007). Total complications were greater in the non-IGS group (RR = 0.66; 95% CI, 0.47-0.94; P = .02). All other outcomes did not reach significance on meta-analysis. Conclusion. Contrary to current review articles on the topic of IGS use during ESS, there is evidence from published studies that the use of IGS for sinus surgery, within selected populations, is associated with a lower risk of major and total complications compared with non-IGS sinus surgery.

    Original languageEnglish
    Pages (from-to)17-29
    Number of pages13
    JournalOtolaryngology-Head and Neck Surgery
    Issue number1
    Publication statusPublished - Jul 2013


    • Endoscopic sinus surgery
    • Image-guided surgery
    • Major complications
    • Meta-analysis
    • Patient reported outcome measures
    • Perioperative morbidity
    • Systematic review


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