Endoscopic Sinus Surgery Research Articles

Comparison of oral pre-medication with clonidine and metoprolol on intraoperative hemodynamics and surgical conditions during functional endoscopic sinus surgery

Background: Functional endoscopic sinus surgery (FESS) is one of the most performed surgical procedures and requires minimal bleeding during the procedure. The success of surgeries is largely dependent on the surgical field, where the presence of significant bleeding is an important factor. Aims and Objectives: The objectives of this study were to evaluate the clinical efficacy of oral clonidine and metoprolol following their pre-medication for induced hypotension during FESS and to assess hemodynamic stability, surgical field quality, and sedation score. Materials and Methods: This is an observational hospital-based study conducted on 60 patients, aged 18–60 years old for FESS assigned by randomization method in two groups including clonidine or metoprolol. Heart rate (HR) and arterial blood pressure are measured after induction, during and end of the surgery. Assessment of bleeding was done by a surgeon who was blinded. Surgical field quality, satisfaction level of the surgeon, Aldrete score, and any side effects were observed. Results: There was no significant difference seen in HR in patients of Group C and Group M in the pre-operative period, after loading the dose of the drug, at extubation (P>0.05). A significant difference was seen in HR with lower mean values in Group C compared to Group M after induction (77.23±12.23), 10 min after induction (69.47±11.99), 20 min after induction (65.63±8.66), 30 min after induction (64±8.32), 40 min after induction (63.77±7.61), and 60 min after induction (63.63±7.89). A significant difference was seen in blood pressure, after loading the dose of the drug, after induction, during surgery monitored every 10 min, at extubation, after extubation monitored every hour for 6 h. Quality of surgical field and surgeon’s satisfaction was better in patients who received clonidine than in those who received metoprolol. Conclusion: Both clonidine and metoprolol can be effectively used for induced hypotension in FESS. Clonidine is better than metoprolol with respect to intraoperative hemodynamics, quality of the surgical field, and surgeon’s satisfaction with the added advantage of sedation, reduced analgesia requirement, and other anesthetic drugs.

Evaluating Resident Education Practices in Endoscopic Sinus Surgery.

Evaluating Resident Education Practices in Endoscopic Sinus Surgery.

Significance as a Prognostic Factor of Eosinophil Count in Nasal Polyp Tissue in Patients with Chronic Rhinosinusitis Accompanied by Asthma

Background/Objectives: Patients with chronic rhinosinusitis (CRS) accompanied by asthma often show poor prognoses and require continuous management. This study aimed to assess the prognostic value of eosinophil counts in nasal polyp tissue for selecting individuals who would benefit from ongoing management in CRS patients with asthma. Methods: Patients with asthma who underwent endoscopic sinus surgery for CRS with nasal polyps were included in the study. Eosinophil counts in nasal polyp tissues were quantified, and retrospective data were collected from laboratory and clinical findings, including endoscopic examinations, CT scans, and Japan Endoscopic Sinus Surgery Rating and Evaluation Committee (JESREC) scores. Disease control status was evaluated through endoscopic examination 6 months post-surgery. Results: A total of 42 patients were divided into two groups based on their disease management status 6 months post-operation: the well-control group (24 patients, 57.14%) and the poor-control group (18 patients, 42.86%). Demographics and laboratory findings did not show significant differences between the groups. However, the JESREC score (p = 0.04) and tissue eosinophil count (p = 0.02) were significantly different. Multivariate analysis identified tissue eosinophil count as the only risk factor associated with prognosis, with a cut-off value of 90/HPF. Conclusions: In CRS patients with asthma, high tissue eosinophil counts in nasal polyps were associated with poor disease control, which is the most potent predictor of prognosis. The assessment of eosinophil counts in nasal polyp tissue could aid in identifying patients who would benefit from continuous management and tailored interventions for improved outcomes.

The Impact of Code Bundling on Medicare Volume and Reimbursements Within Endoscopic Sinus Surgery.

In 2018, Medicare introduced new codes to the Endoscopic Sinus Surgery (FESS) and balloon sinus dilation (BSD) families of Current Procedural Terminology (CPT) codes. Using the Medicare Part B National Summary Data File from 2010 to 2022, an interrupted time-series analysis examined trends in volume and reimbursements before and after 2018. Prior to 2018, volume and reimbursements for FESS grew at a mean rate of 2.5% ± 2.2% per year and 6.9% ± 6.6% per year, respectively, before reimbursements decreased significantly in 2018 by -13.9% (P = .014), leading to a stabilization of volume (growth of 0.72%, P = .602). Volume and reimbursements for BSD saw rapid growth from 2011 to 2015 which plateaued prior to the introduction of bundled codes and did not appear to change significantly in 2018 (-0.6%, P = .306 and 11.9%, P = .392, respectively). In addition to concurrent devaluation of FESS and BSD codes, bundling appears to have further contributed to falling reimbursements in rhinology.

Functional Endoscopic Sinus Surgery: Key Points for Safer Surgery.

Objectives: To review measures for safer functional endoscopic sinus surgery (FESS). Methods: PubMed, EBSCO, UpToDate, Proquest Central at Kırıkkale University, Google, and Google Scholar were used in the literature review. The search was performed using keywords of "functional endoscopic sinus surgery," "FESS," "Safety," "Image-Guided," and "complications" between 2000 and 2024. Results: Inflammatory and infectious sinus illnesses are the most prevalent indications for FESS. The 4 most common methods for FESS are endoscopic uncinectomy, maxillary antral ostomy/ethmoidectomy, anterior ethmoidectomy, and posterior ethmoidectomy. FESS has a complication rate of 0% to 1.5% for significant problems and 1.12% to 20.8% for minor issues. Sinus surgery outcomes can be improved and problems avoided with careful preoperative preparation. Powered instrumentation may enhance the severity of the problems rather than the number of occurrences. Intraoperative detection of cerebrospinal fluid leakage necessitates immediate localization and fixing of the leaking structure. The danger of infection increases and hospital stays are longer when investigation is delayed. In image-guided surgery, surgeons employ preoperative imaging data to pinpoint the exact position of a surgical tool concerning surrounding anatomical structures in real time. Although initially designed for use in neurosurgery, endoscopic sinus surgery has quickly become one of the most popular applications of this technique. Conclusion: Safer FESS can be accomplished with accurate CT scans, good patient preparation, surgical knowledge and training, and by using image guidance for endoscopic sinus surgery.

Forensic Investigation of Rare Complications of Endoscopic Sinus Surgery: Two Case Reports

Forensic Investigation of Rare Complications of Endoscopic Sinus Surgery: Two Case Reports

Time is money: An analysis of cost drivers in ambulatory sinus surgery.

Functional endoscopic sinus surgery (FESS) is one of the most commonly performed otolaryngologic procedures and is associated with significant cost variability. We performed a retrospective analysis of all inflammatory sinus surgeries at a single tertiary care medical center from July 2021 to July 2023. The electronic medical record was reviewed for patient factors and cost variables for each procedure, and multivariable analysis was performed. A total of 221 patients were included in analysis with a mean age of 48.2 years. There was a 44.8% incidence (n=99) of nasal polyps and 31.2% (n=69) of cases were revision surgeries. The average total cost for the surgical encounter was $8960.31 (standard deviation $1967.97). Operating room time represented $4912.46 (54.8% of all costs), while average operating room supply costs were $1296.06 (14.5%) and recovery room costs were $919.48 (10.3%). Total costs were significantly associated with length of surgery ($7.83/min, p=0.04), in addition to presence of nasal polyps ($531.96, p=0.04). There was no significant association between total costs and the remaining clinical and demographic factors. Costs associated with ambulatory FESS for inflammatory sinus disease vary across patients and this cost variability is predominantly driven by time efficiency within the operating room, as well as supply utilization and nasal polyposis to a lesser degree. As a result, operating room efficiency represents a primary target for cost-related interventions. Additionally, our data provide a framework for surgeons and hospitals to make evidence-based decisions on intraoperative equipment in a tradeoff between efficiency and supply costs. Our findings indicate that an approach focused on streamlining efficiency across the entire ambulatory surgery encounter will have the greatest impact on reducing healthcare expenses for both the patient and the health system.

The impact of mitomycin C in endoscopic sinus surgeries: a comprehensive review

Chronic rhinosinusitis (CRS) is an inflammation of the nasal and paranasal sinus linings, often resulting in various debilitating symptoms. Functional endoscopic sinus surgery (FESS) is a common treatment for CRS, aiming to alleviate symptoms by restoring sinus drainage and mucosal repair. However, postoperative complications, including adhesion formation, remain a concern. This systematic review aims to evaluate the effectiveness of mitomycin-C (MMC) in reducing postoperative complications, particularly adhesion formation, in patients undergoing ESS. A systematic review of available evidence on the role of MMC in FESS was conducted. Studies were selected based on predefined inclusion criteria, and relevant data were extracted and synthesized. Nineteen studies met the inclusion criteria, encompassing a total of 763 subjects. The majority of studies reported a reduction in postoperative adhesion formation with MMC use, although statistical significance varied. MMC dosages and application methods varied across studies, contributing to heterogeneity in outcomes. Overall, MMC showed promise in reducing adhesion formation and improving surgical outcomes in FESS. However, further high-quality, prospective, randomized controlled trials are warranted to establish optimal dosage, application methods, and long-term efficacy of MMC in FESS for CRS.

Cemento-ossifying fibroma: an extensive fibro-osseous lesion involving paranasal sinuses

Cemento-ossifying fibroma (COF) is a fibro-osseous lesion arising from cells of the periodontal ligament. This tumor typically occurs in individuals during their third and fourth decades of life, with a predilection for women. COF primarily affects the maxillofacial region, most commonly the mandible. Its localization in the paranasal sinuses and skull base is unusual. However, we present a rare case of COF involving the right paranasal areas of the maxillofacial region in an 18-year-old female. Computed tomography (CT) revealed an expansile lesion measuring 52.45×32×74.29 mm involving the right maxillary sinus, expanding into both the anterior and posterior choanae. The patient underwent endoscopic sinus surgery (ESS) with preservation of adjoining vascular structures. Clinical, radiographic, and histologic features are presented, and differential diagnosis is discussed.

Sinonasal Outcomes Obtained after 2 Years of Treatment with Benralizumab in Patients with Severe Eosinophilic Asthma and CRSwNP: A "Real-Life" Observational Study.

Benralizumab is a monoclonal antibody that targets the interleukin-5 receptor (IL-5Rα), leading to the rapid depletion of blood eosinophils. RCTs have demonstrated efficacy in patients with severe eosinophilic asthma (SEA). The aim of this study was to assess the efficacy of benralizumab on sinonasal outcomes in a real-life setting in patients with SEA and concomitant chronic rhinosinusitis with nasal polyps (CRSwNP). We included 25 patients (mean age: 57.47 years, range: 35-77, F/M = 12:13) who were prescribed 30 mg benralizumab every month for the first three administrations and then every 2 months. The primary endpoint was to evaluate changes in the SinoNasal Outcome Test-22 (SNOT-22) and nasal polyp score (NPS) over a 24-month treatment period. Secondary endpoints included measuring the effects on nasal obstruction and impaired sense of smell. The mean NPS score decreased significantly from 5.11 ± 1.84 at baseline to 2.37 ± 1.96 at 24 months. The mean SNOT-22 decreased from 57 ± 15.30 at baseline to 26 ± 16.73 at 24 months. The SSIT-16 mean score improved with an increase in olfactory performance from 5.23 ± 2.58 at baseline to 7 ± 3.65 at 24 months. Moreover, 8/25 patients (32%) required rescue treatment with systemic steroids and 2 patients required endoscopic sinus surgery. While the improvement may not seem optimal at 12 months, a progressive enhancement was noted during the second year of treatment. Despite our data showing an improvement in quality of life and a reduction in the size of nasal polyps, no significant improvement in olfactory sensitivity was observed. In addition, in several patients, rescue treatments were required to maintain control of nasal and sinus symptoms. A careful risk-benefit assessment is therefore needed when deciding to continue treatment, weighing the potential for further improvement against the risks of complications. Such decisions should always be made in the context of a multidisciplinary team.

The effect of oral clonidine and intravenous dexmedetomidine administration on the quality of functional endoscopic sinus surgery

Background: Clonidine and dexmedetomidine are alpha-2 receptor blockers administered for haemorrhage control during surgery in limited settings. Functional endoscopic sinus surgery (FESS) may be associated with bleeding, thus making it challenging. This study aims to evaluate the effect of dexmedetomidine and clonidine on haemorrhage control during FESS and surgical outcomes. Methods: This three-blinded prospective study included 102 patients who underwent FESS at the Imam Khomeini public referral hospital at the Imam Khomeini public referral hospital, in Urmia, Iran. It was either American Society of Anaesthesiologists (ASA) class I or II. They were divided into three groups (clonidine, dexmedetomidine, and placebo). The volume of blood loss, mean arterial pressure, surgical field visualisation, and surgeon satisfaction were assessed in the three groups. Data analysis was performed using SPSS version 23.0. Results: Dexmedetomidine and clonidine decreased mean arterial pressure, heart rate, and blood loss volume while improving surgical field visualisation. The effect of dexmedetomidine was associated significantly statistically with surgeon satisfaction (p < 0.0001). Furthermore, dexmedetomidine improved the surgical field and reduced operating times in the dexmedetomidine group (p < 0.0001). Conclusion: The present clinical trial findings indicated that the administration of dexmedetomidine during FESS decreased mean arterial pressure, provided balanced anaesthesia and appropriate analgesia, and improved the visibility of the surgical field and increased surgeon satisfaction.

Surgical Intervention Outcome for Patients With Acute Vision Loss Due to Allergic Fungal Rhinosinusitis: A Systematic Review and Meta-Analysis.

Allergic fungal rhinosinusitis (AFRS) is a severe type of chronic rhinosinusitis (CRS) characterized by a high risk of acute vision loss resulting from the affection of optic nerves. This vision loss results from direct pressure upon the optic nerve by the sinus tissues and bone degradation. This is why early involvement of a professional is significant so as not to result in a permanent disability. This systematic review and meta-analysis will analyze the efficacy of surgical operations in enhancing visual outcomes in patients with acute vision loss due to AFRS. A systematic search was carried out based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using PubMed, Embase, Cochrane Library, and Scopus with the keywords "acute vision loss," "allergic fungal rhinosinusitis," and "surgical intervention." The studies included patients who developed AFRS-related acute vision loss, those assessing the outcomes of the surgical interventions, and those published in English. Two separate researchers extracted data and conducted quality assessments. The data synthesis process employed the R studio software (Posit, Boston, MA). The identified studies for the review constituted 12 and involved 320 patients. The mean pooled event rate regarding acute vision loss of AFRS patients was 33.1%. Ear, nose, and throat surgeries, including functional endoscopic sinus surgery (FESS) and optic nerve decompression, had a mean pooled success in vision recovery of 68%. Early treatment and utilization of other types of corticosteroids were utilized to enhance the results. Hence, early and proper surgery like FESS, optic nerve decompression, and corticosteroid treatment have better visual prognosis in AFRS patients. Standard early diagnosis and management guarantee the prevention of irreversible blindness, which stresses the need for an interdisciplinary approach and further studies.

An Outline about Endoscopic Sinus Surgery outcome in Management of Chronic Rhinosinusitis

An Outline about Endoscopic Sinus Surgery outcome in Management of Chronic Rhinosinusitis

Developing a virtual Endoscopic Surgery Planning system to optimize surgical outcomes.

Planning and predicting functional outcomes of endoscopic sinus surgeries (e.g., nasal airflow) based solely on visualizing Computerized Tomography (CT) or endoscopy poses a challenge to produce optimal clinical outcomes. Technology development, retrospective case report. A virtual surgery planning (VSP) tool is developed that can load any patient's CT data and allow surgeons to remove obstructive tissue using both visual and haptic feedback endoscopically. Pre-calculated airflow resistance, wall shear stress, pressure drop are displayed on the anatomy to identify potential sites of obstruction. After each virtual surgery, changes in nasal airflow can be computed, and the process is reiterated until an optimal result is reached. As proof-of-concept, a series of isolated or combined procedures were performed on CT of one patient, who had olfactory losses that may involve obstructions blocking the air/odor flow to the olfactory fossa (OF). For this patient, an isolated medial partial middle turbinectomy (PMT) demonstrated the best outcome, better than traditionally performed lateral PMT, while septal body reduction worsened air/odor flow to OF. This proof of concept case report demonstrates the potential usefulness of VSP in preoperative planning based on objective benchmarks and could be a valuable tool for optimizing future surgical outcomes.

Impact of Biologics on Surgery in Chronic Rhinosinusitis with Polyps and Allergic Fungal Sinusitis.

To compare the efficacy of th2-targeted biologic medications (dupilumab, omalizumab, and mepolizumab) on absolute risk reduction (ARR) of functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) and allergic fungal rhinosinusitis (AFRS). The TriNetX Research Network database was queried for each mAb's market lifespan through March 2024. Adults with CRSwNP were propensity score matched against non-mAb controls based on age, sex, race, and asthma diagnosis. The primary outcome was rate of FESS, with secondary outcomes including inpatient admission, emergency department (ED) visit, and incidence of acute sinusitis. Subgroup analysis was performed for patients with AFRS. All mAbs decreased FESS risk (dupilumab, ARR 11.48%, 95% CI 9.82%-13.15%, p < 0.001; omalizumab, ARR 12.02%, 95% CI 4.36%-19.68%, p = 0.002; mepolizumab, ARR 10.32%, 95% CI 5.24%-15.40%, p < 0.001) in CRSwNP patients. Only dupilumab also reduced risk of inpatient admission (ARR 8.59%, 95% CI 7.04%-10.15%, p < 0.001), ED visit (ARR 5.94%, 95% CI 4.28%-7.61%, p < 0.001), and acute sinusitis (ARR 2.60%, 95% CI 1.09%-4.12%, p = 0.001). In AFRS patients, only dupilumab reduced the risk of all outcomes: FESS (ARR 6.97%, 95 CI 2.86%-11.09%, p = 0.001), inpatient admission (ARR 16.93%, 95% CI 11.30%-22.57%, p < 0.001), ED visit (ARR 13.15%, 95% CI 7.15%-19.14%, p < 0.001), and acute sinusitis (ARR 7.17%, 95% CI 2.18%-12.17%, p = 0.005). Although all mAbs reduced FESS risk in CRSwNP, only dupilumab reduced secondary outcomes as well. Similarly, only dupilumab improved all outcomes in AFRS patients. These data demonstrate the potential of mAbs in reducing disease burden and enhancing patient outcomes in CRSwNP and AFRS. NA Laryngoscope, 2024.

Acute peritumoral brainstem hemorrhage of a clival chondrosarcoma successfully treated via endoscopic endonasal surgery: illustrative case.

Chondrosarcoma is typically a slow-growing tumor, and intratumoral hemorrhage is rare. Acute brainstem hemorrhage due to chondrosarcoma has rarely been reported. A 77-year-old man presented with the sudden onset of headache and vomiting followed by a declining level of consciousness, progressive right hemiparesis, and left ophthalmoplegia. Magnetic resonance imaging showed pontine hemorrhage and a mass in the retroclival space compressing the brainstem. Emergency endoscopic endonasal surgery was performed. Intraoperative observation revealed that a hematoma was located in the pons and subdural space around the tumor mass, suggesting that the hematoma had likely been caused by the rupture of small vessels around the pons, not by intratumoral hemorrhage. The pathological diagnosis was chondrosarcoma. The patient recovered well and underwent radiotherapy. This report describes a case of sudden neurological deterioration due to hemorrhage in a patient with chondrosarcoma of the skull base. An emergency endoscopic endonasal approach for mass reduction and hematoma removal was effective in the acute setting. This approach revealed the suspected etiology of peritumoral hemorrhage, not intratumoral hemorrhage. https://thejns.org/doi/10.3171/CASE2460.

Treatment outcome of modified endoscopic assisted sinus surgery for treating maxillary sinus diseases with three dimensional volumetric analysis

This retrospective study aimed to analyze volumetric changes of the maxillary sinus after modified endoscopic-assisted sinus surgery (MESS) and to assess short-term treatment outcomes. The volumes of the total maxillary sinus, aeration, and sinus pathology were calculated using computed tomography data obtained prior to surgery and six months after surgery. Postoperative radiological improvement was assessed using the Lund–Mackay score. Bone regeneration around the bony window was evaluated during plate removal. A total of 32 patients were evaluated. Compared with before surgery, air and sinus pathology volumes improved significantly (air, increase by 6.0 cm3, p < 0.001; sinus pathology, decrease by 6.4 cm3, p < 0.001). However, there was no statistically significant change in the total maxillary sinus volume after surgery. The preoperative Lund–Mackay score was 2.9, decreasing to 0.4 six months after surgery (p < 0.001). The only predictors of postoperative aeration rate and Lund–Mackay score were preoperative sinus pathology volume (p = 0.049) and Lund–Mackay score (p = 0.015), respectively. The continuity between the bony window and surrounding sinus wall was restored in all patients. The results of this study suggest that MESS can be a successful, effective, and minimally invasive surgical treatment option for treating maxillary sinus diseases.

Efficacy of Fat and Perifascial Areolar Tissue Graft in Refractory Esotropia: A Case Report

Purpose: This case report presents a novel approach for the management of refractory esotropia using adhesiolysis and fat and perifascial areolar tissue (PAT) transplantation.Case summary: A 62-year-old male presented with left eye strabismus fixus following iatrogenic medial rectus (MR) muscle injury and medial orbital wall fracture during endoscopic sinus surgery. One month later, he underwent MR laceration repair and orbital wall reconstruction. Despite three subsequent interventions for exotropia and its subsequent conversion to esotropia, the left eye esodeviation progressively worsened, culminating in strabismus fixus. Initial examination revealed significant left eye esotropia with fixed gaze and 5-mm enophthalmos. Surgery included implant removal, adhesiolysis between the eyeball and surrounding tissues, scar and MR recession, and placement of a fat and PAT graft on the medial aspect of the eyeball to prevent postoperative re-adhesion. Three years of follow-up demonstrated sustained orthophoria in primary gaze with improved extraocular muscle function and enophthalmos.Conclusions: Fat and PAT graft has potential in oculoplastics for preventing re-adhesion and augmenting orbital volume in patients with refractory restrictive strabismus due to multiple surgeries.

Endoscopic Endonasal Skull Base Surgery: Analysis of the Results in the Author’s Initial 200 Cases

Background Endoscopic endonasal approaches represent currently an important tool for approaching the skull base. The evolution of new techniques is based in the continuous acquisition of skills and abilities and it is paramount to determine the safety and effectiveness of new approaches. Based on that, the aim of this study is to analyze our results after the first 200 cases. Material and methods We performed a retrospective review of all cases operated on through an endoscopic endonasal approach in our Skull Base Unit, between January 2007 and May 2018. We analyze the results and all the per-operative complications associated. Results In this study we included 200 cases, comprising 105 female (52,2 %) and 95 male (47,5 %), with a mean age of 45,6 (range 21-85 years-old). The most commonly reported pathology was the pituitary adenoma, comprising 121 cases (60,5 %), followed by 13 meningocele (6,5 %), 9 chordoma (4,5 %), 6 skull base meningioma (3 %) and 7 cranyopharingioma (3,5 %). 161 cases (81 %) represented first surgery. The most frequently reported complication was diabetes insipidous in 17 % of all cases, followed by CSF leak, represented by 15 cases (7,5 %). 12 CSF leak cases were successfully treated by external lumbar draining and 3 patients required second surgery to skull base repair. In the last 50 cases, only one CSF leak has been reported, representing an incidence of 2 %, successfully treated by endoscopic repair. This decrease in CSF leak represents the impact of the learning curve in skull base reconstruction. 5 % of patients suffered meningitis and 5 % presented permanent anosmia. In our serie we reported 1,6 % of transient neurologic deficit represented by oculomotor palsy and 1,6 % of permanent neurologic deficit due to infarction. 3 patients in this serie has died, two due to malignant ICA occlusion and 1 due to infection (overall mortality 1,5 %). The most commonly used approach was the transsphenoidal transsellar approach (58 %), followed by transplanum-transtubercullum approach (8 %). Gross total resection was achieved in 76 % of tumoral pathology, 71 % in cases of pituitary adenomas. Conclusion From this review we can conclude that, in our serie, endoscopic endonasal surgeries represent safe approaches to the skull base to a huge variety of pathologies. Progressive acquisition of skills and experience is paramount to improve the results, avoiding and reducing complications. Appropriate patient and pathology selection is also mandatory.

Assessing adequacy of surgical extent in CRSwNP: The Completion of Surgery Index.

Endoscopic sinus surgery (ESS) maximized for topical steroid irrigations is highly effective for polyp disease. As extent and completeness of ESS varies widely by situation and practitioner, it is important to understand when revision surgery is appropriate, particularly in the era of biologic treatments. A Completion of Surgery Index (CoSI) was developed to assess operative changes in polyp patients using pre- and postoperative computed tomography scans. The CoSI was then applied and tested in a cohort of consecutive chronic rhinosinusitis with nasal polyps (CRSwNP) patients, and examined within the context of quality-of-life improvements. The CoSI assesses surgical extent on a scale of 0-100, with 100 representing the highest possible degree of surgical completeness. Among 100 consecutive CRSwNP patients undergoing ESS in 2021 with postoperative topical steroid irrigations, including 75 revision surgeries, SNOT-22 scores improved at 6months postoperatively, with durable and consistent improvement at 24months (p<0.001). Preoperative CoSI scores in revision surgery patients were 49.4±26.0, improving to 91.0±8.1 postoperatively. SNOT-22 scores for primary ESS patients and patients with a preoperative CoSI score of less than 70 improved by 26.4 and 28.1 points, respectively, in contrast to patients with a preoperative CoSI of 70 or greater (14.1 points, p=0.029). It is important to define extent of surgery in CRSwNP to stratify postsurgical patients based on likelihood to benefit from revision surgery or alternative medications. The CoSI can be utilized to identify patients who are likely to improve significantly with revision surgical intervention.