Adults undergoing septoplasty alongside functional endoscopic sinus surgery on the same day face significantly higher postoperative systemic and intranasal corticosteroid prescribing rates than those who stage the procedures separately, according to a large retrospective cohort study published by Cureus.
Surgical Timing and Corticosteroid Prescribing Patterns
The retrospective cohort study evaluated adult patients undergoing both septoplasty and functional endoscopic sinus surgery (FESS) using data from the TriNetX U.S. Collaborative Network. Researchers categorized patients into same-day and staged cohorts, defining staged procedures as those separated by at least 30 days. To ensure balanced comparisons, investigators used a one-to-one propensity score matching process that accounted for age, sex, race, baseline nasal polyp diagnoses, and prior systemic and intranasal corticosteroid use. Following this matching, exactly 3,171 patients remained in each cohort, with the index date established as the FESS procedure date.
Postoperative medication tracking revealed clear statistical disparities in medication management between the two groups. Systemic corticosteroid use occurred in 925 patients in the same-day cohort, representing 29.17% of those patients, compared with 825 patients, or 26.01%, in the staged cohort. This yielded a risk difference of 3.15% with a 95% confidence interval ranging from 0.96% to 5.35%, an odds ratio of 1.17, and a statistically significant p-value of 0.0050. Intranasal corticosteroid prescribing demonstrated an even wider margin.
Intranasal corticosteroid use was recorded in 1,283 same-day patients, amounting to 40.46% of the cohort, while 1,070 staged patients, or 33.74%, received similar prescriptions. That difference produced a risk difference of 6.72% with a 95% confidence interval between 4.35% and 9.09%, an odds ratio of 1.33, and a highly significant p-value of less than 0.0001. Postoperative corticosteroid use was assessed across a window spanning from 15 to 180 days following the FESS procedure.
Evaluating Postoperative Nasal Polyp Diagnoses
Despite the elevated medication burden observed in the single-session group, coded diagnoses for nasal polyps showed no statistically significant difference over the long term. Researchers evaluated postoperative nasal polyp diagnoses from 15 to 730 days after surgery. The diagnosis occurred in 28.82% of same-day patients compared with 26.96% of staged patients, resulting in a hazard ratio of 1.08 with a 95% confidence interval of 0.98 to 1.18 and a log-rank p-value of 0.1189.
Interpreting coded diagnoses within large electronic health record datasets carries inherent complexities. Investigators noted that diagnostic codes can easily capture persistent disease, new manifestations, recurrent issues, or simply carried-forward coding rather than endoscopically confirmed recurrent polyposis. Consequently, researchers caution that postoperative corticosteroid prescribing patterns may serve as a reflection of postoperative management intensity, whereas coded nasal polyp diagnoses must be interpreted with restraint.
Anatomical Complexity and Surgical Refinements
Surgical decision-making in chronic rhinosinusitis and nasal polyposis involves navigating intricate sinonasal anatomy and severe inflammatory conditions. As detailed in the fourth edition of Endoscopic Sinus Surgery by Peter-John Wormald, operative treatment addresses a wide array of complex pathologies, including chronic rhinosinusitis, nasal polyposis, Samter’s triad, eosinophilic mucus chronic rhinosinusitis, acute orbital hemorrhage, orbital subperiosteal abscess, exophthalmos, and various tumors.
The reference text incorporates simplified anatomical nomenclature established in 2016, which encompasses the reclassification of cells located within the frontal recess and defines the extent of frontal sinus surgery. These updates aim to clarify impacted anatomy and improve understanding of frontal sinus drainage pathways. Furthermore, the literature highlights advanced techniques such as mega-antrostomies, pre-lacrimal approaches to the maxillary sinus, and anterior-based pedicled flaps designed for frontal drillout procedures.
Clinical Implications and Study Limitations
The study authors emphasize that their findings remain strictly hypothesis-generating. The data should not be interpreted as definitive proof that staging surgical procedures actively reduces a patient’s overall corticosteroid burden or guarantees equivalent endoscopic disease control. Chronic rhinosinusitis frequently requires long-term anti-inflammatory management, and clinicians must carefully balance therapeutic benefits against the well-documented risks of repeated systemic corticosteroid exposure.
Those adverse effects include hyperglycemia, hypertension, weight gain, mood disturbances, adrenal suppression, osteoporosis, and increased infection risk. Because decisions regarding same-day versus staged septoplasty and FESS often depend on individual patient anatomy, disease severity, surgeon preference, patient choice, and logistical or insurance considerations, further prospective investigations incorporating standardized medication capture, symptom scoring systems, and direct endoscopic follow-up are required to determine whether surgical timing genuinely dictates postoperative inflammatory control.
