Postoperative Nasal Symptoms and Emergency Department Visits Following Endoscopic Skull Base Surgery

Objective: This study aims to examine the frequency of emergency department (ED) visits and the occurrence of postoperative nasal symptoms (PNSs) following endonasal skull base surgery (EESBS). Methods: A retrospective cohort study of patients who underwent EESBS at a tertiary referral center. The primary outcome was the frequency of ED visits within 30 days following surgery. Secondary outcomes included the incidence of PNS, readmissions, reoperations, and mortality. Results: A total of 307 patients (143 [46.6%] males, mean age: 58.03 years [interquartile range: 47–70.5]) were included in this analysis. Within 30 days following surgery, 89 patients (29%) presented to the ED, and 32 (10.4%) were readmitted. PNSs were the primary complaint in 60 (67.4%) patients, including nasal discharge in 42 (70%), epistaxis in 14 (23.3%), and obstruction in 4 (6.7%). Twenty-four (26.9%) patients had more than one PNS. Among patients presenting with nasal discharge, two were confirmed to have cerebrospinal fluid rhinorrhea. In both univariate and multivariable analyses, PNSs were not associated with nasoseptal flap harvesting, extended (beyond sella) approach, skull base reconstruction, readmissions, or reoperation. The 30-day mortality rate was 0.6%, with no association with PNS. Results remained consistent whether PNSs were analyzed as a composite outcome or as individual symptoms. Conclusions: Nearly one-third of patients visited the ED after EESBS, with two-thirds due to PNS. Most PNSs are self-limited but cause morbidity and prompt medical visits.