Effect of Comorbid Dysautonomia on Postoperative Complications in Sinonasal Surgery

Background Disorders of autonomic dysregulation appear increasingly prevalent in chronic rhinosinusitis (CRS). Objective The purpose of this study was to investigate if dysautonomia portends a riskier postoperative course in patients with CRS undergoing sinonasal surgery. Methods The TriNetX database was queried for patients with CRS with or without comorbid dysautonomia undergoing functional endoscopic sinus surgery, septoplasty, and/or inferior turbinate reduction. Cohorts were propensity-matched based on age, gender, race, and potentially confounding comorbid conditions. Main outcome measures were emergency department utilization, inpatient admission, incidence of postoperative cerebrospinal fluid leak, epistaxis, or hypotension. The use of opioid, neuropathic, antibiotic, benzodiazepine, muscle relaxant, corticosteroid medications, and intravenous fluids within 90 days of surgery were also recorded. Results Each group contained n = 1122 patients. The dysautonomia group had higher risks of epistaxis (odds ratio [OR]: 2.03; confidence interval [CI]: 1.13, 3.66; P = .016) and neuropathic medication use (OR: 2.92; CI: 1.35, 6.31, P = .005) following sinonasal surgery. Conclusion Patients with CRS and comorbid dysautonomia appear at a greater risk of postoperative epistaxis and neuropathic pain medication use following sinonasal surgery. Although further study is necessary, these findings suggest patients with dysautonomia may have a higher rate of postoperative bleeding and increased pain sensitivity.