Comprehensive big database analysis of outcomes and complications of combination endoscopic sinus surgery and septorhinoplasty

Objective: To evaluate postoperative outcomes and complications of combination functional endoscopic sinus surgery (FESS) and septorhinoplasty (SRP). Methods: This is a multicenter retrospective database study utilizing data from 106 healthcare organizations in the United States from January 1, 2010 to July 31, 2025. The TriNetX database was used to obtain summary statistics on adult patients aged 18 years or older who underwent combination FESS/SRP, FESS alone, or SRP alone. Postoperative outcomes and complications evaluated in comparing combined FESS/SRP with either procedure alone included epistaxis, mucocele formation, postoperative pain, orbital injury, abscess or infection, revision rhinoplasty, and septal perforation needing repair among others. Results: Compared with FESS alone, combination FESS/SRP showed higher rates of acute postoperative pain and nasal mucocele (RR: 1.25 [1.02–1.52]; 1.33 [1.15–1.53]) but no increased risk of recurrent acute sinusitis or chronic sinusitis (RR: 0.97 [0.89–1.06]; 0.99 [0.97–1.03]). Combination FESS/SRP did not have a higher rate of cerebrospinal fluid (CSF) leak (RR: 0.24 [0.13–0.44), meningitis (0.44 [0.21–0.91]), and orbital injury (0.84 [0.74–0.95]) compared to FESS alone. Compared with SRP alone, combination surgery was associated with more persistent septal deviation (RR: 1.18 [1.10–1.26]) and higher rates of epistaxis and control of epistaxis procedures (RR: 1.85 [1.49–2.29]; 2.00 [1.28–3.12]). Septal perforation repair was not significantly increased with combination surgery (RR: 1.11 [0.60–2.05]), though nasal infection or abscess was more frequent (RR: 1.17 [1.13–1.21]). Conclusion: Combination surgery did not show significant major complications, though rates of epistaxis, nasal congestion, and infection were higher. Differences in complications and outcomes may reflect patient selection, potentially explaining the lower risk of major complications in the combined surgery group. The data from this study does not support combined surgery for complicated sinus disease, as anatomic complexity could not be distinguished.