Economic evaluation of intranasal wound dressings used in inferior turbinate reduction surgery

Background: Post-operative haemorrhage is a complication of inferior turbinate reduction (ITR) surgery. Due to concerns of secondary haemorrhage and ooze, surgeons develop strong preferences for specific intranasal wound dressings. A multitude of dressings exist, with varying characteristics, purported benefits, and costs. Whether these differences influence the rate of secondary haemorrhage is contested in the literature. The aim of the study was to describe the use, diversity, and cost of intranasal wound dressings used in ITR surgery and the rate of complications including secondary haemorrhage. Method: An audit of consecutive patients who underwent ITR surgery at Macquarie University Hospital was performed. The use, type and cost of intranasal wound dressings were collected from the electronic medical record. Patients completed a three-question survey ≥90 days post-surgery to assess secondary haemorrhage, crusting, and infection. Results: Two hundred patients were included (age 27.9±17.6 years, 32.5% female). Overall secondary haemorrhage was 3.0% [95% confidence interval (CI): 1.1–6.4%] with one patient requiring operative management (0.5%). Other complications occurred in 2.0% of patients. Most (85.5%) received some form of intranasal dressing, with a median cost of $45 [interquartile range (IQR), $34–634]. There was no significant difference in the overall use of intranasal wound dressings between groups (85.6% in the uneventful group vs. 83.3% in the haemorrhage group; P=1.0). The cost of wound dressings did not differ significantly between groups [median $45 (IQR, $34–634) for uneventful cases vs. $45 (IQR, $34–136) for haemorrhage cases; P=0.916]. There was significant cost variability with dressing choice. Conclusions: Substantial variation exists in the use and cost of intranasal dressings used in ITR surgery, without corresponding differences in complication rates. Although the small sample size may limit the findings, these findings highlight the need to balance clinical benefit against cost when selecting intranasal dressings and support further prospective evaluation of dressing use in ITR surgery.