Trends and Complications in Endoscopic and Open Approaches to Orbital Decompression Surgery in the United States: Analysis of the Trinetx Database

Objectives: Techniques for performing orbital decompression have evolved with the advent of endoscopic endonasal surgery; however, outcomes following these varying techniques are limited. This study investigates national trends in endoscopic and open approaches and postoperative outcomes over the last decade.

Methods: The TriNetX database was queried for patients undergoing either endoscopic or open orbital decompression between 2013 and 2022. Data were collected on patient demographics, diagnoses, and postoperative complications.

Results: A total of 2,446 endoscopic and open orbital decompression surgeries were performed between 2013 and 2022, of which 883 approaches were purely endoscopic and 1248 were purely open. Except for the first year in the analysis, the open approach was consistently the most common orbital decompression approach. Average thyroid-stimulating immunoglobulin (TSI) was significantly higher in patients undergoing endoscopic decompression compared to patients treated via open approach (271 ± 228 vs. 73.3 ± 142 IU/L; p < 0.001). Patients requiring orbital decompression were more likely to undergo open decompression for exophthalmos (44 vs. 39%; p = 0.009), whereas patients more often underwent endoscopic decompression for acute inflammation of the orbit (20 vs. 2%; p < 0.001) and for disorders of the optic nerve and visual pathways (19 vs. 15%; p = 0.003). There was no difference in open versus endoscopic approach in patients presenting with deformity of the orbit including trauma, iatrogenic injury, or bone disease (p = 0.62) and benign neoplasms (p = 0.27). Both endoscopic and open approaches showed similar odds of postoperative blindness and vision loss (2.02% vs. 1.03%, p = 0.08), diplopia or strabismus (8.49 vs. 9.86%, p = 0.38), cerebrospinal fluid leak (1.17 vs. 0.81%, p = 0.40), epistaxis (1.44 vs. 0.81%, p = 0.17), and orbital hemorrhage (1.15 vs. 0.81%, p = 0.80).

Conclusion: Open orbital decompression is the most common approach when compared to endoscopic decompression with similar 90-day postoperative complications. Endoscopic orbital decompression is much more common in treating acute illness, for access to the optic nerve, and potentially in more severe thyroid eye disease as indicated by significant differences in TSI levels ([Fig. 1]).

Fig. 1

Publication History

Article published online:
05 February 2024