Surgical management of posterior epistaxis: A changing paradigm

Objective. To demonstrate that surgery, as the initial treatment option for posterior epistaxis, can provide comparable success and complication rates to nonsurgical management with fewer associated costs. Study Design: A retrospective chart review and cost analysis. Methods: Two hundred three consecutive charts were reviewed for patient outcome, complications, and hospitalization time. Average costs were calculated from hospital department and physician fee schedules. Results: Average success rate of all surgical procedures performed for posterior epistaxis was 90%, anterior-posterior packing success was 62%, and embolization success was 75%. The packing-only group had a significantly greater mean hospitalization time (5.29 d) than patients who were treated either surgically (2.1 d) or with embolization (2.6 d). The average per-patient admission charges were, for successful posterior packing, $5136 per patient; for surgical treatment, $3851 per patient; and for embolization, $5697 per patient. Surgery offered a cost savings of $1846 per patient over traditional packing. There was no significant difference in complication rates between the groups. Conclusion: The review suggests that a better success rate, a comparable complication rate, and a cost savings can be achieved with surgical intervention as the first-line treatment for intractable epistaxis when compared with traditional anterior-posterior packing and embolization.