Standardized Video-Endoscopy and Surgical Field Grading Scale for Endoscopic Sinus Surgery: A Multi-Centre Study

Background: Bleeding is a major concern in endoscopic sinus surgery (ESS), as it may impede surgical progress and is often associated with complications. To improve the study and management of intraoperative bleeding, a standardized method of recording bleeding during ESS is needed. The aim of this study was to develop a standardized method of documenting bleeding in ESS and of grading the surgical field. Methods: Bleeding after endoscopic sinus surgery was recorded using video‐endoscopy. Standardized and non‐standardized video‐endoscopies of 20 patients were graded using a previously published grading scale (the Boezaart scale) in randomized order on two different occasions. Effects of standardization on intra‐ and interrater reliability were evaluated. Based on this experience, a new 11‐point surgical field grading scale was developed and simultaneously compared with the six‐point Boezaart scale via means of a DVD in three international centers. Results: Inter and intrarater reliability of the Boezaart and new Wormald scales significantly improved by employing a standardized video‐endoscopy technique. The Wormald scale had significantly higher interrater (0.80 vs. 0.74, P < .001) and intrarater (0.89 vs. 0.83, P < .001) reliability than the Boezaart scale. Linear regression analysis revealed the Wormald scale to be more sensitive to changes in the most common surgical fields experienced in ESS. Conclusion: Standardized video‐endoscopy has been demonstrated to significantly improve reliability and reproducibility of results and is recommended for future work evaluating bleeding in ESS. The new Wormald grading scale has been shown to be an inexpensive, reliable, and sensitive tool to rapidly evaluate intraoperative bleeding in ESS. It overcomes several limitations of the Boezaart scale, enabling us to analyze currently employed and newly developed hemostatic methods and agents.