How should a patient with sinus issues be managed prior to scheduled rotator cuff surgery?

Management of Sinus Issues Before Rotator Cuff Surgery

A patient with sinus issues should proceed with scheduled rotator cuff surgery tomorrow unless they have active purulent sinusitis or severe symptoms, as there is no evidence that mild to moderate sinus conditions negatively impact rotator cuff surgical outcomes.

Assessment of Sinus Condition

When evaluating a patient with sinus issues prior to rotator cuff surgery, focus on:

• Presence of active infection vs. chronic inflammation
• Severity of symptoms
• Impact on breathing/anesthesia risk

Red Flags That May Warrant Surgery Postponement

• Purulent nasal discharge
• Fever associated with sinus symptoms
• Severe nasal congestion that could complicate airway management
• Acute bacterial sinusitis requiring antibiotic treatment

Management Algorithm

1. For mild to moderate symptoms (VAS score 0-3):

   • Proceed with surgery as scheduled
   • Continue intranasal corticosteroids if already prescribed 1
   • Consider saline nasal lavage pre-operatively 1

2. For moderate to severe symptoms (VAS score >3-10) without purulence:

   • Proceed with surgery if symptoms are manageable
   • Continue intranasal corticosteroids 1
   • Add saline nasal lavage 1
   • Consider consulting anesthesiologist about airway management

3. For severe symptoms with purulence or suspected infection:

   • Consider postponing surgery
   • Obtain culture if possible 1
   • Consider appropriate antibiotic therapy
   • Consult with otolaryngologist if necessary 1

Rationale for Recommendation

There is no specific evidence in the guidelines that mild to moderate sinus issues negatively impact rotator cuff surgical outcomes or increase perioperative risks 1. The primary concerns would be:

1. Anesthesia complications related to compromised airways
2. Theoretical risk of spreading infection during intubation
3. Patient comfort during recovery

Important Considerations

• The timing of rotator cuff repair can impact outcomes. Some evidence suggests better results when repairs are performed within 3 weeks of acute injury 1, so unnecessary delays should be avoided.

• Sinus symptoms without active infection do not constitute a contraindication to surgery.

• For patients with chronic sinus conditions, their baseline status should be considered - if current symptoms represent their typical state, postponing surgery may not offer any benefit.

Post-Operative Considerations

• Continue appropriate sinus management post-operatively
• Be aware that some pain medications may cause nasal dryness
• Maintain hydration to help with both sinus symptoms and surgical recovery

In conclusion, unless the patient has severe sinus symptoms with active infection, the scheduled rotator cuff surgery should proceed as planned, with appropriate management of the sinus condition continuing through the perioperative period.