(1225) Practice Patterns for Multidisciplinary Dacryocystorhinostomy at a Single Academic Institution

Introduction: Dacryocystorhinostomy (DCR) is a surgical procedure performed by ophthalmologists and otorhinolaryngologists, and there are no published guidelines to indicate which cases may benefit from a multidisciplinary approach involving rhinologists. This retrospective study analyzes practice patterns and outcomes of DCR surgery at a tertiary academic center with established multidisciplinary surgical teams.

Methods: Retrospective review of all DCR cases with complete medical records and at least 3 months of follow up was performed at a single institution from 2018 to 2022. Patient and surgical characteristics were recorded for 239 cases.

Results: A combined approach between a rhinologist and an oculoplastic surgeon was performed in 29.7%. Of those cases, 83.1% had pre-existing sinonasal pathology (history of cancer, radiation, or trauma) compared to 13.1% of ophthalmology cases (p < 0.01). Patients treated by rhinologists were younger (54.7 vs 63.6 years, p < 0.01) and included more males (47.9% vs 31.5%, p = 0.016). The rate of revision surgery was significantly higher among rhinology DCRs (33.8% vs 10.1%, p < 0.01). Preoperative CT imaging was more commonly available for rhinology cases (98.6% vs 23.1%, p < 0.01). Functional success was achieved in 77.5% of rhinology cases and in 88.1% of ophthalmology cases (p = 0.036). The success rates of primary surgeries involving rhinologists and ophthalmology were comparable (84% vs 89.4%. p = 0.34), as were the success rates for rhinology and ophthalmology revision DCR groups (75% vs 76.5% (p = 0.91)).

Conclusions: Rhinologists were lead surgeons in most DCR cases for patients with preexisting sinonasal pathology and revision cases. The lower overall success rate for rhinology DCR surgery likely reflects this more challenging patient population and is in the range of success rates in prior studies of similar cohorts. When separating primary surgery and revision groups, success rates were equivalent, suggesting that rhinologist involvement may help optimize outcomes in high-risk groups such as patients with history of sinonasal carcinoma or radiation.