Comparison of outcomes for Draf IIB vs Draf III in endoscopic frontal sinus surgery: a comprehensive systematic review and meta-analysis

Background: Understanding the factors associated with increased rates of restenosis following Draf procedures is crucial for developing targeted strategies to mitigate complications such as mucocele formation, reduce the need for revision surgeries, and improve long-term patient outcomes. Methodology: A systematic search was conducted using Embase, Medline, CINAHL, AMED, PubMed, and the Cochrane Database on January 17th, 2024. Research articles published in English language were included. Abstracts were independently screened by two reviewers, and data were extracted and assessed for quality in adherence to PRISMA guidelines. Meta- and sub-group analyses were conducted using the REML model and random-effects model to address high heterogeneity and I² values. Results: A total of 96 studies met the inclusion criteria. For the Draf IIB subgroup (15 studies, 239 sinuses), the restenosis rate was 7%, compared to 20% in the Draf III subgroup (40 studies, 1,910 sinuses). Revision surgery rates were 5% for Draf IIB versus 12% for Draf III. Adjuvant interventions, such as steroid-impregnated stents, were associated with improved outcomes, showing an ostium patency OR of 2.20. Conclusion: Draf IIB had superior outcomes compared to Draf III with respect to restenosis and revision surgery. The use of steroid-impregnated stents appears effective in reducing restenosis rates.