Factores predictores de complicaciones en cirugía endoscópica nasosinusal: índice de masa corporal y comorbilidades
Resumen
Introducción: La rinosinusitis crónica (RSC) es una enfermedad inflamatoria frecuente que afecta de forma importante la calidad de vida y, cuando es refractaria al tratamiento médico, puede requerir cirugía endoscópica y funcional de nariz y senos paranasales. El objetivo fue identificar factores asociados a complicaciones transoperatorias y/o posoperatorias en pacientes intervenidos por RSC. Método: Estudio observacional, analítico, transversal y retrospectivo mediante revisión de expedientes en un hospital de alta especialidad del IMSS (Ciudad Obregón, Sonora). Se incluyeron pacientes ≥18 años operados por RSC con pólipos, sin pólipos o fúngica alérgica entre enero de 2020 y marzo de 2025. Se analizaron variables demográficas, clínicas y quirúrgicas; las complicaciones (hasta 2 meses) se clasificaron en mayores y menores según criterios estandarizados. Se aplicó análisis bivariante (ji cuadrada/Fisher) con cálculo de Odds Ratio (OR) cruda e IC95 %, y regresión logística multivariante (p≤0,05). Resultados: Se revisaron 301 expedientes y se incluyeron 234 pacientes (media 46,9±16,2 años); 54,7 % fueron hombres. Predominó sobrepeso/obesidad (83,8 %) y RSC con pólipos (78,6 %). Presentó al menos una complicación el 53 %; la principal complicación mayor fue hemorragia que requirió transfusión (4,3 %). Las menores más frecuentes fueron sinequias (23,9 %) y sangrado con taponamiento (14,5 %). En el análisis bivariante, se asociaron significativamente a complicaciones: comorbilidades (OR=2,42; IC95 % 1,38-4,25; p=0,002), tabaquismo (OR=4,50; IC95 % 1,47–13,74; p=0,004) y sexo masculino (OR=1,77; IC95 % 1,05–2,97; p=0,032). El IMC ≥30 (Obesidad) mostró una OR=1,98 (IC95 % 0,95-4,15; p=0,069). El tipo de RSC no se asoció (p=0,241). En el modelo de regresión logística ajustado, el tabaquismo (ORa=4,12; IC95 %: 1,32–12,89; p=0,008) y las comorbilidades (ORa=2,01; IC95 %: 1,15–3,52; p=0,014) se mantuvieron como predictores independientes. Discusión: La mayoría de eventos fueron menores; los factores sistémicos y modificables explican buena parte del riesgo. La alta tasa de sinequias requiere análisis específico en relación con cuidados postoperatorios y perfil metabólico. Conclusiones: El tabaquismo y la presencia de comorbilidades son factores de riesgo independientes para complicaciones. La obesidad muestra una tendencia clínicamente relevante. Se recomienda optimizar factores modificables y seguimiento estrecho en grupos de alto riesgo.
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Sataloff RT, Brandwein-Gensler MS. Sataloff's Comprehensive Textbook of Otolaryngology: Head and Neck Surgery (Rhinology/Allergy and Immunology). Vol. 2. Jaypee Brothers Medical Publishers; 2016. https://doi.org/10.5005/jp/books/12714
Malik A, Shakera S, Quadri MAB, Husain S. Clinical Implications of Anatomical Variations in the Sinonasal Region on Sinus Pathology: A Systematic Review. Sch Int J Anat Physiol. 2024;7(2). https://doi.org/10.36348/sijap.2024.v07i02.003
Papadopoulou AM, Bakogiannis N, Skrapari I, Bakoyiannis C. Anatomical Variations of the Sinonasal Area and Their Clinical Impact on Sinus Pathology: A Systematic Review. Int Arch Otorhinolaryngol. 2022;26(3):e483-e496. https://doi.org/10.1055/s-0042-1742327 PMID: 35846811; PMCID: PMC9282972.
Hosemann W, Draf C. Danger points, complications and medico-legal aspects in endoscopic sinus surgery. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2013;12:Doc06. https://doi.org/10.3205/cto000098
Joshi S, Kumar Patel A, Kumar Verma R. Assessment of outcome of functional endoscopic sinus surgery in patients with chronic sinusitis with or without sinonasal polyposis. Int J Sci Res. 2023;12(9). https://doi.org/10.36106/ijsr/0908306
Shah SA, Kobayashi M. Pathogenesis of chronic rhinosinusitis with nasal polyp and a prominent T2 endotype. Heliyon. 2023;9(9):e19249. https://doi.org/10.1016/j.heliyon.2023.e19249 PMID: 37674852; PMCID: PMC10477494.
Luo S, Zhu Z, Li S. Chronic rhinosinusitis: A narrative review of predisposing factors and their relationships with endotypes. Allergy Medicine. 2025;4. https://doi.org/10.1016/j.allmed.2025.100050
Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020;58(Suppl S29):1-464. https://doi.org/10.4193/Rhin20.600 PMID: 32077450.
Abuduruk SH, Sabb Gul BK, AlMasoudi SM, Alfattani EH, Mohammad MA, Alshehri HM, et al. Factors Contributing to the Recurrence of Chronic Rhinosinusitis With Nasal Polyps After Endoscopic Sinus Surgery: A Systematic Review. Cureus. 2024;16(8):e67910. https://doi.org/10.7759/cureus.67910 PMID: 39328679; PMCID: PMC11425789.
Flint PW, Haughey BH, Lund VJ, Niparko JK, Robbins T, Thomas JR, et al. Cummings Otolaryngology: Head and Neck Surgery. 6a ed. Philadelphia: Elsevier Saunders; 2014.
Hackman TG, Ferguson BJ. Powered instrumentation and tissue effects in the nose and paranasal sinuses. Curr Opin Otolaryngol Head Neck Surg. 2005;13(1):22-6. https://doi.org/10.1097/00020840-200502000-00007 PMID: 15654211.
Cornet ME, Reinartz SM, Georgalas C, van Spronsen E, Fokkens WJ. The microdebrider, a step forward or an expensive gadget? Rhinology. 2012;50(2):191-8. https://doi.org/10.4193/Rhino11.250 PMID: 22616081.
Palmer JN, Conley DB, Dong RG, Ditto AM, Yarnold PR, Kern RC. Efficacy of Endoscopic Sinus Surgery in the Management of Patients with Asthma and Chronic Sinusitis. Am J Rhinol. 2001;15(1):49-53. https://doi.org/10.2500/105065801781329400 PMID: 11258656.
Manandhar S, Khan SA, Pokharel A, Shah D. Revolutionizing chronic rhinosinusitis treatment with functional endoscopic sinus surgery: Insights from a low-middle income country. Medicine (Baltimore). 2025;104. https://doi.org/10.1097/MD.0000000000042382 PMID: 40324223; PMCID: PMC12055043.
Bunzen DL, Campos A, Leão FS, Morais A, Sperandio F, Neto SC. Efficacy of functional endoscopic sinus surgery for symptoms in chronic rhinosinusitis with or without polyposis. Rev Bras Otorrinolaringol. 2006;72(2):242-6. https://doi.org/10.1016/s1808-8694(15)30062-8 PMID: 16951859; PMCID: PMC9445759.
Koizumi M, Suzuki S, Matsui H, Fushimi K, Yamasoba T, Yasunaga H. Trends in complications after functional endoscopic sinus surgery in Japan: A comparison with a previous study (2007-2013 vs. 2013-2017). Auris Nasus Larynx. 2020;47(5):814-819. https://doi.org/10.1016/j.anl.2020.04.003 PMID: 32418661.
Cheng SY, Wu YF, Gu XW, Zhao Q, Meng LH, Chen YX, et al. The incidence, risk factors, management and prognosis of postoperative systemic complications after ophthalmic surgery: a retrospective study at a tertiary, academic referral hospital over a decade. Ann Med. 2023;55(2):2262502. https://doi.org/10.1080/07853890.2023.2262502 PMID: 37796532; PMCID: PMC10557541.
Dharap SB, Barbaniya P, Navgale S. Incidence and Risk Factors of Postoperative Complications in General Surgery Patients. Cureus. 2022;14(10):e30975. https://doi.org/10.7759/cureus.30975 PMID: 36465229; PMCID: PMC9714582.
Ramakrishnan VR, Kingdom TT, Nayak JV, Hwang PH, Orlandi RR. Nationwide incidence of major complications in endoscopic sinus surgery. Int Forum Allergy Rhinol. 2012;2(1):34-9. https://doi.org/10.1002/alr.20101 PMID: 22311839.
Vargas-Aguayo AM, Copado-Ceballos RE, Vivar-Acevedo E, Waizel-Haiat S, Contreras-Herrera R, Desentis-Vargas E. Cirugía endoscópica de nariz y senos paranasales: Complicaciones en 150 pacientes. Rev Med Inst Mex Seguro Soc. 2014;52(1):50-55.
Alharbi A, Alhussain F, Alyamani A, Aljohani M, Alsergani A, AbaAlkhail M, et al. Complications of endoscopic sinus surgery for chronic rhinosinusitis in a tertiary care teaching hospital in Saudi Arabia. Saudi Med J. 2023;44(6):578-584. https://doi.org/10.15537/smj.2023.44.6.20230911 PMID: 37343994; PMCID: PMC10284225.
Dhamija R, Das N, Ding P. Complication Rates Following Endoscopic Sinus Surgery for Chronic Sinusitis. Am J Rhinol Allergy. 2025;39(2):197-204. https://doi.org/10.1177/19458924251315434 PMID: 39881591.
Aldajani A, Alroqi A, Alrashidi A, Alsaif A, Almeshari S, Aldwaighri M, et al. Outcomes of Endoscopic Sinus Surgery for Chronic Rhinosinusitis With Nasal Polyposis and Risk Factors of Recurrence in a Tertiary Care Teaching Hospital. Ther Adv Allergy Rhinol. 2024;15. https://doi.org/10.1177/27534030241274764 PMID: 39246331; PMCID: PMC11375676.
Bayer K, Hamidovic S, Besser G, Mueller CA, Liu DT. Factors Associated with Revision Sinus Surgery in Patients with Chronic Rhinosinusitis. J Pers Med. 2022;12(2):167. https://doi.org/10.3390/jpm12020167 PMID: 35207656; PMCID: PMC8878652.
Asaka D, Nakayama T, Hama T, Okushi T, Matsuwaki Y, Yoshikawa M, et al. Risk factors for complications of endoscopic sinus surgery for chronic rhinosinusitis. Am J Rhinol Allergy. 2012;26(1):61-4. https://doi.org/10.2500/ajra.2012.26.3711 PMID: 22236984.
Fischer JL, Gallagher TJ, Lin ME, Kim I, Wrobel BB, Beswick DM, et al. Complications in Endoscopic Sinus Surgery: A TriNetX Network Analysis. Int Forum Allergy Rhinol. 2025. https://doi.org/10.1002/alr.70009 PMID: 40782144; PMCID: PMC12676657.
Krings JG, Kallogjeri D, Wineland A, Nepple KG, Piccirillo JF, Getz AE. Complications of primary and revision functional endoscopic sinus surgery for chronic rhinosinusitis. Laryngoscope. 2014;124(4):838-45. https://doi.org/10.1002/lary.24401 PMID: 24122737; PMCID: PMC4357345.
Qin X, Sun Q, Chen G, Liu J, Gao T, Bai G, et al. Risk factors for postoperative bleeding after endoscopic sinus surgery to treat chronic rhinosinusitis. Acta Otolaryngol. 2021;141(4):397-402. https://doi.org/10.1080/00016489.2021.1878276 PMID: 33586594.
Zein M, Zaitouny N, Ghalayini N, Jaarour S, Chawareb EA, El Hajj A. Predictors of bleeding requiring transfusion following partial nephrectomy: an analysis of the ACS-NSQIP database. BMC Urol. 2025;25(1). https://doi.org/10.1186/s12894-025-01951-z PMID: 41107825; PMCID: PMC12535155.
Rudmik L, Mace JC, Smith TL. Smoking and endoscopic sinus surgery: Does smoking volume contribute to clinical outcome? Int Forum Allergy Rhinol. 2011;1(3):145-52. https://doi.org/10.1002/alr.20045 PMID: 21731825; PMCID: PMC3124774.
Krzeski A, Galewicz A, Chmielewski R, Kisiel M. Influence of cigarette smoking on endoscopic sinus surgery long-term outcomes. Rhinology. 2011;49(5):577-82. https://doi.org/10.4193/Rhino.10.038 PMID: 22125789.
Asokan A, Mace JC, Rice JD, Smith TL, Soler ZM, Ramakrishnan VR. Sex Differences in Presentation and Surgical Outcomes From a Prospective Multicenter Chronic Rhinosinusitis Study. Otolaryngol Head Neck Surg. 2023;168(1):114-122. https://doi.org/10.1177/01945998221102810 PMID: 35639480.
Tirreau AR, Veloz TM, Valdés PC. Una nueva perspectiva en rinosinusitis: EPOS 2020. Rev Otorrinolaringol Cir Cabeza Cuello. 2022;82(3):371-382. https://doi.org/10.4067/S0718-48162022000300371
Golet M, Padullés Zamora N, Portillo A, Caballero JM, Muñoz Esquerre M, Sastre J, et al. Comparison of the EPOS 2020 and POLINA 2.0 guidelines for indicating biologic treatment in adults with chronic rhinosinusitis and nasal polyps. Acta Otorrinolaringol Esp. 2025;76(4). https://doi.org/10.1016/j.otorri.2025.512224 PMID: 40122169.
Santos-Pérez J, Fernández-Rodríguez A, Sánchez-Martínez A. Manejo del paciente con rinosinusitis y poliposis nasosinusal: de las guías a la práctica clínica. Rev ORL. 2018;9(6):1-6. https://doi.org/10.14201/orl.18424
Malik A, Shakera S, Quadri MAB, Husain S. Clinical Implications of Anatomical Variations in the Sinonasal Region on Sinus Pathology: A Systematic Review. Sch Int J Anat Physiol. 2024;7(2). https://doi.org/10.36348/sijap.2024.v07i02.003
Papadopoulou AM, Bakogiannis N, Skrapari I, Bakoyiannis C. Anatomical Variations of the Sinonasal Area and Their Clinical Impact on Sinus Pathology: A Systematic Review. Int Arch Otorhinolaryngol. 2022;26(3):e483-e496. https://doi.org/10.1055/s-0042-1742327 PMID: 35846811; PMCID: PMC9282972.
Hosemann W, Draf C. Danger points, complications and medico-legal aspects in endoscopic sinus surgery. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2013;12:Doc06. https://doi.org/10.3205/cto000098
Joshi S, Kumar Patel A, Kumar Verma R. Assessment of outcome of functional endoscopic sinus surgery in patients with chronic sinusitis with or without sinonasal polyposis. Int J Sci Res. 2023;12(9). https://doi.org/10.36106/ijsr/0908306
Shah SA, Kobayashi M. Pathogenesis of chronic rhinosinusitis with nasal polyp and a prominent T2 endotype. Heliyon. 2023;9(9):e19249. https://doi.org/10.1016/j.heliyon.2023.e19249 PMID: 37674852; PMCID: PMC10477494.
Luo S, Zhu Z, Li S. Chronic rhinosinusitis: A narrative review of predisposing factors and their relationships with endotypes. Allergy Medicine. 2025;4. https://doi.org/10.1016/j.allmed.2025.100050
Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020;58(Suppl S29):1-464. https://doi.org/10.4193/Rhin20.600 PMID: 32077450.
Abuduruk SH, Sabb Gul BK, AlMasoudi SM, Alfattani EH, Mohammad MA, Alshehri HM, et al. Factors Contributing to the Recurrence of Chronic Rhinosinusitis With Nasal Polyps After Endoscopic Sinus Surgery: A Systematic Review. Cureus. 2024;16(8):e67910. https://doi.org/10.7759/cureus.67910 PMID: 39328679; PMCID: PMC11425789.
Flint PW, Haughey BH, Lund VJ, Niparko JK, Robbins T, Thomas JR, et al. Cummings Otolaryngology: Head and Neck Surgery. 6a ed. Philadelphia: Elsevier Saunders; 2014.
Hackman TG, Ferguson BJ. Powered instrumentation and tissue effects in the nose and paranasal sinuses. Curr Opin Otolaryngol Head Neck Surg. 2005;13(1):22-6. https://doi.org/10.1097/00020840-200502000-00007 PMID: 15654211.
Cornet ME, Reinartz SM, Georgalas C, van Spronsen E, Fokkens WJ. The microdebrider, a step forward or an expensive gadget? Rhinology. 2012;50(2):191-8. https://doi.org/10.4193/Rhino11.250 PMID: 22616081.
Palmer JN, Conley DB, Dong RG, Ditto AM, Yarnold PR, Kern RC. Efficacy of Endoscopic Sinus Surgery in the Management of Patients with Asthma and Chronic Sinusitis. Am J Rhinol. 2001;15(1):49-53. https://doi.org/10.2500/105065801781329400 PMID: 11258656.
Manandhar S, Khan SA, Pokharel A, Shah D. Revolutionizing chronic rhinosinusitis treatment with functional endoscopic sinus surgery: Insights from a low-middle income country. Medicine (Baltimore). 2025;104. https://doi.org/10.1097/MD.0000000000042382 PMID: 40324223; PMCID: PMC12055043.
Bunzen DL, Campos A, Leão FS, Morais A, Sperandio F, Neto SC. Efficacy of functional endoscopic sinus surgery for symptoms in chronic rhinosinusitis with or without polyposis. Rev Bras Otorrinolaringol. 2006;72(2):242-6. https://doi.org/10.1016/s1808-8694(15)30062-8 PMID: 16951859; PMCID: PMC9445759.
Koizumi M, Suzuki S, Matsui H, Fushimi K, Yamasoba T, Yasunaga H. Trends in complications after functional endoscopic sinus surgery in Japan: A comparison with a previous study (2007-2013 vs. 2013-2017). Auris Nasus Larynx. 2020;47(5):814-819. https://doi.org/10.1016/j.anl.2020.04.003 PMID: 32418661.
Cheng SY, Wu YF, Gu XW, Zhao Q, Meng LH, Chen YX, et al. The incidence, risk factors, management and prognosis of postoperative systemic complications after ophthalmic surgery: a retrospective study at a tertiary, academic referral hospital over a decade. Ann Med. 2023;55(2):2262502. https://doi.org/10.1080/07853890.2023.2262502 PMID: 37796532; PMCID: PMC10557541.
Dharap SB, Barbaniya P, Navgale S. Incidence and Risk Factors of Postoperative Complications in General Surgery Patients. Cureus. 2022;14(10):e30975. https://doi.org/10.7759/cureus.30975 PMID: 36465229; PMCID: PMC9714582.
Ramakrishnan VR, Kingdom TT, Nayak JV, Hwang PH, Orlandi RR. Nationwide incidence of major complications in endoscopic sinus surgery. Int Forum Allergy Rhinol. 2012;2(1):34-9. https://doi.org/10.1002/alr.20101 PMID: 22311839.
Vargas-Aguayo AM, Copado-Ceballos RE, Vivar-Acevedo E, Waizel-Haiat S, Contreras-Herrera R, Desentis-Vargas E. Cirugía endoscópica de nariz y senos paranasales: Complicaciones en 150 pacientes. Rev Med Inst Mex Seguro Soc. 2014;52(1):50-55.
Alharbi A, Alhussain F, Alyamani A, Aljohani M, Alsergani A, AbaAlkhail M, et al. Complications of endoscopic sinus surgery for chronic rhinosinusitis in a tertiary care teaching hospital in Saudi Arabia. Saudi Med J. 2023;44(6):578-584. https://doi.org/10.15537/smj.2023.44.6.20230911 PMID: 37343994; PMCID: PMC10284225.
Dhamija R, Das N, Ding P. Complication Rates Following Endoscopic Sinus Surgery for Chronic Sinusitis. Am J Rhinol Allergy. 2025;39(2):197-204. https://doi.org/10.1177/19458924251315434 PMID: 39881591.
Aldajani A, Alroqi A, Alrashidi A, Alsaif A, Almeshari S, Aldwaighri M, et al. Outcomes of Endoscopic Sinus Surgery for Chronic Rhinosinusitis With Nasal Polyposis and Risk Factors of Recurrence in a Tertiary Care Teaching Hospital. Ther Adv Allergy Rhinol. 2024;15. https://doi.org/10.1177/27534030241274764 PMID: 39246331; PMCID: PMC11375676.
Bayer K, Hamidovic S, Besser G, Mueller CA, Liu DT. Factors Associated with Revision Sinus Surgery in Patients with Chronic Rhinosinusitis. J Pers Med. 2022;12(2):167. https://doi.org/10.3390/jpm12020167 PMID: 35207656; PMCID: PMC8878652.
Asaka D, Nakayama T, Hama T, Okushi T, Matsuwaki Y, Yoshikawa M, et al. Risk factors for complications of endoscopic sinus surgery for chronic rhinosinusitis. Am J Rhinol Allergy. 2012;26(1):61-4. https://doi.org/10.2500/ajra.2012.26.3711 PMID: 22236984.
Fischer JL, Gallagher TJ, Lin ME, Kim I, Wrobel BB, Beswick DM, et al. Complications in Endoscopic Sinus Surgery: A TriNetX Network Analysis. Int Forum Allergy Rhinol. 2025. https://doi.org/10.1002/alr.70009 PMID: 40782144; PMCID: PMC12676657.
Krings JG, Kallogjeri D, Wineland A, Nepple KG, Piccirillo JF, Getz AE. Complications of primary and revision functional endoscopic sinus surgery for chronic rhinosinusitis. Laryngoscope. 2014;124(4):838-45. https://doi.org/10.1002/lary.24401 PMID: 24122737; PMCID: PMC4357345.
Qin X, Sun Q, Chen G, Liu J, Gao T, Bai G, et al. Risk factors for postoperative bleeding after endoscopic sinus surgery to treat chronic rhinosinusitis. Acta Otolaryngol. 2021;141(4):397-402. https://doi.org/10.1080/00016489.2021.1878276 PMID: 33586594.
Zein M, Zaitouny N, Ghalayini N, Jaarour S, Chawareb EA, El Hajj A. Predictors of bleeding requiring transfusion following partial nephrectomy: an analysis of the ACS-NSQIP database. BMC Urol. 2025;25(1). https://doi.org/10.1186/s12894-025-01951-z PMID: 41107825; PMCID: PMC12535155.
Rudmik L, Mace JC, Smith TL. Smoking and endoscopic sinus surgery: Does smoking volume contribute to clinical outcome? Int Forum Allergy Rhinol. 2011;1(3):145-52. https://doi.org/10.1002/alr.20045 PMID: 21731825; PMCID: PMC3124774.
Krzeski A, Galewicz A, Chmielewski R, Kisiel M. Influence of cigarette smoking on endoscopic sinus surgery long-term outcomes. Rhinology. 2011;49(5):577-82. https://doi.org/10.4193/Rhino.10.038 PMID: 22125789.
Asokan A, Mace JC, Rice JD, Smith TL, Soler ZM, Ramakrishnan VR. Sex Differences in Presentation and Surgical Outcomes From a Prospective Multicenter Chronic Rhinosinusitis Study. Otolaryngol Head Neck Surg. 2023;168(1):114-122. https://doi.org/10.1177/01945998221102810 PMID: 35639480.
Tirreau AR, Veloz TM, Valdés PC. Una nueva perspectiva en rinosinusitis: EPOS 2020. Rev Otorrinolaringol Cir Cabeza Cuello. 2022;82(3):371-382. https://doi.org/10.4067/S0718-48162022000300371
Golet M, Padullés Zamora N, Portillo A, Caballero JM, Muñoz Esquerre M, Sastre J, et al. Comparison of the EPOS 2020 and POLINA 2.0 guidelines for indicating biologic treatment in adults with chronic rhinosinusitis and nasal polyps. Acta Otorrinolaringol Esp. 2025;76(4). https://doi.org/10.1016/j.otorri.2025.512224 PMID: 40122169.
Santos-Pérez J, Fernández-Rodríguez A, Sánchez-Martínez A. Manejo del paciente con rinosinusitis y poliposis nasosinusal: de las guías a la práctica clínica. Rev ORL. 2018;9(6):1-6. https://doi.org/10.14201/orl.18424
ROMÁN-NÁJERA, M. F., LUGO-MACHADO, J. A., & SERRANO-OSUNA, R. (2026). Factores predictores de complicaciones en cirugía endoscópica nasosinusal: índice de masa corporal y comorbilidades. Revista ORL, e34621. https://doi.org/10.14201/orl.34621
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