Predictors of Complications in Sinonasal Endoscopic Surgery: Body Mass Index and Comorbidities
Abstract
Introduction: Chronic rhinosinusitis (CRS) is a prevalent inflammatory disease that substantially impairs quality of life. When refractory to medical therapy, endoscopic and functional sinonasal surgery may be required. This study aimed to identify risk factors associated with intraoperative and/or postoperative complications in patients undergoing surgery for CRS. Method: Observational, analytical, cross-sectional, retrospective chart review conducted at a tertiary IMSS hospital (Ciudad Obregón, Sonora, Mexico). Adults (≥18 years) who underwent endoscopic and functional nose and paranasal sinus surgery for CRS with polyps, without polyps, or allergic fungal rhinosinusitis from January 2020 to March 2025 were included. Demographic, clinical, and surgical variables were collected. Complications within 2 months were classified as major or minor using standardized criteria. Bivariate analysis (chi-square/Fisher’s exact test) with crude Odds Ratio (OR) and 95 % CI was performed, followed by multivariate logistic regression (p≤0,05). Results: A total of 301 medical records were reviewed, and 234 patients were included (mean age 46,9 ± 16,2 years); 54,7 % were male. Overweight/obesity (83,8 %) and chronic rhinosinusitis with nasal polyps (78,6 %) were predominant. At least one complication occurred in 53 % of patients; the most frequent major complication was hemorrhage requiring transfusion (4,3 %). The most common minor complications were synechiae (23,9 %) and bleeding requiring nasal packing (14,5 %). In the bivariate analysis, comorbidities (OR = 2,42; 95 % CI 1,38–4,25; p = 0,002), smoking (OR = 4,50; 95 % CI 1,47–13,74; p = 0,004), and male sex (OR = 1,77; 95 % CI 1,05–2,97; p = 0,032) were significantly associated with complications. BMI ≥30 (obesity) showed a non-significant trend (OR = 1,98; 95 % CI 0,95–4,15; p = 0,069). CRS phenotype was not associated (p = 0,241). In the adjusted logistic regression model, smoking (aOR = 4,12; 95 % CI 1,32–12,89; p = 0,008) and comorbidities (aOR = 2,01; 95 % CI 1,15–3,52; p = 0,014) remained independent predictors. Discussion: Most events were minor; systemic and modifiable factors (smoking/comorbidities) largely drove complication risk. The high synechiae rate warrants specific analysis regarding postoperative care and metabolic profile. Conclusions: Most events were minor; systemic and modifiable factors accounted for a substantial proportion of the risk. The high rate of synechiae warrants specific analysis in relation to postoperative care and metabolic profile.
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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). Predictors of Complications in Sinonasal Endoscopic Surgery: Body Mass Index and Comorbidities. Revista ORL, 17(3), e34621. https://doi.org/10.14201/orl.34621
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