Endoscopic sphenopalatine artery cauterization versus double-balloon nasal packing for posterior epistaxis: clinical outcomes and hospital cost analysis in a real-world cohort

BACKGROUND: Optimal initial management of posterior epistaxis remains controversial. We compared primary endoscopic sphenopalatine artery (SPA) cauterization with double-balloon posterior nasal packing. AIMS/OBJECTIVES: To compare treatment success, hospital stay, and costs between both strategies. MATERIALS AND METHODS: This retrospective cohort included 75 consecutive patients with posterior epistaxis treated at a tertiary referral center (January 2020 and December 2025). Clinical outcomes, hospitalization, and hospital costs were compared by primary treatment strategy (intention-to-treat) and by definitive treatment received, using generalized linear models, and a hospital cost-per-success analysis. Mean hospital cost per patient did not differ significantly between primary strategies (€4,115.69 vs. €4,193.31), resulting in a lower cost per successfully treated patient with primary cauterization (€4,224 vs. €6,073). Rescue surgery-patients had the longest hospitalization and highest costs. CONCLUSIONS: Primary endoscopy SPA cauterization achieved higher success and shorter hospitalization, without increasing hospital cost per patient at the strategy level. Despite higher adjusted costs, delayed surgery after packing failure was the least efficient strategy.