ABSTRACT Background The potential complications of endoscopic sinus surgery (ESS) remain a critical surgical consideration. This study aims to examine complication rates and identify trends in ESS‐related complications. Methods The TriNetX network was queried for patients undergoing ESS between 2005 and 2024. Diagnosis and procedural codes identified patients with a new post‐operative diagnosis relating to epistaxis, cerebrospinal fluid (CSF) leak, meningitis, and/or orbital injury. Complication rates were calculated. The relative risk for demographic differences in complication rates was assessed. Joinpoint regression analysis determined trends in complication rates. Results A total of 127,333 patients undergoing ESS were included. There was a 0.28% CSF leak rate, 0.24% meningitis rate, 2.09% rate of orbital complications, and 2.27% rate of hemorrhage requiring intervention. Among orbital complications, 0.10% of patients experienced retrobulbar hematoma, 0.40% experienced an extraocular muscle injury, and 0.30% experienced post‐operative blindness or low vision. The 30‐day readmission rates were 1.47% and 1.62% of patients sought emergency department (ED) care within 30 days of surgery. There were small but significant changes in rates of meningitis (annual percent change [APC] = ‒3.42; 95% confidence interval [CI] ‒5.65, 1.13), hemorrhage requiring intervention (APC = 3.0; 95% CI 1.92–4.10), and 30‐day ED visits (APC = 5.43; 95% CI 2.52, 8.43) over time. There were multiple differences in complication rates based on patient sex, age, and race/ethnicity ( p < 0.05) Conclusions There are age‐related and demographic differences in complication rates related to ESS. The majority of complication rates have remained stable over 20 years, with only meningitis rates decreasing while rates of hemorrhage requiring intervention and emergency room visits have increased.