Patient reported outcome measures in septorhinoplasty surgery

Abstract

INTRODUCTION Surgical procedures incorporating a cosmetic element such as septorhinoplasty and otoplasty are currently under threat in the National Health Service (NHS) as they are deemed to be procedures of 'limited clinical benefit' by many primary care providers. Patient reported outcome measures (PROMs), which assess the quality of care delivered from the patients' perspective, are becoming increasingly important in documenting the effectiveness of such procedures. METHODS The Rhinoplasty Outcomes Evaluation (ROE) questionnaire, a validated PROM tool, was used to assess patient satisfaction in 141 patients undergoing septorhinoplasty surgery over a 90-month period at the University Hospital Southampton NHS Foundation Trust. RESULTS Overall, 100 patients with a mean follow-up period of 36 months completed the study. The mean ROE score was 73.3%. In addition, 75% of patients questioned were happy with the final result of their operation and 83% would undergo the procedure again if required. These benefits occurred irrespective of age, sex and primary versus revision surgery, and were maintained for up to 71 months following surgery. CONCLUSIONS This study has shown that patients are generally satisfied with their functional and cosmetic outcomes following septorhinoplasty surgery. These results help support the case for septorhinoplasty surgery to continue being funded as an NHS procedure.

Evidence-Based Medicine

“…These measures focus on quality-of-life (QOL) issues and provide a quantitative assessment of otherwise subjective results. 12 Because the primary goal of functional rhinoplasty surgery is to improve nasal obstructive symptoms, QOL measures have been commonly used to evaluate efficacy of surgery. Disease-specific measures are most useful for this because the health status changes from nasal surgery may be too subtle to be appreciated by global instruments.…”

Welche Qualität macht den Unterschied?

“…Cost payers will increasingly include these calculations to help them to decide whether an intervention is economically justified or not. Similar developments are already seen in Great Britain, where specific interventions are no longer paid by the health insurances from a specific age (e. g. hip replacement) or the decisions are made individually in particular cases (e. g. septorhinoplasty) [51]. By implication, this means that from the cost payerʼs point of view the costs of the intervention have to be lower (lower DRG) or that the gained QALY would have to clearly increase with unchanged costs.…”

Comparison of anterior nasal packing and absence of packing after rhinoplasty

“…4,5 Although not visible immediately, it becomes apparent after a few hours of surgery. 3,16 Complete resolution of this postoperative morbidity may take up to 2 to 3 weeks.…”

“…This mainly results in a dissatisfied patient as it can cause social as well as work related inconvenience, the rate of which is estimated to be 10-25% especially in the early post op period. [3][4][5] There have been a few studies to address this problem of edema of the eyelid and periorbital ecchymosis, by using anti-inflammatory drugs such as steroids, modified surgical techniques and cold compression techniques. 6,7 The most common mode of treatment of rhinoplasty is with the use of the nasal packing and external immobilization with splint as hemostasis may occur as well as this is required for the fixation of the operated bones and caartillages.…”