The Rhinoplasty Health Care Monitor: An Update on the Practical and Clinical Benefits after 10 Years of Prospective Outcome Measurements

Abstract

The era of value-based health care is characterized by an increasing interest in patient-reported health outcomes. For this purpose we developed the rhinoplasty health care monitor (RHM), a streamlined outcome measurement protocol, including all rhinoplasty patients since 2014. Statistical analyses of patient-reported outcome data are automated and visually presented on a custom web-based dashboard. We describe the clinical and practical benefits of the RHM and discuss how routine prospective outcome measurements have upgraded our care standards. For this prospective study, 979 consecutive patients referred for functional (revision) rhinoplasty from April 2014 to August 2023 were included. Preoperative and 3- and 12-month postoperative scores on the Nasal Obstruction Symptom Evaluation scale (NOSE), Utrecht Questionnaire (UQ), and visual analog scales (VAS) were obtained. Of 979 referred patients, 599 (61.2%) were eligible for rhinoplasty. One year postoperatively, mean NOSE scale sum score improved from 69.1 ± 22.8 to 23.1 ± 23.5 (p < 0.001). Functional VAS scores improved from 4.1 ± 2.8 (left) and 4.1 ± 2.8 (right) to 7.5 ± 1.9 (left) and 7.3 ± 2.0 (right; p < 0.001). Mean UQ sum score improved from 12.0 ± 6.4 to 6.8 ± 3.3 and aesthetic VAS score improved from 4.5 ± 2.5 to 7.4 ± 1.7 (p < 0.001) 1 year postoperatively. Benefits of the outcome routine were improved patient selection, data-driven expectation management and patient empowerment, and targeted critical appraisals of surgical performance. In conclusion, routine, automated, prospective outcome monitoring provides physicians with a response to the increasing demand for data-driven insights in health outcomes. The limited effort that is needed to gather and monitor outcome data is heavily repaid by valuable insights into aspects of care that can be improved.

Keywords

rhinoplasty - nasal obstruction - patient-reported outcome measures - value-based health care - patient empowerment

Publication History

Accepted Manuscript online:
28 November 2023

Article published online:
10 January 2024

• References

• 1 Floyd EM, Ho S, Patel P, Rosenfeld RM, Gordin E. Systematic review and meta-analysis of studies evaluating functional rhinoplasty outcomes with the NOSE Score. Otolaryngol Head Neck Surg 2017; 156 (05) 809-815
• 2 Zhao R, Chen K, Tang Y. Effects of functional rhinoplasty on nasal obstruction: a meta-analysis. Aesthetic Plast Surg 2022; 46 (02) 873-885
• 3 Wolpert M. Uses and abuses of patient reported outcome measures (PROMs): potential iatrogenic impact of PROMs implementation and how it can be mitigated. Adm Policy Ment Health 2014; 41 (02) 141-145
• 4 Batty MJ, Moldavsky M, Foroushani PS. et al. Implementing routine outcome measures in child and adolescent mental health services: from present to future practice. Child Adolesc Ment Health 2013; 18 (02) 82-87
• 5 Warinner C, Loyo M, Gu J, Wamkpah NS, Chi JJ, Lindsay RW. Patient-reported outcomes measures in rhinoplasty: need for use and implementation. Facial Plast Surg 2023; 39 (05) 517-526
• 6 van Zijl FVWJ, Mokkink LB, Haagsma JA, Datema FR. Evaluation of measurement properties of patient-reported outcome measures after rhinoplasty: a systematic review. JAMA Facial Plast Surg 2019; 21 (02) 152-162
• 7 Rimmer J, Hellings P, Lund VJ. et al. European position paper on diagnostic tools in rhinology. Rhinology 2019; 57 (Suppl S28): 1-41
• 8 Rhee JS, Weaver EM, Park SS. et al. Clinical consensus statement: diagnosis and management of nasal valve compromise. Otolaryngol Head Neck Surg 2010; 143 (01) 48-59
• 9 Datema FR, van Zijl FVWJ, van der Poel EF, Baatenburg de Jong RJ, Lohuis PJFM. Transparency in functional rhinoplasty: benefits of routine prospective outcome measurements in a tertiary referral center. Plast Reconstr Surg 2017; 140 (04) 691-702
• 10 Stewart MG, Witsell DL, Smith TL, Weaver EM, Yueh B, Hannley MT. Development and validation of the nasal obstruction symptom evaluation (NOSE) scale. Otolaryngol Head Neck Surg 2004; 130 (02) 157-163
• 11 van Zijl FVWJ, Timman R, Datema FR. Adaptation and validation of the Dutch version of the nasal obstruction symptom evaluation (NOSE) scale. Eur Arch Otorhinolaryngol 2017; 274 (06) 2469-2476
• 12 Lipan MJ, Most SP. Development of a severity classification system for subjective nasal obstruction. JAMA Facial Plast Surg 2013; 15 (05) 358-361
• 13 Lohuis PJFM, Hakim S, Duivesteijn W, Knobbe A, Tasman AJ. Benefits of a short, practical questionnaire to measure subjective perception of nasal appearance after aesthetic rhinoplasty. Plast Reconstr Surg 2013; 132 (06) 913e-923e
• 14 Chang W, Cheng J, Allaire J, Xie Y, McPherson J. shiny: web application framework for R, 2016. R Packlage, Version 13.1. Accessed 17 October 2023 at https://CRAN.R-project.org/package=shiny
• 15 Saleh H, Rennie C. Assessment and the psychological aspects for septorhinoplasty. Int J Head Neck Surg 2018; 9 (01) 38-45
• 16 Stolovitzky P, Sidle DM, Ow RA, Nachlas NE, Most SP. A prospective study for treatment of nasal valve collapse due to lateral wall insufficiency: outcomes using a bioabsorbable implant. Laryngoscope 2018; 128 (11) 2483-2489
• 17 Jahandideh H, Dehghani Firouzabadi F, Dehghani Firouzabadi M, Jfm Lohuis P, Roomiani M. The Persian version of Utrecht Questionnaire for evaluation of aesthetic rhinoplasty outcomes: translation and validation. World J Plast Surg 2020; 9 (02) 141-145
• 18 Rosa F, Lohuis PJFM, Almeida J. et al. The Portuguese version of “The Utrecht questionnaire for outcome assessment in aesthetic rhinoplasty”: validation and clinical application. Rev Bras Otorrinolaringol (Engl Ed) 2019; 85 (02) 170-175
• 19 Spiekermann C, Rudack C, Stenner M. Reliability and validity of the German version of the Utrecht Questionnaire for outcome assessment in aesthetic rhinoplasty (D-OAR). Eur Arch Otorhinolaryngol 2017; 274 (11) 3893-3898
• 20 Spataro E, Most SP. Measuring nasal obstruction outcomes. Otolaryngol Clin North Am 2018; 51 (05) 883-895