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A Comparative Health Utility Value Analysis of Outcomes for Patients Following Septorhinoplasty With Previous Nasal Surgery.

ABSTRACT: Importance:Using health utility values (HUVs) as an outcome measure for surgical procedures, including rhinoplasty, allows for a standardized measurement of the qualitative and financial benefit of that procedure on overall health. Objective:To use Euroqol 5-Dimension (EQ-5D)-derived HUVs to evaluate nasal obstruction outcomes following surgery between primary rhinoplasty (PSRP) and rhinoplasty with previous nasal surgery (RNS) in a prospective cohort study. Design, Setting, and Participants:A single-institution prospective cohort study between 2013 and 2017 was carried out including 185 patients who underwent RNS before functional rhinoplasty and 278 patients who underwent PSRP for nasal obstruction. The analysis was carried out between December 2018 and February 2019. Main Outcomes and Measures:Patients in the RNS cohort and PSRP cohort who completed the EQ-5D questionnaire immediately prior to surgery and postoperatively at 2, 4, 6, and 12 months were included in the study. The EQ-5D scores were converted to HUV scores and compared to evaluate for improvement in health status following surgery. Results:Of the 185 patients in the RNS cohort, 97 (52%) were women and the mean (SD) age was 42.6 (13.4) years. Of the 278 in the PSRP cohort, 156 (55%) were women and the mean (SD) age was 36.0 (15.8) years. Both cohorts experienced significant improvement in HUV postoperatively. The mean (SD) HUV values were decreased in the RNS cohort versus the PSRP cohort both preoperatively (0.85 [0.16] versus 0.89 [0.14]) and postoperatively at 1 year (0.92 [0.14] versus 0.94 [0.11]); however, the difference in HUV was not statistically significant after 6 months postoperatively. Patients in the RNS cohort were typically older (76 [41%] older than 40 years vs 84 [31%], P?=?.02) and more likely to have sleep apnea (31 [19%] vs 24 [10%], P?=?.01) than in the PSRP cohort. On multivariable analysis, the use of spreader grafts and alar rim grafts in the PSRP cohort was significantly associated with improved HUV at 12 months. (r?=?-0.06; 95% CI, -0.11 to -0.01, P?=?.03). Conclusions and Relevance:Patients with a history of prior nasal surgery may represent a unique cohort when assessing health utility outcomes. Euroqol 5-dimension questionnaire-derived HUVs are a valid predictor of outcomes in all patients who undergo septorhinoplasty. Although outcomes were significantly improved for both cohorts, previous surgical history should be considered when performing cost utility analysis on the benefits of functional rhinoplasty. Level of Evidence:3.

SUBMITTER: Gadkaree SK

PROVIDER: S-EPMC6567843 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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A Comparative Health Utility Value Analysis of Outcomes for Patients Following Septorhinoplasty With Previous Nasal Surgery.

Gadkaree Shekhar K SK Fuller Jennifer C JC Justicz Natalie S NS Derakhshan Adeeb A Mohan Suresh S Yu Phoebe K PK Lindsay Robin W RW

JAMA facial plastic surgery 20190901 5

<h4>Importance</h4>Using health utility values (HUVs) as an outcome measure for surgical procedures, including rhinoplasty, allows for a standardized measurement of the qualitative and financial benefit of that procedure on overall health.<h4>Objective</h4>To use Euroqol 5-Dimension (EQ-5D)-derived HUVs to evaluate nasal obstruction outcomes following surgery between primary rhinoplasty (PSRP) and rhinoplasty with previous nasal surgery (RNS) in a prospective cohort study.<h4>Design, setting, an ...[more]

PMID: 31194223

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Project description:Importance:Initial treatment of nasal fractures can result in long-standing cosmetic or functional defects, but the risk factors for subsequent septorhinoplasty have not been explored. Objective:To assess the risk factors for septorhinoplasty after the initial treatment of isolated nasal fracture. Design, Setting, and Participants:This retrospective population-based analysis of US patients diagnosed with nasal fracture between January 1, 2007, and December 31, 2015, used insurance claims data from the Commercial and Medicare Supplemental categories of the Truven Health MarketScan database. Of the 340?715 patients diagnosed with nasal fracture, 78?474 were included in the final study cohort, excluding those who did not meet enrollment criteria or were diagnosed with concomitant facial fracture. Patients were classified into 1 of 4 groups according to the type and timing of treatment. Main Outcomes and Measures:Septorhinoplasty between 6 and 24 months after nasal fracture diagnosis. Explanatory variables included initial fracture treatment, demographics, comorbidities, and diagnoses associated with a preexisting nasal obstruction or defect. Results:Most of the 78?474 patients were under 65 years of age (66?770 [85.1%]) and male (41?997 [53.5%]) and lived in an urban area (67?938 [86.6%]). Among patients with no preexisting diagnosis of nasal obstruction or defect, open treatment within 3 weeks (adjusted odds ratio [aOR], 1.76; 95% CI, 1.33-2.32) of nasal fracture and between 3 weeks and 6 months (aOR, 1.52; 95% CI, 1.14-2.04) after fracture were associated with increased risk of subsequent septorhinoplasty. In patients with a diagnosis of preexisting nasal obstruction or defect, observation (aOR, 3.56; 95% CI, 2.80-4.53), closed reduction treatment (aOR, 3.10; 95% CI, 1.93-4.96), and open treatment within 3 weeks (aOR, 2.02; 95% CI, 1.48-2.77) of fracture were all associated with increased risk of subsequent septorhinoplasty, with observation having the highest risk. Patients were also more likely to undergo subsequent septorhinoplasty if they were younger than 65 years, with the greatest risk seen in patients 18 to 34 years of age (aOR, 6.02; 95% CI, 4.26-8.50), lived in an urban area (aOR, 1.21; 95% CI, 1.01-1.44), or had a history of anxiety (aOR, 1.45; 95% CI, 1.18-1.78), but less likely if they were male (aOR, 0.82; 95% CI, 0.73-0.91). Conclusions and Relevance:This study suggests that a preexisting diagnosis of nasal obstruction or defect and other aspects of a patient's history are factors to consider when assessing the likelihood of surgical revision of initial treatment of nasal fracture. Level of Evidence:NA.

Dataset Information

A Comparative Health Utility Value Analysis of Outcomes for Patients Following Septorhinoplasty With Previous Nasal Surgery.

Publications

A Comparative Health Utility Value Analysis of Outcomes for Patients Following Septorhinoplasty With Previous Nasal Surgery.

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