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Transparency in Functional Rhinoplasty: Benefits of Routine Prospective Outcome Measurements in a Tertiary Referral Center

Datema, Frank R., M.D., Ph.D.; van Zijl, Floris V. W. J., M.D.; van der Poel, Egge F., Ph.D.; Baatenburg de Jong, Robert J., M.D., Ph.D.; Lohuis, Peter J. F. M., M.D., Ph.D.

Plastic and Reconstructive Surgery: October 2017 - Volume 140 - Issue 4 - p 691-702
doi: 10.1097/PRS.0000000000003701
Cosmetic: Original Articles
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Background: Patients, governments, health care providers, and insurance companies are increasingly interested in medical performance. Transparent outcome reporting requires a thorough methodologic design, dedicated prospective data collection process, and preferably no interference with the efficacy of daily practice. The primary aim of this article is to describe how these bottlenecks are tackled with an automated prospective rhinoplasty outcome routine. The secondary aim is to motivate others by describing practical benefits encountered during implementation.

Methods: Since April 2014, 269 consecutive patients referred for functional-aesthetic (revision) rhinoplasty were included. The Nasal Obstruction Symptom Evaluation scale, the Utrecht Questionnaire, and visual analogue scales were offered to all patients before primary consultation and follow-up to translate the subjective burden of nasal problems and change herein following surgery, into data. These data were exported for real-time automated outcome analysis supported by graphic output through a customized Web-based dashboard.

Results: One hundred seventy-one patients proved eligible for rhinoplasty, of which 121 had sufficient follow-up. The dashboard provides an overview of demographic characteristics of different populations, reasons why rhinoplasties were not performed, and real-time short- and long-term change in functional and aesthetic outcome in both primary and revision cases. Practical benefits of the instruments used are presented and discussed.

Conclusions: Routine prospective outcome monitoring provides an evidence-based response to the increasing demand for transparency in health care. The dashboard proved valuable during patient counseling, patient selection, and management of expectations and has the potential to compare rhinoplasty results between surgeons and institutions, provided that the populations share similar characteristics.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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Rotterdam and Zeist, The Netherlands

From the Department of Otolaryngology/Head and Neck Surgery, Erasmus Medical Center, Rotterdam; and the Department of Otolaryngology/Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery, Diakonessen Hospital Utrecht.

Received for publication December 23, 2016; accepted March 14, 2017.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Floris V. W. J. van Zijl, M.D., Department of Otolaryngology/Head and Neck Surgery, Erasmus Medical Center, ‘s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands, f.vanzijl@erasmusmc.nl

Copyright © 2017 by the American Society of Plastic Surgeons