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Original Investigation
May 23, 2019

Health Utility Values as an Outcome Measure in Patients Undergoing Functional Septorhinoplasty

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston
  • 2Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota
JAMA Facial Plast Surg. Published online May 23, 2019. doi:10.1001/jamafacial.2019.0234
Key Points

Question  Can health utility values derived from patient scores on the EuroQol 5-Dimension questionnaire be used to measure outcomes of septorhinoplasty?

Findings  In this cohort study of 463 patients undergoing septorhinoplasty, the mean preoperative health utility value was significantly increased 12 months after surgery.

Meaning  Health utility values can be used to measure outcomes in patients undergoing septorhinoplasty, and nasal obstruction is associated with a substantial detriment to overall health in line with other chronic conditions.

Abstract

Importance  By measuring health utility values (HUVs) for patients with nasal obstruction after septorhinoplasty, the association of nasal congestion with overall health can be measured and the functional outcomes of septorhinoplasty can be determined.

Objective  To use the EuroQol 5-Dimension (EQ-5D) questionnaire to evaluate nasal obstruction outcomes after septorhinoplasty and to determine HUVs.

Setting, Participants, and Design  This prospective cohort study included patients who underwent septorhinoplasty for nasal obstruction at a single institution by a single surgeon from January 1, 2013, through December 31, 2017. Participants completed the EQ-5D questionnaire immediately before surgery and postoperatively at 2, 4, 6, and 12 months. The EQ-5D scores were converted to HUVs using population-based data for individuals with chronic diseases. Data were analyzed from May 1 through December 31, 2018.

Exposure  Functional septorhinoplasty.

Main Outcomes and Measures  Preoperative and postoperative EQ-5D scores were compared to evaluate improvement in overall health after septorhinoplasty.

Results  A total of 463 patients (53.8% women; mean [SD] age, 36.8 [15.7] years) who underwent septorhinoplasty and completed EQ-5D surveys at baseline and postoperatively were included in the study population. Overall mean (SD) preoperative HUV was 0.872 (0.01), compared with 1.00 for those with a perfect state of health. On univariate analysis, female sex (mean [SD] HUV, 0.853 [0.01]; P = .004), previous nasal surgery (mean [SD] HUV, 0.85 [0.16]; P = .02), previous septoplasty (mean [SD] HUV, 0.88 [0.15]; P = .02), and previous sinus surgery (mean [SD] HUV, 0.79 [0.20]; P = .009) were associated with significantly lower baseline HUVs. On multivariate regression including these variables, only previous septoplasty was significantly associated with a positive change in mean (SD) HUV (0.88 [0.15] vs 0.85 [0.16]; P = .02). Mean (SD) HUV was significantly improved at 2 months postoperatively to 0.91 (0.14; P = .001) and remained significantly improved from baseline at 12 months, at 0.93 (0.13; P < .001).

Conclusions and Relevance  Nasal obstruction is associated with significant detriment to overall health, in line with other chronic conditions affecting the US population. Functional septorhinoplasty appears to substantially improve overall health, as measured by HUV, in an immediate and sustained fashion.

Level of Evidence  3.

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