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Original Investigation
June 13, 2019

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

Author Affiliations
  • 1Department of Otolaryngology, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts
  • 2Department of Otolaryngology, University of Minnesota, Minneapolis
JAMA Facial Plast Surg. 2019;21(5):402-406. doi:10.1001/jamafacial.2019.0176
Key Points

Question  Do patients who undergo primary septorhinoplasty and revision septorhinoplasty have similar improvements in health utility values (HUVs) following surgery?

Findings  In this cohort analysis that included 185 patients who underwent prior nasal surgery (RNS) before functional rhinoplasty and 278 patients who underwent primary septorhinoplasty (PSRP), HUVs were lower for the RNS cohort throughout the first year postoperatively; however, after 6 months, the 2 cohorts were not significantly different on statistical analysis.

Meaning  Euroqol 5-dimension questionnaire-derived HUVs are a valid predictor of outcomes in all patients who undergo septorhinoplasty and, although outcomes are still significantly improved for both primary and revision septorhinoplasty cohorts, previous surgical history should be considered when performing cost utility analysis on the benefits of functional rhinoplasty.

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.

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