Do patients who undergo primary septorhinoplasty and revision septorhinoplasty have similar improvements in health utility values (HUVs) following surgery?
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.
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.
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.
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.
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
Gadkaree SK, Fuller JC, Justicz NS, et al. A Comparative Health Utility Value Analysis of Outcomes for Patients Following Septorhinoplasty With Previous Nasal Surgery. JAMA Facial Plast Surg. Published online June 13, 201921(5):402–406. doi:10.1001/jamafacial.2019.0176
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: