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Original Investigation
September 19, 2019

Association Between Pain and Patient Satisfaction After Rhinoplasty

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
  • 2Harvard Medical School, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts
JAMA Facial Plast Surg. Published online September 19, 2019. doi:10.1001/jamafacial.2019.0808
Key Points

Question  In rhinoplasty surgery is there an association between postoperative pain and perception of surgical success?

Findings  In this prospective case series survey study of 104 patients who underwent cosmetic and/or functional rhinoplasty, a statistically significant negative association was found between perception of pain and perception of outcome (breathing improvement) in purely functional rhinoplasty. In contrast, among patients who underwent rhinoplasty with simultaneous cosmetic changes, no association between pain and perception of surgical success was found.

Meaning  This prospective study highlights important results that may help guide preoperative rhinoplasty counseling because patients who are interested in purely functional improvement (without cosmetic change) may warrant additional pain-specific counseling to optimize patient satisfaction.

Abstract

Importance  In light of the current opioid crisis, there exists a demonstrated need to balance adequate postrhinoplasty pain control with measured use of narcotics. If pain is inadequately controlled, patients may be unsatisfied with their elective surgical experience.

Objectives  To characterize the association between patient-reported pain outcomes, objective opioid use, and perception of surgical success.

Design, Setting, and Participants  A case series survey study was conducted from July 2018 to January 2019. Consecutive patients who underwent cosmetic and/or functional rhinoplasty by 2 facial plastic surgeons (D.A.S. and L.N.L.) at an academic medical center were surveyed 1 month after surgery.

Main Outcomes and Measures  The number of oxycodone tablets taken, patient-reported pain outcomes, number of narcotic prescription refills, and patient-reported functional and cosmetic outcomes were recorded. Perception of pain, surgical outcome, and oxycodone intake were also evaluated by sex. Demographic information and perception of surgical results were recorded. Statistical analysis was performed using STATA statistical software (version 12.0, STATA Corp). Spearman rank order correlation was used for ordinal, monotonic variables with P < .05 being considered statistically significant.

Results  Overall, 104 patients were surveyed; 6 were lost to follow-up. Of the participants included, 50 were women with a mean (SD) age of 38 (16.0) years and 48 were men with a mean (SD) age of 38 (16.7) years. Although patients were prescribed a range of 10 to 40 tablets of oxycodone, patients took a mean (SD) of 5.2 tablets (range, 0-23). There were no significant sex differences in perception of pain, perception of outcome, or narcotic use. Among patients undergoing purely functional rhinoplasty, a statistically significant negative association between perception of pain and perception of functional outcome (breathing improvement) was evident. Patients who experienced less pain than they expected had a greater perception of functional improvement (rs = −0.62, P = .001). In contrast, among patients who underwent rhinoplasty with cosmetic improvement, no association was found between pain and perception of surgical outcome (rs = 0.05, P = .64).

Conclusions and Relevance  To our knowledge, this is the first study to prospectively evaluate the association between opioid use, patient-reported pain, and perceived surgical success. These data may help guide preoperative counseling because patients who are interested purely in breathing improvement (without cosmetic change) may warrant additional pain-specific counseling to optimize patient satisfaction.

Level of Evidence  3

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