Disparities in NOSE Scores and Surgical Approaches among Patients Undergoing Functional Rhinoplasty

Overview

Social factors influence outcomes across medicine but had not been examined in functional rhinoplasty. The authors reviewed records from one health network to compare breathing scores and surgical approach between patients with public and private insurance.

Sections of note

• Records of 178 patients who had functional rhinoplasty in a single health network from 2013 to 2016 were reviewed; 116 with both preoperative and postoperative NOSE scores were analyzed.
• Mean age 34.7 years, SD 16.2; 57 (49.1%) female.
• 21 patients (18.1%) had public insurance, of whom 18 had Medicaid.
• Mean NOSE improvement was 56.39, SD 15.6, in Medicaid patients versus 47.90, SD 25.6, in non-Medicaid patients, p 0.067.
• No statistically significant difference in preoperative NOSE scores or in postoperative improvement between insurance types.
• No statistically significant difference in surgical approaches between groups.
• Medicaid patients had a closer association with a history of nasal trauma and prior surgery. The authors call for further study of socioeconomic status and disparities in care.

What it means for a patient

• Insurance type did not measurably change how much breathing improved or which operation was performed here.
• The majority of patients receiving functional rhinoplasty in this network had private insurance.
• The Medicaid group's greater improvement fell just short of significance, and that group had more trauma and prior surgery, so their starting point differed.
• Limits: 116 patients, one health network, retrospective, only 21 publicly insured patients, and insurance used as a proxy for socioeconomic status.

Why this paper matters

Access to elective functional surgery varies by insurance, and this is a first look at whether outcomes do too. The finding of no significant difference in results is reassuring but rests on small numbers. The composition difference, more trauma and prior surgery among Medicaid patients, points to access rather than outcome as the disparity.

Terms

• Functional rhinoplasty: Nasal surgery aimed at breathing rather than appearance.
• NOSE score: The Nasal Obstruction Symptom Evaluation, a validated blockage questionnaire.
• Social determinants of health: Non-medical factors such as income and insurance that affect health outcomes.
• Medicaid: A United States public health insurance program for people with low income.
• Retrospective review: Analysis of records after the events occurred.