Association Between Pain and Patient Satisfaction After Rhinoplasty

Gadkaree SK, Shaye DA, Occhiogrosso J, Lee LN.

PubMed 31536105 Publisher (DOI)Free full text (PMC)

What this paper says

Among 98 patients surveyed a month after rhinoplasty, mean oxycodone use was 5.2 tablets against prescriptions of 10 to 40, and among purely functional patients less pain than expected tracked with a better perceived breathing result.

Overview

Balancing adequate pain control against restrained opioid prescribing is a live issue, and inadequately controlled pain may leave patients dissatisfied with an elective operation. This case series surveyed consecutive rhinoplasty patients about tablets taken, pain experienced, and how they judged the result.

Sections of note

Case series survey from July 2018 to January 2019; consecutive cosmetic and functional rhinoplasty patients of 2 facial plastic surgeons at an academic medical center, surveyed 1 month after surgery.
104 patients surveyed, 6 lost to follow-up; 50 women and 48 men, both groups mean age 38 years.
Patients were prescribed 10 to 40 oxycodone tablets and took a mean of 5.2, range 0 to 23.
No significant sex differences in perception of pain, perception of outcome, or narcotic use.
Among purely functional rhinoplasty patients, less pain than expected was associated with greater perceived breathing improvement, rs -0.62, P .001.
Among patients having cosmetic improvement, no association between pain and perception of the surgical outcome, rs 0.05, P .64.
The authors state this is the first prospective evaluation linking opioid use, reported pain, and perceived success. Level of evidence 3.

What it means for a patient

Patients took roughly a fifth of what was prescribed at the upper end of the range.
For breathing-only surgery, how the recovery felt influenced how successful the result was judged to be.
For cosmetic surgery, pain and perceived result were unrelated, presumably because the result is judged by looking.
Limits: 98 patients, two surgeons, one center, self-reported tablet counts, and a single survey at 1 month.

Why this paper matters

Perceived success is what patients act on, and this identifies a group whose judgment is colored by the recovery experience rather than the result itself. That argues for pain-specific counseling before purely functional surgery. The correlation is from one small cohort and has not been replicated.

Terms

Oxycodone: An opioid pain medication.
Functional rhinoplasty: Nasal surgery aimed at breathing rather than appearance.
Case series: A report on a group of patients with no comparison group.
Spearman rank order correlation: A statistical test of whether two ranked measures move together.
Perceived surgical success: How successful the patient judges the operation to have been.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

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.

Abstract as indexed by PubMed; the article is open access (PubMed Central).