Evidence-Based Performance Measures for Rhinoplasty: A Multidisciplinary Performance Measure Set

Overview

The American Society of Plastic Surgeons, the American Academy of Otolaryngology Head and Neck Surgery, and the American Academy of Facial Plastic and Reconstructive Surgery commissioned a multidisciplinary work group to draft quality measures for patients having rhinoplasty, both for breathing and for appearance. The group identified one outcome measure and three process measures.

Sections of note

• Consensus document produced by a multidisciplinary work group; no patient data, rates or follow up are reported.
• The outcome measure covers patient satisfaction with rhinoplasty procedures.
• The first process measure covers motivations and expectations for the procedure.
• The second process measure covers airway assessment.
• The third process measure covers nonnarcotic shared decision making strategies for pain management.
• The measures were approved by the plastic surgery society's quality work group and executive committee, and by the otolaryngology foundation, the facial plastic surgery academy, The Rhinoplasty Society and the American Association of Oral and Maxillofacial Surgeons.
• The group recommends the measures for quality initiatives, continuing medical education, maintenance of certification, clinical data registry reporting and national quality reporting.

What it means for a patient

• These measures define what the societies consider adequate rhinoplasty care rather than what technique to use.
• Three of the four concern the consultation and the medication plan, not the surgery itself.
• Airway assessment is included even for cosmetic cases, meaning breathing should be checked before appearance surgery.
• Nothing here measures whether following the measures improves results; that has not been studied.

Why this paper matters

Rhinoplasty quality has been judged mainly by individual surgeon results, with no agreed standard across specialties. This document establishes one, endorsed by the main American societies. Whether the measures are adopted, and whether they change outcomes, remains to be seen.

Terms

• Performance measure: a defined standard used to assess whether care met an agreed benchmark.
• Outcome measure: a measure of the result of care, here patient satisfaction.
• Process measure: a measure of whether a step of care was carried out.
• Nonnarcotic: pain relief that does not use opioid medication.
• Shared decision making: the patient and clinician choosing a plan together.