The Rhinoplasty Health Care Monitor: Using Validated Questionnaires and a Web-Based Outcome Dashboard to Evaluate Personal Surgical Performance

Overview

The authors present a method for a single surgeon to measure and evaluate their own performance using a web based dashboard. All patients referred to the senior author for functional and aesthetic rhinoplasty, including revisions, between April 2014 and September 2020 were included prospectively. Patients completed validated questionnaires before and after surgery and the scores fed automatically into the dashboard.

Sections of note

• Prospective analytic cohort study; 603 patients referred, of whom 363 were eligible for rhinoplasty.
• Instruments were the NOSE scale, the Utrecht Questionnaire and visual analog scales.
• Scores were exported to a customized web based dashboard called the rhinoplasty health care monitor.
• The monitor analyses functional and aesthetic outcomes automatically with real time graphic output.
• Mean NOSE score fell from 66.6 plus or minus 23.5 to 23.2 plus or minus 24.0 at one year, P less than 0.001.
• Mean Utrecht Questionnaire score fell from 12.2 plus or minus 6.3 to 7.1 plus or minus 3.9, P less than 0.001.
• The authors state the dashboard helps the surgeon analyse results, identify learning needs and detect trends in performance.

What it means for a patient

• Both breathing and appearance scores improved substantially at one year.
• Only 363 of 603 referred patients were considered eligible for surgery, so selection was a substantial part of the process.
• This is one surgeon's practice with no comparison group, so the scores reflect that surgeon rather than rhinoplasty generally.
• The wide standard deviation on the postoperative NOSE score indicates results varied considerably between patients.

Why this paper matters

Individual surgeon performance in rhinoplasty is rarely measured systematically, and outcome data usually appears only in retrospective publications. This describes a continuous, automated method for tracking it. Whether monitoring changes a surgeon's results has not been demonstrated.

Terms

• NOSE scale: the Nasal Obstruction Symptom Evaluation, where higher scores mean worse breathing.
• Utrecht Questionnaire: a validated questionnaire on satisfaction with nasal appearance.
• Visual analog scale: a rating along a line, used here for self assessment.
• Prospective cohort: a group followed forward in time from enrollment.
• Dashboard: a screen displaying tracked data updated automatically.