Defining Our Terms: Are Postoperative Complications Adequately Defined in the Rhinoplasty Literature?

Oleck NC, Cason RW, Hernandez JA, Marcus JR, Phillips BT.

PubMed 36307563 Publisher (DOI)Free full text (PMC)

What this paper says

Reviewing 30 rhinoplasty studies, 63 percent failed to define a single complication they reported, making complication rates across studies effectively incomparable.

Overview

Rhinoplasty is among the commonest aesthetic operations yet its complication profile is described as ill defined and underreported. The study examined the quality of complication reporting in the literature and proposed a framework for future classification. Studies were drawn from a previously published 2019 systematic review and each was re-examined for which complications were reported and how they were defined.

Sections of note

Review of complication reporting across 30 included studies; level of evidence III.
Reported complications were analysed for occurrence rate, presence and location of a definition, whether the definition was subjective or objective, and whether a severity grading system was used.
Nineteen studies, 63 percent, failed to provide a definition for any complication they reported.
Eleven studies, 37 percent, provided at least one definition.
Eight studies included a grading or severity scale.
A specific complication was identified as a primary outcome in 15 cases.
Definitions were included for 11 of those 15, so complications named as primary outcomes were significantly more likely to be defined, P less than 0.01.
The authors state definitions, when present, are often subjective and rarely graded for severity.

What it means for a patient

Published complication rates for rhinoplasty cannot be compared between studies because the studies do not agree on what counts as a complication.
Where definitions exist they are often subjective, meaning they depend on the observer's judgment.
Almost no studies grade complications by severity, so a minor irregularity and a lost graft may be counted alike.
This affects any figure quoted from the literature about how risky rhinoplasty is.

Why this paper matters

Meaningful comparison of techniques depends on measuring complications the same way, and this study shows the field does not. It documents the extent of the problem across 30 studies. Until definitions are standardized, pooled complication rates remain unreliable.

Terms

Postoperative complication: an unwanted outcome following surgery.
Complication definition: a stated rule for what counts as that complication.
Severity grading system: a scale ranking complications by how serious they are.
Primary outcome: the main result a study is designed to measure.
Systematic review: a structured search and appraisal of studies meeting set criteria.

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

Abstract

Background: Rhinoplasty is one of the most common aesthetic surgical procedures, and yet its postoperative complication profile remains somewhat ill-defined and underreported. The purpose of this study was to examine the quality of complication reporting in the rhinoplasty literature and provide a framework for future complication classification.

Methods: Studies were identified from a previously published 2019 systematic review conducted at Duke University Medical Center. Each included study was again reviewed to determine the reported complications and definitions. Reported complications were analyzed to determine occurrence rate, definition presence/absence, definition location, subjectivity/objectivity, and presence of severity grading system.

Results: A total of 30 studies were included. Overall, 63% (n = 19) of studies failed to provide a single definition for any reported complications. The remaining 11 studies (37%) provided at least one definition for their reported complications. Grading/severity scales were included by 8 studies. A specific complication was identified as a "primary outcome" in 15 cases. Definitions were included for 11 (73%) of these 15 complications. Complications denoted as "primary outcomes" were significantly more likely to have an included definition (p <0.01).

Conclusions: Postoperative complications following rhinoplasty are inadequately defined in the available literature, with over sixty percent of studies failing to define a single-reported complication. When complication definitions are included, they are often subjective in nature and rarely include a grading or severity scale. In the absence of standardized rhinoplasty complication definitions, comparing complication rates across studies is exceedingly difficult, and the ability to conduct high-quality meta-analyses is limited.

Level Of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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