The Rhinoplasty Health Care Monitor: An Update on the Practical and Clinical Benefits after 10 Years of Prospective Outcome Measurements

Overview

The authors built the Rhinoplasty Health Care Monitor, a streamlined protocol that collects patient reported outcomes from every rhinoplasty patient since 2014, analyses them automatically and displays them on a web dashboard. This paper reports both the accumulated results and the practical effects of running such a system on their care standards.

Sections of note

• Design: prospective outcome collection, 979 consecutive patients referred for functional or revision rhinoplasty from April 2014 to August 2023.
• 599 of 979 referred patients, 61.2 percent, were judged eligible for surgery.
• Instruments: the NOSE scale, the Utrecht Questionnaire and visual analog scales, collected before surgery and at 3 and 12 months.
• Mean NOSE sum score improved from 69.1 to 23.1 at one year, and functional visual analog scores rose from 4.1 on both sides to 7.5 left and 7.3 right, p less than 0.001.
• Mean Utrecht Questionnaire sum score improved from 12.0 to 6.8, and aesthetic visual analog score from 4.5 to 7.4, p less than 0.001.
• Reported benefits of the routine: better patient selection, data driven expectation management, patient empowerment, and critical appraisal of surgical performance.

What it means for a patient

• Nearly four in ten patients referred for functional rhinoplasty were not judged suitable for it, which is itself an outcome of systematic assessment.
• Blockage scores fell by about two thirds and both breathing and appearance ratings improved a year after surgery.
• Routine measurement lets a surgeon show a prospective patient what results their own practice actually achieves.
• Limits: single centre, no control group, functional and revision cases only, and outcomes measured entirely by questionnaire.

Why this paper matters

Rhinoplasty outcomes have historically been reported selectively by the operating surgeon. Collecting them on every patient by default removes that selection and produces a benchmark a practice can be held to. Whether routine monitoring changes surgical results, as opposed to measuring them, is not demonstrated.

Terms

• Patient-reported outcome: a result recorded by the patient rather than the clinician.
• NOSE scale: a questionnaire measuring nasal blockage, where higher means worse.
• Utrecht Questionnaire: a validated patient questionnaire for aesthetic rhinoplasty outcomes.
• Visual analog scale: a line on which a patient marks severity or quality.
• Value-based health care: judging and paying for care by measured outcomes rather than volume.
• Functional rhinoplasty: nose surgery performed mainly to improve breathing.