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Introduction

Dear colleagues and friends,

In the era of “value based health care”, transparency about the effectiveness of commonly performed surgical ENT-procedures is becoming a common request. The goal of our septoplasty and rhinoplasty health care monitor is to facilitate prospective outcome measurements without interfering a busy daily practice. In depth statistical knowledge is not required.

In the absence of a global consensus on the value of objective measurements of nasal patency, we consider our patients as the most qualified persons to evaluate the quality of received health care. The health care monitor is fueled by validated, internationally accepted and disease-specific patient reported outcome instruments (PROMs) that quantify the burden of nasal obstruction and body perception in relation to nasal appearance and change herein following surgery.

Since 2014, this outcome routine is part of our rhinology care standards and while every day new patients are included in the dataset, the clinical value of health care monitoring is becoming more and more apparent. The limited effort that is needed to fill the database and monitor patient follow-up is heavily repaid by automated statistical analyses, presented on a web-based dashboard (the health care monitor).

We have written several papers about our experiences and now feel ready to share this principle for free, with every ENT-surgeon that is interested in prospective outcome evaluations. Important to mention is that we are not benchmarking, nor are we storing or using your data (unless written approval has been given for research purposes). Feel free to explore the dashboard, download a blank database for your own practice and contact us whenever you feel the need for additional clarifications by sending an email to: info@rhinoplasty.care

Mandatory requirements for proper database management and automated outcome analysis:

  1. You need IBM SPSS statistics version 25 or higher to manage your data.
  2. Download the blank database and do not modify or delete columns and value labels.
  3. Use a separate database for septoplasty, rhinoplasty or cleft-lip rhinoplasty.
  4. Fill each column with as much data as possible.
  5. When a patient is lost to follow-up, use the “no data” value label to discreet missing values.
  6. Try to avoid selection bias by including every referred patient.
  7. If you decide that a patient is not eligible for surgery, define the proper reason why.
  8. Upload your database to the dashboard (data will not be stored!!)
  9. If the dashboard shows error notifications, then you probably have entered a wrong value somewhere. Check the database accordingly.

Population characteristics

Non-surgical population: reasons why surgery was not performed

Input dataset (subset columns)

Outcome table

Numbers for patients with both preoperative (T1) and postoperative (T2/T3) scores

Mean NOSE scale sum score distribution: level of nasal obstruction before and after surgery

                        

Click on the bar to identify the patients.

Distribution of mean functional postoperative improvement according to VAS (left + right)/2

                        

Click on the bar to identify the patients.

Durability of functional results until 1 year following surgery

Outcome table

Numbers for patients with both preoperative (T1) and postoperative (T2/T3) scores

Utrecht Questionnaire sumscore distribution before and after surgery

                        

Click on the bar to identify the patients.

Distribution of mean aesthetic improvement according to VAS

                        

Click on the bar to identify the patients.

Durability of aesthetic results until 1 year following surgery

Surrogate functional learning curve: how patients annually evaluate benefits of care

Distribution of outcome data and number of patients for each year of surgery




A. How patients evaluate nasal airway patency one year after surgery (mean VAS improvement)

B1. How patients evaluate nasal obstruction one year after surgery (mean NOSE scale sum score)

B2. How patients evaluate nasal airway patency one year after surgery (mean VAS)

Publications about prospective rhinoplasty outcome evaluations


  1. van Zijl FVWJ, Mokkink LB, Haagsma JA, Datema FR. Evaluation of Measurement Properties of Patient-Reported Outcome Measures After Rhinoplasty: A Systematic Review. JAMA Facial Plast Surg. 2019;21:152-162. Pubmed link

  2. van Zijl FVWJ, Versnel S, Poel van der E, Baatenburg de Jong RJ, Datema FR. Use of Routine Prospective Functional and Aesthetic Patient Satisfaction Measurements in Secondary Cleft Lip Rhinoplasty. JAMA Facial Plast Surg. 2018;20:488-494. Pubmed link

  3. Datema FR, Zijl van FVWJ, Poel van der EF, Baatenburg de Jong RJ, Lohuis PJFM. Transparency in functional rhinoplasty: Benefits of Routine Prospective Outcome Measurements in a Tertiary Referral Center. Plast Reconstr Surg 2017; 140: 691-702. Pubmed link

  4. Van Zijl FVWJ, Timman R, Datema FR. Adaptation and validation of the Dutch version of the nasal obstruction symptom evaluation (NOSE) scale. Eur Arch Otorhinolaryngol. 2017;274:2469-2476. Pubmed link

  5. Lohuis PJFM, Datema FR. Patient Satisfaction in Caucasian and Mediterranean open rhinoplasty using the tongue-in-groove technique: prospective statistical analysis of change in subjective body image in relation to nasal appearance following aesthetic rhinoplasty. Laryngoscope. 2015;125:831-6. Pubmed link