2017-18 HSC Section 4 Green Book

Reprinted by permission of JAMA Facial Plast Surg. 2016; 18(3):212-219.

Research

Original Investigation

Revision Rates and Risk Factors of 175 842 Patients Undergoing Septorhinoplasty

Emily Spataro, MD; Jay F. Piccirillo, MD; Dorina Kallogjeri, MD, MPH; Gregory H. Branham, MD; Shaun C. Desai, MD

Invited Commentary page 220

IMPORTANCE Estimates of the rate of revision septorhinoplasty and the risk factors associated with revision are unknown because the current published literature is limited to small, retrospective, single-surgeon studies with limited follow-up time.

Author Audio Interview at jamafacialplasticsurgery.com CME Quiz at jamanetworkcme.com and CME Questions page 236

OBJECTIVES To determine the rate of revision for septorhinoplasty surgery and to determine the risk factors associated with revision.

DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort analysis of 175 842 patients undergoing septorhinoplasty between January 1, 2005, and December 31, 2009, from the Healthcare Cost and Utilization Project’s State Inpatient Databases, State Ambulatory Surgery and Services Databases, and State Emergency Department Databases from California, Florida, and New York. Revisit information for these patients was then collected from the 3 databases between January 1, 2005, and December 31, 2012, with a minimal follow-up time of 3 years; and study analysis done January 1, 2005, to December 31, 2012. MAIN OUTCOMES AND MEASURES Revision surgery after an index septorhinoplasty was the main outcome measure, and the rate of revision was calculated within subgroups of patients based on different demographic and clinical characteristics. A multivariable model was then used to determine independent risk factors for the performance of revision surgery. RESULTS The study cohort comprised 175 842 participants who underwent septorhinoplasty procedures; mean (SD) age was 41.0 (15.3) years, and 57.0%were male. The overall revision rate for any septorhinoplasty procedure was 3.3% (5775 of 175 842) (99% CI, 3.2%-3.4%). After separating the patients into primary septorhinoplasty and secondary septorhinoplasty groups, the primary group had an overall revision rate of 3.1% (5389 of 172 324), while the secondary group had an overall revision rate of 11.0% (386 of 3518). Patient characteristics associated with an increased rate of revision include younger age (5.9% [633 of 10 727]), female sex (3.8% [2536 of 67 397]), a history of anxiety (3.9% [168 of 4350]) or autoimmune disease (4.4% [57 of 1286]), and surgery for cosmetic (7.9% [340 of 4289]) or congenital nasal deformities (8.9% [208 of 2334]). CONCLUSIONS AND RELEVANCE The study results, derived from a large cohort of patients with long follow-up time, suggest that the rate of revision septorhinoplasty is low, but certain patient characteristics are associated with higher revision rates. These data provide valuable preoperative counseling information for patients and physicians. This study also provides robust data for third-party payers or government agencies in an era in which physician performance metrics require valid risk adjustment before being used for reimbursement and quality initiatives.

Author Affiliations: Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, Missouri (Spataro, Piccirillo, Kallogjeri); Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, Missouri (Branham, Desai); currently with the Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, The Johns Hopkins University School of Medicine, Bethesda, Maryland (Desai). Corresponding Author: Shaun C. Desai, MD, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, The Johns Hopkins University School of Medicine,

LEVEL OF EVIDENCE 3.

JAMA Facial Plast Surg . 2016;18(3):212-219. doi: 10.1001/jamafacial.2015.2194 Published online March 10, 2016.

Bethesda, MD 20817 ( sdesai27@jhmi.edu ).

(Reprinted) jamafacialplasticsurgery.com

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