Jennifer C Fuller1, Patricia A Levesque1, Robin W Lindsay2. 1. Massachusetts Eye and Ear Infirmary, Boston2Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts. 2. Massachusetts Eye and Ear Infirmary, Boston3Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts.
Abstract
IMPORTANCE: Nasal airway obstruction is a common presenting complaint among patients in otolaryngology practices, and its treatment necessitates critical outcomes evaluation and cost-utility analysis. OBJECTIVE: To evaluate the utility and applicability of the EuroQol 5-Dimension (EQ5D) global health-related quality-of-life (HRQoL) questionnaire for the assessment of clinical outcomes in functional septorhinoplasty. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study at a university-based tertiary medical center of patients undergoing functional septorhinoplasty for treatment of nasal obstruction. INTERVENTIONS: Patient demographic characteristics, operative intervention, and preoperative and postoperative Nasal Obstruction Symptom Evaluation (NOSE) and EQ5D scores were collected and analyzed between November 2013 and June 2016. MAIN OUTCOMES AND MEASURES: Comparison of preoperative and postoperative EQ5D and NOSE scores at 2 and 6 or more months following surgery (long-term follow-up). RESULTS: A total of 135 patients (56.3% male; mean [SD] age, 36.8 [14.8] years) completed EQ5D and NOSE surveys preoperatively and postoperatively, with mean (SD) follow-up of 5.82 (4.1) months. Of these, 117 completed the 2-month survey and 64 completed their last survey at 6 or more months. Baseline NOSE and EQ5D visual analog scale (VAS) scores were moderately correlated (r = -0.37, P < .001) as were changes in NOSE and EQ5D VAS scores at long-term follow-up (r = -0.33, P = .007). Mean baseline NOSE score of 64.3 (95% CI, 60.5-68.2) decreased to 24.8 (95% CI, 18.8-30.9) at long-term follow-up (P < .001). The frequency of patients reporting problems in the EQ5D domains of pain/discomfort and usual activity decreased by more than half in the long-term follow-up group (30 [47%] vs 14 [22%] and 11 [17%] vs 4 [6%]; P = .002 and .02, respectively). The minimal clinically important difference of the EQ5D VAS score was calculated at 9.5. The EQ5D VAS scores had statistically and clinically significant improvement at long-term follow-up in patients with NOSE score improvements of 30 to 60 points (EQ5D VAS increased from mean [SD] of 72.3 [20] to 85.9 [10]; P < .001) and 65 to 100 points (EQ5D VAS increased from mean [SD] of 66.2 [25] to 82.0 [13]; P = .01). CONCLUSIONS AND RELEVANCE: The EQ5D, a global HRQoL instrument, was able to detect clinically significant improvement following functional septorhinoplasty for nasal obstruction. Nasal valve correction improved not only disease-specific quality of life but also global HRQoL. The ability to calculate health utility values from the EQ5D and its low response burden make it an attractive tool for septorhinoplasty outcomes research. LEVEL OF EVIDENCE: 4.
IMPORTANCE: Nasal airway obstruction is a common presenting complaint among patients in otolaryngology practices, and its treatment necessitates critical outcomes evaluation and cost-utility analysis. OBJECTIVE: To evaluate the utility and applicability of the EuroQol 5-Dimension (EQ5D) global health-related quality-of-life (HRQoL) questionnaire for the assessment of clinical outcomes in functional septorhinoplasty. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study at a university-based tertiary medical center of patients undergoing functional septorhinoplasty for treatment of nasal obstruction. INTERVENTIONS: Patient demographic characteristics, operative intervention, and preoperative and postoperative Nasal Obstruction Symptom Evaluation (NOSE) and EQ5D scores were collected and analyzed between November 2013 and June 2016. MAIN OUTCOMES AND MEASURES: Comparison of preoperative and postoperative EQ5D and NOSE scores at 2 and 6 or more months following surgery (long-term follow-up). RESULTS: A total of 135 patients (56.3% male; mean [SD] age, 36.8 [14.8] years) completed EQ5D and NOSE surveys preoperatively and postoperatively, with mean (SD) follow-up of 5.82 (4.1) months. Of these, 117 completed the 2-month survey and 64 completed their last survey at 6 or more months. Baseline NOSE and EQ5D visual analog scale (VAS) scores were moderately correlated (r = -0.37, P < .001) as were changes in NOSE and EQ5D VAS scores at long-term follow-up (r = -0.33, P = .007). Mean baseline NOSE score of 64.3 (95% CI, 60.5-68.2) decreased to 24.8 (95% CI, 18.8-30.9) at long-term follow-up (P < .001). The frequency of patients reporting problems in the EQ5D domains of pain/discomfort and usual activity decreased by more than half in the long-term follow-up group (30 [47%] vs 14 [22%] and 11 [17%] vs 4 [6%]; P = .002 and .02, respectively). The minimal clinically important difference of the EQ5D VAS score was calculated at 9.5. The EQ5D VAS scores had statistically and clinically significant improvement at long-term follow-up in patients with NOSE score improvements of 30 to 60 points (EQ5D VAS increased from mean [SD] of 72.3 [20] to 85.9 [10]; P < .001) and 65 to 100 points (EQ5D VAS increased from mean [SD] of 66.2 [25] to 82.0 [13]; P = .01). CONCLUSIONS AND RELEVANCE: The EQ5D, a global HRQoL instrument, was able to detect clinically significant improvement following functional septorhinoplasty for nasal obstruction. Nasal valve correction improved not only disease-specific quality of life but also global HRQoL. The ability to calculate health utility values from the EQ5D and its low response burden make it an attractive tool for septorhinoplasty outcomes research. LEVEL OF EVIDENCE: 4.
Authors: Ruth Masterson Creber; Arnaldo Dimagli; Cristiano Spadaccio; Annie Myers; Marco Moscarelli; Michelle Demetres; Matthew Little; Stephen Fremes; Mario Gaudino Journal: Eur Heart J Qual Care Clin Outcomes Date: 2022-05-05
Authors: Shekhar K Gadkaree; Jennifer C Fuller; Natalie S Justicz; Adeeb Derakhshan; Suresh Mohan; Phoebe K Yu; Robin W Lindsay Journal: JAMA Facial Plast Surg Date: 2019-09-01 Impact factor: 4.611
Authors: Shekhar K Gadkaree; Jennifer C Fuller; Natalie S Justicz; Rachel E Weitzman; Adeeb Derakhshan; Suresh Mohan; Robin W Lindsay Journal: JAMA Facial Plast Surg Date: 2019-09-01 Impact factor: 4.611
Authors: Cherian K Kandathil; Emily A Spataro; Katri Laimi; Sami P Moubayed; Sam P Most; Mikhail Saltychev Journal: JAMA Facial Plast Surg Date: 2018-07-01 Impact factor: 4.611
Authors: Richard Tjahjono; Raquel Alvarado; Larry Kalish; Raymond Sacks; Raewyn Campbell; George Marcells; Carolyn Orgain; Richard John Harvey Journal: JAMA Facial Plast Surg Date: 2019-03-01 Impact factor: 4.611
Authors: Nicholas B Abt; Olivia Quatela; Alyssa Heiser; Nate Jowett; Oren Tessler; Linda N Lee Journal: JAMA Facial Plast Surg Date: 2018-12-01 Impact factor: 4.611