A Comprehensive Analysis of Outcomes and Complication Profiles for Primary and Revision Rhinoplasty
To evaluate patient outcomes and complications associated with primary and secondary cosmetic rhinoplasties using the Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database.
Methods/Technique
:This is a retrospective cohort review from 2003 to 2018 of the (TOPS) database, where Current Procedural Terminology (CPT) codes for primary and secondary rhinoplasties, autogenous grafts and indications were used to evaluate outcomes and complications (20910, 20912, 30400, 30410, 30420, 30430, 30435, 30450, 30460, 30462, 30465, 30520, 21230, 21235). The codes correspond to costochondral cartilage, nasal septum grafts, primary rhinoplasty (lateral and alar cartilages and/or elevation of nasal tip), complete primary rhinoplasty (external parts including bony pyramid), primary rhinoplasty including major septal repair, secondary rhinoplasty minor revision, secondary rhinoplasty intermediate revision, secondary major revision, osteotomies with repair of vestibular stenosis, repair of nasal vestibular stenosis, septoplasty or submucous resection, rib cartilage and auricular cartilage, respectively. The main comparison groups were divided into primary and secondary rhinoplasties. Categorical variables are described as frequencies and compared with Fisher’s exact or Pearson’s Chi-squared test. Continuous variables, based on normality test, are described as means (SD) or medians (IQR) and compared with Wilcoxon Rank-sum or Student’s T-test. A stepwise multivariate regression analysis was performed to assess the effect size of risk factors for adverse events, variables with p-value <0.1 were included in the model and alfa error was set at 0.05 for significance.
Results/Complications
:A total of 11,800 rhinoplasties were analyzed, median age was 30 years and 75.61% were female. We report 10,050 (85.2%) primary and 1,750 (14.83%) secondary or revision rhinoplasties. The secondary rhinoplasty group showed a higher rate of male gender (21.3% vs. 18.78%; p: 0.01), older age (35y vs. 31y; p:<0.001), higher rate of >3 procedures at same time of index case and lower rate of white race (61% vs. 64%; p: 0.03). Comparing perioperative factors, secondary rhinoplasties had higher rates of autogenous grafts (rib: 1.2% vs 0.33%; p:<0.001, septal: 1.83% vs 1.19%; p: 0.03, costochondral: 1.14% vs. 0.25%; p: <0.001, and auricular: 5.31% vs. 0.78%; p: <0.001), higher rate of septoplasty (13.14% vs. 7.5%; p: <0.001) and lower rate of vestibular stenosis (2.6% vs. 4.1%; p: 0.002). Type of anesthesia was similar between the groups. Overall complication rate was 1.78%; additionally, even though statistical significance was not reached, secondary rhinoplasties appear to have higher rates of overall complications in univariate analysis (2.1% vs 1.5%; p:0.07). Individual complication rates of seroma, hematoma, wound disruption, superficial surgical site infection (SSI), and return to OR were similar between the groups; however a trend towards higher deep SSI (0.17% vs 0.04%; p:0.07) and readmission (0.17% vs 0.05%; p:0.1) was seen without reaching significance (Table 1). On multivariate regression analysis, using rib graft (OR 2.65 95%CI 1.54-4.46; p:<0.001), performing >3 procedures at same time of index surgery (OR 1.5 95%CI 1.05-2.15; p:0.27) and obesity (OR 1.47 95%CI 1.11-1.94; p:0.007) show a higher likelihood for overall complications. For primary rhinoplasties, >3 surgeries at same time of index surgery (OR 1.7; p: 0.28) increases the likelihood for complications while auricular graft (OR: 0.28; p:0.32) and male gender (OR 0.42, p:0.001) appear to lower the probability. For secondary rhinoplasties, costochondral graft (OR 14.4, p: <0.001) and Asian race (OR 3.88, p: 0.003) increase the likelihood for a postoperative complication
Conclusion
:Results from this study show a prevalence of 1.8% complication rate in overall rhinoplasties. These complications are negatively impacted by performing more than 3 concurrent procedures at time of index surgery, using rib grafts and obesity. Looking into primary and secondary rhinoplasties, the use of auricular graft and male gender are protective factors while costochondral and Asian race increase the probability for postoperative complications.