Upload your Microsoft Excel or IBM SPSS file to start analyzing outcomes
Feel free to explore the dashboard, download a blank database for your own practice, and contact us if you need any further clarifications by sending an email to: info@rhinoplasty.care
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:
- You need Microsoft Excel or IBM SPSS statistics version 25 or higher to manage your data.
- Download the blank database and do not modify or delete columns and value labels.
- Use a separate database for septoplasty, rhinoplasty or cleft-lip rhinoplasty.
- Fill each column with as much data as possible.
- When a patient is lost to follow-up, use the “no data” value label to discreet missing values.
- Try to avoid selection bias by including every referred patient.
- If you decide that a patient is not eligible for surgery, define the proper reason why.
- If the dashboard shows error notifications, then you probably have entered a wrong value somewhere. Check the database accordingly.
Download blank Excel databases
Download blank SPSS databases
Health care monitor - User manual
Download English questionnaires
Download Nederlandse vragenlijsten
Population characteristics
Since 2014, all consecutive patients referred for functional nasal surgery are included in the health care monitor.
We monitor three different populations with separate databases (see downloads):
1. The septoplasty health care monitor (SHM)
2. The rhinoplasty health care monitor (RHM)
3. The secondary cleft lip rhinoplasty health care monitor (CRHM)
Following an upload of your specific database, the total number of consecutive patients is shown (baseline population), divided into a surgical population and non-surgical population. Basic demographic characteristics of the surgical population are shown (boxed).
Reasons why surgery was not performed (non-surgical population)
This overview outlines the reasons why patients were deemed ineligible for surgical treatment.
Notably, in our academic hospital, cosmetic surgery is not performed and patients are unable to pay out of pocket.
Functional outcome assessments | Table with NOSE scale and VAS scale
First, the table presents the mean NOSE scale scores for each of the five questions [range 0-20] and the mean sum score [range 0-100]. Higher scores indicate more severe symptoms of chronic nasal obstruction.
Second, the table displays the mean VAS scores to rate nasal airway patency on the left and right side [range 0-10]. Lower scores indicate more severe nasal obstruction.
Questionnaires were completed at three time points:
T1: before first consultation
T2: at 3 months post-surgery
T3: at 12 months post-surgery
Click on the button below the table to exclude patients that were lost to follow-up.
Functional outcome assessments | Bar charts with NOSE scale sum score distributions
Here bar charts are shown for each of the three time points:
T1: before surgery
T2: at 3 months post-surgery
T3: at 12 months post-surgery
Patients are categorized as having mild [range 5-25], moderate [range 30-50], severe [range 55-75], or extreme [range 80-100] nasal obstruction.
Click on each bar to identify the patients in that specific category, facilitating a targeted critical appraisal of their electronic patient file.
Functional outcome assessments | Average VAS scale change at 12 months post-surgery | VAS (left + right) /2
The distribution of average VAS score changes at 12 months post-surgery is graphically depicted. The mean improvement score is highlighted by a red vertical dashed line.
Patients further to the right of the curve reported a greater improvement in nasal obstruction, while those on the left side experienced an increase in nasal obstruction.
Click on each bar to identify the patients in that specific category, facilitating a targeted critical appraisal of their electronic patient file.
Functional outcome assessments | Durability of functional results according to the average VAS scale
Graphically depicted is the mean VAS score of the surgical population at three time points.
T1: before first consultation
T2: at 3 months post-surgery
T3: at 12 months post-surgery
Aesthetic outcome assessments | Table with Utrecht Questionnaire and VAS scale
First, the table presents the mean UQ scores for each of the five questions [range 1-5] and the mean sum score [range 5-25]. Higher scores indicate more severe concerns with body perception in relation to nasal appearance.
Second, the table displays the mean VAS score to rate nasal appearance [range 0-10]. Lower scores indicate more severe concerns.
Questionnaires were completed at three time points:
T1: before first consultation
T2: at 3 months post-surgery
T3: at 12 months post-surgery
Click on the button below the table to exclude patients that were lost to follow-up
Aesthetic outcome assessments | Bar charts with UQ sum score distributionsy
Here bar charts are shown for each of the three time points:
T1: before first consultation
T2: at 3 months post-surgery
T3: at 12 months post-surgery
Patients are categorized as having little [range 6 – 10], moderate [range 11 - 15], much [range 16-20], and very much [range 21-25] concerns about their body perception in relation to nasal appearance.
Click on each bar to identify the patients in that specific category, facilitating a targeted critical appraisal of their electronic patient file.
Aesthetic outcome assessments | Mean VAS scale change at 12 months post-surgery
The distribution of average VAS score changes at 12 months post-surgery is graphically depicted. The mean improvement score is highlighted by a red vertical dashed line.
Patients further to the right of the curve reported a greater improvement in nasal aesthetics, while those on the left side experienced a decrease.
Click on each bar to identify the patients in that specific category, facilitating a targeted critical appraisal of their electronic patient file.
Aesthetic outcome assessments | Durability of functional results according to the average VAS scale
Graphically depicted is the mean VAS score of the surgical population at three time points:
T1: before first consultation
T2: at 3 months post-surgery
T3: at 12 months post-surgery
Surrogate functional learning curve: how patients annually evaluate benefits of care
A. Distribution of outcome data and number of patients for each year of surgery
B. How patients evaluate nasal obstruction after surgery (mean NOSE scale sum score)
C1. How patients evaluate nasal airway patency at T1 and T3 of both sides (mean VAS)
C2. How patients evaluate nasal airway patency at T1 and T3 of the affected side (mean VAS)
Publications about prospective rhinoplasty outcome evaluations
- van Zijl FV, Declau F, Rizopoulos D, Datema FR. The Rhinoplasty Rosetta Stone: using Rasch analysis to create and validate crosswalks between the NOSE and SCHNOS functional subscale. Plast Reconstr Surg. 2024 Mar 29. doi: 10.1097/PRS.0000000000011438. PMID: 38551458. Pubmed link
- van Dam VS, van Zijl FVWJ, Kremer B, Datema FR. The Rhinoplasty Health Care Monitor: An Update on the Practical and Clinical Benefits after 10 Years of Prospective Outcome Measurements. Facial Plast Surg. 2024 Jan 10. doi: 10.1055/a-2218-7189. PMID: 38016662. Pubmed link
- van Dam VS, van Zijl FVWJ, Lohuis PJFM, Datema FR. Functional and Aesthetic Outcomes of Septal Reconstructions: Results of a Prospective Longitudinal Outcome Study. Facial Plast Surg. 2023 Feb 2. doi: 10.1055/a-1995-1692. PMID: 36481968. Pubmed link
- Maldonado-Chapa F, Datema FR, van Zijl FVWJ, Bran G, Flores-Torres OA, Stapleton-Garcia P, Filipović B, Lohuis PJFM. Clinical Benefits of the Utrecht Questionnaire for Aesthetic Outcome Assessment in Rhinoplasty: An Update. Facial Plast Surg. 2022 Dec 23. doi: 10.1055/a-1967-5943. Epub ahead of print. PMID: 36283415. Pubmed link
- van Zijl FVWJ, Lohuis PJFM, Datema FR. The Rhinoplasty Health Care Monitor: Using Validated Questionnaires and a Web-Based Outcome Dashboard to Evaluate Personal Surgical Performance. Facial Plast Surg Aesthet Med. 2021 Pubmed link
- van Zijl FVWJ, Perrett DI, Lohuis PJFM, Touw CE, Xiao D, Datema FR. The Value of Averageness in Aesthetic Rhinoplasty: Humans Like Average Noses. Aesthet Surg J. 2020 Nov 19;40(12):1280-1287. Pubmed link
- 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
- 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
- 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
- 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
- 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
- PhD thesis FVWJ van Zijl 2022: Outcome Based Rhinoplasty: towards data-driven decision-making in functional and aesthetic nasal surgery. Link