鼻腔气道阻塞对健康的损害及鼻中隔成形术对健康效用值的改变。
Health Impairment From Nasal Airway Obstruction and Changes in Health Utility Values From Septorhinoplasty.
机构信息
Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia.
University of Sydney Medical School, Sydney, Australia.
出版信息
JAMA Facial Plast Surg. 2019 Mar 1;21(2):146-151. doi: 10.1001/jamafacial.2018.1368.
IMPORTANCE
The association of nasal airway obstruction with health is significant, and the health care resources utilized in open septorhinoplasty need to be included in health economic analyses.
OBJECTIVES
To describe the association of nasal airway obstruction and subsequent open septorhinoplasty with patient health.
DESIGN, SETTING, AND PARTICIPANTS: A prospective case series study was conducted from September 30, 2009, to October 29, 2015, at 2 tertiary rhinologic centers in Sydney, Australia, among 144 consecutive adult patients (age, ≥18 years) with nasal airway obstruction from septal and nasal valve disorders.
INTERVENTIONS
Open septorhinoplasty.
MAIN OUTCOMES AND MEASURES
Patients were assessed before undergoing open septorhinoplasty and then 6 months after the procedure. Health utility values (HUVs) were derived from the 36-Item Short Form Health Survey. Nasal obstruction severity was also measured using the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire and the Sino-Nasal Outcome Test 22 questionnaires.
RESULTS
A total of 144 patients (85 women and 59 men; mean [SD] age, 38 [13] years) were assessed. The baseline mean (SD) HUV for patients in this study was 0.72 (0.09), which was below the weighted mean (SD) Australian norm of 0.81 (0.22). After open septorhinoplasty, the mean (SD) HUV improved to 0.78 (0.12) (P < .001). Improvements in HUV were associated with changes in disease-specific patient-reported outcome measures, including Nasal Obstruction Symptom Evaluation scores (r = -0.48; P = .01) and Sino-Nasal Outcome Test 22 scores (r = -0.68; P = .01).
CONCLUSIONS AND RELEVANCE
Patients with nasal airway obstruction reported baseline HUVs that were lower than the Australian norm and similar to those in individuals with chronic diseases with significant health expenditure. There was a clinically and statistically significant improvement in HUVs after open septorhinoplasty that was associated with a reduction in Nasal Obstruction Symptom Evaluation and Sino-Nasal Outcome Test 22 scores. Outcomes from this study may be used for health economic analyses of the benefit associated with open septorhinoplasty.
LEVEL OF EVIDENCE
重要性
鼻气道阻塞与健康的关联非常重要，因此需要将接受鼻中隔成形术的患者的医疗资源利用情况纳入健康经济学分析中。
目的
描述鼻气道阻塞和随后的鼻中隔成形术与患者健康之间的关系。
设计、地点和参与者：这是一项前瞻性病例系列研究，于 2009 年 9 月 30 日至 2015 年 10 月 29 日在澳大利亚悉尼的 2 个三级鼻科中心进行，纳入了 144 例连续的鼻中隔和鼻阀疾病所致鼻气道阻塞的成年患者（年龄≥18 岁）。
干预措施
鼻中隔成形术。
主要结局和测量指标
患者在接受鼻中隔成形术前和术后 6 个月接受评估。健康效用值（HUV）源自 36 项简短健康调查。使用鼻腔阻塞症状评估量表（NOSE）和 22 项鼻-鼻窦结局测试量表评估鼻腔阻塞严重程度。
结果
共评估了 144 例患者（85 例女性和 59 例男性；平均[标准差]年龄 38[13]岁）。本研究中患者的基线平均（标准差）HUV 为 0.72（0.09），低于澳大利亚加权平均（标准差）标准值 0.81（0.22）。鼻中隔成形术后，HUV 平均（标准差）升高至 0.78（0.12）（P<.001）。HUV 的改善与疾病特异性患者报告结局测量指标的变化相关，包括鼻腔阻塞症状评估量表评分（r=-0.48；P=.01）和 22 项鼻-鼻窦结局测试量表评分（r=-0.68；P=.01）。
结论和相关性
鼻气道阻塞患者报告的 HUV 基线值低于澳大利亚标准值，与慢性疾病（具有重大健康支出）患者的 HUV 相似。鼻中隔成形术后 HUV 有显著的临床和统计学改善，与鼻腔阻塞症状评估量表和 22 项鼻-鼻窦结局测试量表评分降低相关。本研究的结果可用于鼻中隔成形术相关获益的健康经济学分析。
证据等级
4 级。
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