From the Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center; and Research and Education Services, Duke University Medical Center Library.
Plast Reconstr Surg. 2020 Mar;145(3):669-684. doi: 10.1097/PRS.0000000000006561.
Adverse events after rhinoplasty vary in etiology and severity, a fact that is reflected in the current American Society of Plastic Surgeons rhinoplasty consent form. However, there is currently no literature providing a comprehensive summation of evidence-based quantifiable risk of adverse events after rhinoplasty. Given this limitation, patients considering rhinoplasty are unable to fully ascertain preoperative risk, and the ability of physicians to obtain true informed consent is similarly flawed. This systematic review provides the first rigorous, comprehensive, and quantitative reporting of adverse events after rhinoplasty.
This review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) database (registration no. CRD42018081826) in April of 2018. Eligible articles were published in peer-reviewed journals with available abstracts and full-text articles. Interventions included primary functional, aesthetic, and combined functional/aesthetic rhinoplasty. The following data were extracted: study size, population characteristics, indication, surgical approach, concomitant procedures, and incidence of adverse events.
A search yielded 3215 publications for title and abstract screening. Three hundred twenty-two were eligible for full-text review. Thirty-six met final inclusion criteria. A total of 13 adverse events were reported among these studies and included need for revision (0 to 10.9 percent), infection (0 to 4 percent), dehiscence (0 to 5 percent), bleeding (0 to 4.1 percent), septal perforation (0 to 2.6 percent), nasal airway obstruction requiring revision (0 to 3 percent), and hypertrophic scarring (0 to 1.5 percent).
This systematic review presents the first comprehensive and quantitative reporting of adverse event frequency after rhinoplasty. This is a crucial tool for preoperative patient counseling and an essential adjunct in the acquisition of informed consent. Future investigations will benefit from transparency and standardization of reporting to further quantify adverse event rates.
隆鼻术后的不良事件在病因和严重程度上存在差异，这一事实反映在当前美国整形外科学会的隆鼻术同意书中。然而，目前尚无文献提供全面总结隆鼻术后基于证据的可量化不良事件风险。鉴于这一局限性，考虑隆鼻术的患者无法充分确定术前风险，医生获得真正知情同意的能力同样存在缺陷。本系统评价首次对隆鼻术后不良事件进行了严格、全面和定量的报告。
本研究于 2018 年 4 月在国际前瞻性系统评价注册库（PROSPERO）数据库（注册号：CRD42018081826）进行了注册。合格的文章发表在同行评议的期刊上，具有摘要和全文文章。干预措施包括原发性功能、美容和联合功能/美容隆鼻术。提取的数据包括研究规模、人群特征、适应证、手术入路、伴随手术以及不良事件的发生率。
标题和摘要筛选共检索到 3215 篇文章。322 篇文章有资格进行全文审查。最终有 36 篇符合纳入标准。这些研究共报告了 13 种不良事件，包括需要修复（0 至 10.9%）、感染（0 至 4%）、裂开（0 至 5%）、出血（0 至 4.1%）、鼻中隔穿孔（0 至 2.6%）、需要修复的鼻气道阻塞（0 至 3%）和增生性瘢痕（0 至 1.5%）。
本系统评价首次全面、定量地报告了隆鼻术后不良事件的发生率。这是术前患者咨询的重要工具，也是获得知情同意的重要辅助手段。未来的研究将受益于报告的透明度和标准化，以进一步量化不良事件的发生率。
