Abstract
Social determinants of health have been widely studied throughout medicine; however,
their role relating to functional rhinoplasty has not been previously evaluated. The
records of 178 patients who underwent functional rhinoplasty in a single health network
from 2013 to 2016 were reviewed. The Nasal Obstruction Symptom Evaluation (NOSE) score
was used to assess patient-reported symptoms, and patients with both preoperative
and postoperative NOSE scores were included in this study. Basic demographics and
surgical techniques were also collected. Differences between NOSE scores and surgical
approaches to functional rhinoplasty on the basis of insurance type were measured.
One hundred and sixteen patients were included for analysis, the mean age was 34.7
years (standard deviation [SD] = 16.2) and 57 (49.1%) were female. Twenty-one (18.1%)
patients had public insurance and, of these, 18 patients had Medicaid. Patients (mean,
SD) with Medicaid insurance (56.39, 15.6) had a slightly greater improvement in NOSE
scores compared with patients with non-Medicaid insurance (47.90, 25.6) (p = 0.067). There was no statistically significant difference in preoperative NOSE
scores or postoperative improvement in NOSE scores between patients with different
health insurance. Furthermore, there was no statistically significant difference in
surgical approaches. The majority of patients receiving functional rhinoplasty had
private insurance. Medicaid patients trended toward a greater NOSE score improvement
after functional rhinoplasty, but also had a closer association with a history of
nasal trauma and prior surgery. Future study is needed to better understand the association
between socioeconomic status and disparities in care. Understanding how social determinants
of health affect patients may reveal potential inherent biases, improve delivery of
care, and translate to better patient outcomes.
Keywords
rhinoplasty - social determinants of health - functional rhinoplasty - NOSE score
- NOSE
