Our Summary

This research paper is about finding a way to measure the success of a type of nose surgery called septoplasty, which is done to fix nasal obstruction (a condition where the nose gets blocked). The success of the surgery was judged by the patients themselves, who rated their nasal obstruction on a scale of 0 (no obstruction) to 100 (complete obstruction) before and about 6 months after the surgery. The researchers used these ratings to calculate two measures of success: the ‘minimal clinically important difference’ (MCID) and the ‘desirable clinically important difference’ (DCID).

The MCID is the smallest change in the score that patients would consider an improvement. The DCID, on the other hand, is the score change that patients would consider a significant improvement. The study found that, even when there was a statistically significant improvement in the rating after surgery (meaning that the change was not due to chance), this did not always mean that patients felt their condition had improved.

The researchers suggest that a 15% improvement in a patient’s rating (corresponding to a MCID of 9.5) can be considered a ‘clinically important difference’, meaning that the patient feels their condition has improved. Similarly, a 45% improvement (a DCID of 28.5) can be considered a ‘desirable clinically important difference’, meaning that the patient feels their condition has significantly improved. These percentages were the same regardless of the patient’s age or gender.

In simple terms, this study helps doctors understand how much of an improvement patients need to feel after their surgery for it to be considered a success.

FAQs

  1. What is the minimal clinically important difference in a septoplasty procedure according to the study?
  2. How is the success of a septoplasty measured according to this study?
  3. What is the desirable clinically important difference in septoplasty as defined by the study?

Doctor’s Tip

A helpful tip a doctor might tell a patient about septoplasty is that while there may be a statistically significant improvement in nasal obstruction ratings following the procedure, what is most important is the clinical significance of that improvement. It is important to establish what constitutes a minimal clinically important difference and a desirable clinically important difference in order to determine the success of the surgery. In this case, a minimal clinically important difference of 15% improvement over baseline and a desirable clinically important difference of 45% improvement over baseline are suggested as relevant indicators of septoplasty success. It is important for patients to have realistic expectations and understand what level of improvement they can expect from the surgery.

Suitable For

Patients who are typically recommended septoplasty are those who experience chronic nasal obstruction that significantly impacts their quality of life. This study suggests that a minimal clinically important difference of 15.1% improvement in nasal obstruction ratings and a desirable clinically important difference of 45.2% improvement can be used as useful measures of septoplasty success. These values can help guide clinicians in determining which patients may benefit most from septoplasty surgery.

Timeline

Before Septoplasty:

  1. Patient experiences symptoms of nasal obstruction, difficulty breathing through the nose, and possibly recurrent sinus infections.
  2. Patient consults with an otolaryngologist (ENT) who recommends septoplasty after a physical examination and possibly imaging studies.
  3. Pre-operative assessments and tests are conducted to evaluate the patient’s overall health and suitability for surgery.
  4. Patient receives pre-operative instructions and discusses potential risks and benefits of the procedure with their surgeon.

After Septoplasty:

  1. Patient undergoes septoplasty surgery to correct a deviated septum, typically performed under general anesthesia.
  2. Patient may experience some discomfort, swelling, and congestion in the days following surgery.
  3. Follow-up appointments are scheduled to monitor healing and remove any nasal packing or splints.
  4. Patient gradually experiences improved nasal breathing and reduced symptoms of nasal obstruction.
  5. At around 5.5 months post-operatively, patient rates their nasal obstruction on a visual analogue scale and provides a global outcome rating.
  6. The minimal clinically important difference and desirable clinically important difference are calculated to determine the success of the septoplasty in improving nasal obstruction.
  7. Patient follows up with their surgeon as needed to assess long-term outcomes and address any concerns.

What to Ask Your Doctor

  1. What is the success rate of septoplasty in improving nasal obstruction?
  2. What are the potential risks and complications associated with septoplasty?
  3. How long is the recovery period after septoplasty?
  4. Will septoplasty improve my ability to breathe through my nose?
  5. What can I expect in terms of post-operative pain and discomfort?
  6. How long do the results of septoplasty typically last?
  7. Are there any lifestyle changes or restrictions I should follow after septoplasty?
  8. How soon after septoplasty can I resume normal activities, such as exercise or work?
  9. Will I need any follow-up appointments after the surgery?
  10. What are the alternative treatment options for nasal obstruction if septoplasty is not successful?

Reference

Authors: Haye R, Døsen LK, TarAngen M, Gay C, Pripp AH, Shiryaeva O. Journal: J Laryngol Otol. 2023 Nov;137(11):1285-1288. doi: 10.1017/S0022215123000993. Epub 2023 May 24. PMID: 37221875