American Association of Plastic Surgeons

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Incidence of Post-Operative Adverse Events After Rhinoplasty: A Systematic Review
Banafsheh Sharif-Askary, B.S.1, Anna R. Carlson, M.D.2, Jeffrey R. Marcus, M.D.2.
1Duke University School of Medicine, Durham, NC, USA, 2Duke University Medical Center, Durham, NC, USA.

Purpose: Adverse events after rhinoplasty vary widely in etiology and severity. The current American Society of Plastic Surgeons Rhinoplasty Consent lists a range of adverse events, however, current literature lacks a comprehensive summation of evidence-based quantifiable risk of specific adverse events. Given this limitation, patients considering rhinoplasty are not able to fully ascertain pre-operative risk, and the ability of physicians to obtain true informed consent is similarly limited. This systematic review aims to summarize the current literature describing adverse events after rhinoplasty.
Methods: This review was registered on PROSPERO (CRD42018081826) in April 2018. Eligible articles were published in peer-reviewed journals with available abstracts and full-text articles. Interventions of interest included primary functional, aesthetic, and combined functional/aesthetic rhinoplasty. The following data were extracted: Study size, population characteristics, indication for operation, surgical approach, concomitant procedures, and incidence of adverse events.
Results: A search yielded 3,215 publications for title and abstract screening. Two hundred and ninety-nine (299) were eligible for full-text review. Thirty-six met final inclusion criteria.  A total of 14 adverse events were reported among these studies, and included: need for revision, 0-10.9%; infection, 0-4%; dehiscence, 0-5%; bleeding, 0-4.1%; septal perforation, 0-2.6%; nasal airway obstruction requiring revision, 0-3%; hypertrophic scarring, 0-1.5%.
Conclusions: This comprehensive review provides the first quantitative consolidation of event frequency for adverse events after rhinoplasty. This will be a valuable tool for pre-operative patient counseling and acquisition of informed consent. Future investigations may benefit from transparency and standardization of reporting to further quantify adverse event rates.


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