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Health utility of rhinectomy, surgical nasal reconstruction, and prosthetic rehabilitation
Author(s) -
Faris Callum,
Heiser Alyssa,
Quatela Olivia,
Jackson Matthew,
Tessler Oren,
Jowett Nate,
Lee Linda N.
Publication year - 2020
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.28480
Subject(s) - medicine , rehabilitation , psychosocial , visual analogue scale , analysis of variance , surgery , physical therapy , psychiatry
Objectives Advanced nasal malignancies may require rhinectomy, which can have profound psychosocial impacts. Rhinectomy defects can be rehabilitated through surgery or prosthetics. We seek to understand the health utility of the rhinectomy defect, surgical, and prosthetic reconstruction, which have not been previously studied. Study Design Prospective clinical study Methods Adult naïve observers (n = 273) ranked the utility of five randomized health states (monocular blindness, binocular blindness, post‐rhinectomy nasal defect, postsurgical reconstruction, and post‐prosthetic rehabilitation). Health utilities were measured using visual analogue scale (VAS), standard gamble (SG), and time trade‐off (TTO). One‐way analysis of variance (ANOVA) with post hoc Scheffe's test and the independent samples T‐test for a priori comparisons were performed. Multiple linear regression was performed using participant demographics as independent predictors of utility scores. Results Health utilities (VAS, SG, TTO) were reported as follows (mean ± SD): monocular blindness (0.71 ± 0.21, 0.84 ± 0.20, 0.85 ± 0.19), binocular blindness (0.48 ± 0.25, 0.68 ± 0.28, 0.63 ± 0.28), post‐rhinectomy nasal defect (0.59 ± 0.24, 0.74 ± 0.24, 0.74 ± 0.24), postsurgical reconstruction (0.88 ± 0.16, 0.90 ± 0.18, 0.89 ± 0.13), and post‐prosthetic rehabilitation (0.67 ± 0.22, 0.80 ± 0.23, 0.82 ± 0.20). Both surgical reconstruction ( P < .001) and prosthetic rehabilitation ( P < .001) significantly improved health utility. SG and TTO utility scores were inversely associated with observer age ( P < .001) and participants who identified themselves as non‐Caucasians ( P < .05) in post‐rhinectomy nasal defect, post‐nasal surgical reconstruction, and post‐nasal prosthetic rehabilitation health states, while higher levels of education were directly associated with SG scores ( P < .05), respectively. Conclusion This is the first study to demonstrate the significant negative impact of the rhinectomy nasal defect on health utility. Rehabilitation by surgical or prosthetic techniques significantly increases health utility as rated by naïve observers. Laryngoscope , 130:1674–1679, 2020