by Kelsey Herbers
Out-of-pocket costs are associated with patient satisfaction after nasal breathing surgery, a new study by Vanderbilt University Medical Center researchers revealed.
The study, published in JAMA Open Network, surveyed more than 250 patients who underwent surgery for nasal obstruction both before and after their surgery to identify factors associated with their overall satisfaction.
The survey utilized patient-reported outcome measures (PROMs) to determine symptoms specific to nasal breathing, whether the patient felt the surgery was worth it and whether they’d recommend it to a friend. The questions were designed to gauge patient satisfaction components including patient-perceived outcome, global care satisfaction and financial factors to determine the value patients perceived from surgery.
Overall, patients were highly satisfied with their outcomes, rating an 87% satisfaction score.
The report found that patients who still had a fair amount of nasal obstructive symptoms after surgery had a lower satisfaction rate than those whose symptoms were mostly resolved. Interestingly, this was true regardless of the patient’s symptom score on the preoperative survey, suggesting that the final resolution of the symptoms carried more weight than the net change in symptoms.
Because nasal obstruction is a subjective patient complaint without reliable objective symptomatic measurements, evaluating surgical outcomes from a patient’s perspective using PROMs is critical for determining the surgery’s success, says Scott Stephan, MD, assistant professor of Otolaryngology-Head and Neck Surgery at VUMC.
“I can objectively examine or measure the volume of a nasal cavity and say that it is open, but if the patient doesn’t feel like air is easily going through their nose, then none of my objective measurements matter. If you don’t stop to look at patient-directed satisfaction outcomes and value, you’re making assumptions that what you did truly made a difference for them,” said Stephan.
“In medicine, I think we’ve been hesitant across all services to ask these customer service-related questions in a clinical setting because if the results aren’t what you anticipated, then that can make for a challenging doctor-patient interaction, particularly when the considerations involve cost, value and outcomes.”
Though data collection for the study ended in 2018, the department has continued the survey process to assess patient satisfaction and consider opportunities for improvement.
“We are working to include PROMs in every aspect of otolaryngology, even outside facial plastics,” said Ashley Nassiri, MD, MBA, chief resident in Otolaryngology. “There has been a notable uptake in the number of instruments developed and under development to measure patient-perceived satisfaction, which supports that we are moving in the right direction. Ideally, this will help guide doctors in medical and surgical decision making and aligning goals with their patients.”
The researchers believe that PROMs will continue to become increasingly important for all elective surgeries relying on subjective pre- and post-intervention symptoms.
“PROMs in the future will be a main component of the evaluation of surgical outcome. For operations that lack objective outcomes, such as a hearing test after ear surgery, asking the patient in simple terms if the operation was worth it or if they’d recommend it to a friend — when added to our other evaluation inventory — will help to guide us for future treatments,” said Roland Eavey, MD, Guy M. Maness Professor and chair of Otolaryngology-Head and Neck Surgery and director of the Vanderbilt Bill Wilkerson Center.
