Incidence of Post-Operative Adverse Events After Rhinoplasty: A Systematic Review.

Sharif-Askary, Banafsheh; Carlson, Anna R; Van Noord, Megan G; Marcus, Jeffrey R

BACKGROUND Adverse events after rhinoplasty vary in etiology and severity, a fact that is reflected in the current American Society of Plastic Surgeons Rhinoplasty Consent. However, there is currently no literature providing a comprehensive summation of evidence-based quantifiable risk of adverse events after rhinoplasty. Given this limitation, patients considering rhinoplasty are unable to fully ascertain pre-operative risk, and the ability of physicians to obtain true informed consent is similarly flawed. This systematic review provides the first rigorous, comprehensive and quantitative reporting of 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 included primary functional, aesthetic, and combined functional/aesthetic rhinoplasty. The following data were extracted: Study size, population characteristics, indication, 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 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 systematic review presents the first comprehensive and quantitative reporting of adverse event frequency after rhinoplasty. This is a crucial tool for pre-operative patient counseling and an essential adjunct in the acquisition of informed consent. Future investigations will benefit from transparency and standardization of reporting to further quantify adverse event rates.