初次鼻整形术后患者报告的美学满意度与鼻功能：一项回顾性观察研究

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中文摘要

背景： 患者报告结局是鼻整形评估的核心，但来自库尔德和中东人群的证据仍然有限。本研究评估了初次鼻整形术后回顾性报告的鼻部满意度、患者感知功能、参与者报告的术后并发症，以及与所报告的1年结局的探索性关联。
方法： 这项基于问卷的回顾性观察研究纳入了400例至少在12个月前接受过初次鼻整形的患者。在一次调查中，参与者使用1-10视觉模拟量表（VAS）回顾性评价其鼻部，涉及三个参照时期：手术前、手术时和手术后1年。条目式问题评估了外观、呼吸、自信、他人评论以及再次接受鼻整形的意愿。并发症状态来源于单个参与者报告字段，该字段允许一个主要回答，且未经临床裁定。三个回忆VAS评分之间的差异采用广义估计方程并以患者为聚类进行分析。一个扩展多变量线性回归模型对回忆的1年VAS评分进行建模，一项探索性logistic回归检验了不愿重复手术的情况。
结果： 样本以女性为主（298/400，74.5%），平均年龄为24.64 ± 5.40岁。回顾性报告的平均VAS评分在手术前为4.84 ± 2.55，手术时为7.05 ± 2.20，1年时为7.65 ± 2.33。与回忆的术前评分相比，手术时的校正平均差异为2.21分（95% CI 1.92至2.51），1年时为2.81分（95% CI 2.49至3.12）（两者Holm校正后p < 0.001）。在1年时，333例患者（83.2%）的总体结局为良好至优秀，302例（75.5%）报告呼吸轻松，74例（18.5%）明确愿意再次接受鼻整形。160例患者（40.0%）记录了主要参与者报告的术后并发症。在扩展模型（n = 399）中，年龄、回忆的术前VAS、教育程度和参与者报告的并发症状态与回忆的1年VAS相关；该模型解释了26.0%的结局方差（校正R² = 0.211）。在探索性分析中，参与者报告的并发症状态与未明确愿意重复手术的校正比值更高相关（OR = 2.15，95% CI 1.18至3.93）。
结论： 参与者对手术时和1年时的状态评价优于回忆的术前状态。由于所有三个评分均是在一次调查中回顾性获得的，因此不应将其解释为前瞻性观察到的变化。在单一类别、未经裁定的参与者报告并发症测量的局限性内，并发症状态与较低的回忆1年满意度和未明确愿意再次接受该手术的更高比值相关。这些关联为探索性，不应作因果解释。

英文摘要

BACKGROUND: Patient-reported outcomes are central to rhinoplasty evaluation, but evidence from Kurdish and Middle Eastern populations remains limited. This study evaluated retrospectively reported nasal satisfaction, patient-perceived function, participant-reported postoperative complications, and exploratory associations with the reported 1-year outcome after primary rhinoplasty.
METHODS: This retrospective questionnaire-based observational study included 400 patients who had undergone primary rhinoplasty at least 12 months earlier. During one survey, participants retrospectively rated their nose on a 1-10 visual analogue scale (VAS) for three reference periods: before surgery, at the time of surgery, and 1 year after surgery. Item-level questions assessed appearance, breathing, confidence, comments from others, and willingness to undergo rhinoplasty again. Complication status was derived from a single participant-reported field permitting one primary response and was not clinically adjudicated. Differences among the three recalled VAS ratings were analyzed using generalized estimating equations with patient clustering. An expanded multivariable linear regression modeled the recalled 1-year VAS score, and an exploratory logistic regression examined unwillingness to repeat surgery.
RESULTS: The sample was predominantly female (298/400, 74.5%), with a mean age of 24.64 ± 5.40 years. Mean retrospectively reported VAS ratings were 4.84 ± 2.55 before surgery, 7.05 ± 2.20 at the time of surgery, and 7.65 ± 2.33 at 1 year. Compared with the recalled preoperative rating, adjusted mean differences were 2.21 points (95% CI 1.92 to 2.51) at the time of surgery and 2.81 points (95% CI 2.49 to 3.12) at 1 year (both Holm-adjusted p < 0.001). At 1 year, 333 patients (83.2%) had a good-to-excellent global outcome, 302 (75.5%) reported easy breathing, and 74 (18.5%) were definitely willing to undergo rhinoplasty again. A primary participant-reported postoperative complication was recorded by 160 patients (40.0%). In the expanded model (n = 399), age, recalled preoperative VAS, education, and participant-reported complication status were associated with the recalled 1-year VAS; the model explained 26.0% of outcome variance (adjusted R² = 0.211). In exploratory analysis, participant-reported complication status was associated with greater adjusted odds of not being definitely willing to repeat surgery (OR = 2.15, 95% CI 1.18 to 3.93).
CONCLUSIONS: Participants rated the surgical and 1-year states more favorably than the recalled preoperative state. Because all three ratings were obtained retrospectively in one survey, they should not be interpreted as prospectively observed change. Within the limitations of a single-category, non-adjudicated participant-reported complication measure, complication status was associated with lower recalled 1-year satisfaction and greater odds of not being definitely willing to undergo the procedure again. These associations are exploratory and should not be interpreted causally.