Incidence of Postoperative Adverse Events after Rhinoplasty: A Systematic Review

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 form. 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 preoperative 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 the International Prospective Register of Systematic Reviews (PROSPERO) database (registration no. CRD42018081826) in April of 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 3215 publications for title and abstract screening. Three hundred twenty-two were eligible for full-text review. Thirty-six met final inclusion criteria. A total of 13 adverse events were reported among these studies and included need for revision (0 to 10.9 percent), infection (0 to 4 percent), dehiscence (0 to 5 percent), bleeding (0 to 4.1 percent), septal perforation (0 to 2.6 percent), nasal airway obstruction requiring revision (0 to 3 percent), and hypertrophic scarring (0 to 1.5 percent). Conclusions: This systematic review presents the first comprehensive and quantitative reporting of adverse event frequency after rhinoplasty. This is a crucial tool for preoperative 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.