(241) Which Septoplasty Patients Proceed to Rhinoplasty? A National Database Study.

Introduction: Endonasal septoplasty is commonly performed to treat nasal obstruction, though a subset of patients later undergo rhinoplasty for persistent functional or structural concerns. This study sought to identify patient-level factors associated with progression to rhinoplasty following septoplasty.

Methods: We performed a retrospective cohort analysis using the TriNetX Research Network, a federated, multi-institutional database of 170 healthcare organizations. Adult patients undergoing endonasal septoplasty (2009-2025) were identified and stratified into those who later underwent rhinoplasty and those who did not. Baseline demographic and clinical characteristics, including nasal structural, psychiatric, and sleep-related diagnoses present at the time of septoplasty, were compared between cohorts. Odds ratios were used to assess associations with subsequent rhinoplasty.

Results: Among 271,975 adult patients undergoing septoplasty, 4,010 (1.5%) subsequently underwent rhinoplasty with a mean follow-up of 3.1 years (SD 3.6 years). The strongest associations with subsequent rhinoplasty were structural diagnoses, including acquired nasal deformity (OR 37.8, 95% CI 29.9–47.9), prior nasal bone fracture (OR 6.50, 95% CI 5.81–7.27), and dentofacial anomalies (OR 2.69, 95% CI 2.43–2.98). Modest associations were observed for allergic/vasomotor rhinitis (OR 1.26, 95% CI 1.18–1.35), and sleep disorders (OR 1.47, 95% CI 1.37–1.57). Patients who later underwent rhinoplasty also had more headache (OR 1.85, 95% CI 1.69–2.03), chronic pain syndromes (OR 2.10, 95% CI 1.78–2.47), and psychiatric comorbidities including anxiety disorders (OR 2.07, 95% CI 1.96–2.18) and mood disorders (OR 2.07, 95% CI 1.96–2.19).

Conclusions: Although only a small proportion of septoplasty patients underwent subsequent rhinoplasty, the frequency of septoplasties being performed by otolaryngologists makes this subgroup clinically relevant. Recognition of nasal anatomic complexity (e.g prior trauma), and higher symptom burden may reduce the need for later revision procedures.