Policy related to rhinoplasty in publicly funded elective surgery programs: a systematic review

Objectives  This systematic review set out to establish best practice in relation to policy for the inclusion/exclusion of rhinoplasty within public health systems. Inclusion criteria  The review considered any studies relating to rhinoplasty that addressed issues of inclusion/exclusion from public funded health systems including criteria for clinical need, contraindications, fit/ready for surgery, policy compliance and issues in relation to surgical training. Search strategy  The search strategy sought to find published and unpublished studies and papers limited to English. An initial search of Medline and CINAHL was undertaken, followed by an analysis of keywords contained in the title, abstract and index terms. A second comprehensive search was then undertaken using Medline, CINAHL, EMBASE, AUSTROM, Health Business, and FullTEXT Elite and PsycINFO. The search was restricted to the period 1995-2005. Methodological quality  Each paper was assessed by two independent reviewers for methodological quality before inclusion in the review using an appropriate critical appraisal instrument from the Joanna Briggs Institute System for the Unified Management and Assessment Review Instrument package. Results  A total of nine papers were included in the review. Owing to the diverse nature of these papers, meta-synthesis was only possible for three of the seven papers. For this reason, the rest of the results are presented in narrative form. The majority of the papers included in the review related to psychological indicators for surgery and the potential impact of surgery on quality of life. Conclusion  Where clinical indications for surgery are determined and documented following thorough diagnostic evaluation, rhinoplasty may be conducted.