Recently, at the Sixth Annual Rhinoplasty Society held in New York, I had the opportunity to present my research on a PDA-based Rhinoplasty operative database. It is my belief that the critical assessment of one's operative results is essential for determining future surgical success and this in turn is determined significantly by an accurate and easily queried database containing both text and graphic representation of the intraoperative maneuvers.
The goal of this project was to evaluate the performance of integrated, forms-based software and graphic recording tools that allow the surgeon to accurately, reliably and reproducibly record rhinoplasty surgical events. This essential data may then be transmitted to a pre-existing database either by modem or direct cable link for further manipulation.
Choice of EquipmentFor the purposes of this study, A Palm Vx was utilized to collect data immediately postoperatively of 15 patients undergoing rhinoplasty. The data was subsequently downloaded to a personal computer by either modem or cable link.
Initially, I was unable to locate a PDA database application that contained the large number of surgical text descriptors that also provided template standardized line drawn images that could be modified according to the patient specific procedure. Instead, I constructed my own, integrating a forms based database and image application to record rhinoplasty surgical maneuvers.
For a user-modifiable, fields-oriented database, I used Pendragon Forms 3.1(http://www.pendragon-software.com/index.html). Rhinoplasty requires that the user record over 80 specific surgical descriptors, and Pendragon Forms allowed this through an easily navigable database (I have also utilized Pendragon Forms to construct both a surgical billing form for my Otolaryngology-Head and Neck Surgical Practice and used the same software to generate a hand-held surgical database for surgical residents in training at The University of Illinois, Chicago College of Medicine where I am Clinical Assistant Professor. The latter project was presented at the Annual Meeting of The American Academy of Otolaryngology - Head and Neck Surgery in Washington, D.C., September, 2000).
The graphic portion of the database was provided by TealPaint 4.90 (http://www.tealpoint.com/software.htm). TealPaint is unique because it allows the physician user to specify image templates that may then be used to indicate which operative maneuvers were employed in each part of the procedure. These images are then added to the Pendragon text descriptors, thus completing the Rhinoplasty Operative Database.
Data Collection and AnalysisInitially, data was entered postoperatively on both the PDA and on paper to ensure all information was collected and recorded correctly. In a very short period of time however, the PDA replaced the paper record entirely as entering data through the use of check boxes and on screen diagrams soon proved reliable and much more time efficient.
Once populated with data, the Rhinoplasty Operative Database can be text queried for specific operative maneuvers using a number of commonly used desktop-based database applications (the Pendragon Forms and TealPaint integrated database was tested with three separate patient computer databases: Microsoft Excel; Microsoft Access and FileMaker Pro). The graphic representation of the operative maneuvers can also be retrospectively reviewed to discern the subtleties of the procedures employed.
The search capability also provides a distinct advantage over paper records as the speed with which information can be accessed is significantly reduced. Using the Rhinoplasty Operative Database, it is extremely simple to rapidly assemble a complete history of surgical maneuvers that have been performed on any given patient. Similarly, it allows the surgeon to search the database to find all those patients in whom certain grafting techniques, incisions and/or implants have been used.
Review of the information stored in the database provides an essential, critical evaluation of one's Rhinoplasty results, allowing the surgeon to learn from past successes and errors. This in turn contributes to the development of superior future results, improving the level of patient care.
SummaryThe above-described, user created, text and graphic operative events collection system for the Palm OS device provides a portable, reliable and easy to use method of rhinoplasty database building and retrieval. The system can be modified to include virtually any text-based or image descriptors utilized in rhinoplasty and these may then be integrated into common commercially available database management systems for the personal computer. Once stored on the personal computer, the information can be rapidly searched and reviewed to provide comprehensive patient histories and/or critical review or results to facilitate continued skill development.