The outcomes of outcome studies in plastic surgery: A systematic review of 17 years of plastic surgery research

BACKGROUND: The authors assessed the state of outcomes studies in plastic surgery since the initiation of the modern outcomes movement in 1988 and propose future research directions. METHODS: A systematic review of health outcomes research in plastic surgery was conducted. Studies were extracted from the journals Plastic and Reconstructive Surgery and Annals of Plastic Surgery from 1988 to 2004, yielding 3520 articles, 1670 of which did not meet the inclusion criteria; thus, 1850 articles were reviewed. Studies were analyzed with respect to topic of interest, category of outcome study, study design, endpoint of results, and level of impact on health outcomes, rated on a scale of 1 to 4 using a revised version of the Agency for Healthcare Research and Quality's outcomes impact scale. A level 4 study demonstrates the greatest direct impact on patient outcomes. RESULTS: Ninety percent of studies had a level 1 impact; 10 percent had a level 4 impact. Breast surgery was most represented, constituting 26 percent of studies. Morbidity and objective clinical outcomes were the most frequent endpoints, cited in 52 percent and 32 percent of studies, respectively. Economic analyses were the least frequently encountered outcome study category, represented in only 0.6 percent of studies. CONCLUSIONS: Most studies in this review had a level 1 impact, signifying that most outcomes studies in plastic surgery do not show a direct policy impact in patient outcomes. However, they are important in confirming the effectiveness of interventions already in clinical practice and raising new research questions. There is a need for more economic analysis research in plastic surgery outcomes studies. ©2007American Society of Plastic Surgeons.