How “Low-Level” Evidence Has Changed Plastic Surgery

Momeni, Arash; Wan, Derrick C.

doi:10.1097/sap.0000000000000596

Cited by 8 publications

(8 citation statements)

References 37 publications

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“…The creative nature of plastic surgery is reflected by the fact that advances in the specialty have commonly originated from the contributions of individual surgeons who have reported their innovations via “low-level evidence” studies, such as retrospective case reports and case series. 16 , 17 Although the importance of low-level evidence is beyond dispute, plastic surgeons have recognized that the rigorous, data-driven approaches that have been adopted in other fields of medicine are important for improving decision-making and, ultimately, ascertaining “the best course of care for a patient.” 6 , 18 As such, multiple efforts have been made in recent years to increase awareness of evidence-based plastic surgery as well as increase the overall level of evidence of studies in the plastic surgery literature. In particular, the Colorado Springs EBM Summit in 2010 convened leaders in plastic surgery with experts in EBM, representing a sea change in the emphasis on EBM in the specialty.…”

Section: Discussionmentioning

confidence: 99%

AAPS Podium Presentations—Has the Level of Evidence Changed over the Past Decade?

Chattopadhyay¹,

Wan²,

Momeni³

2021

Plastic and Reconstructive Surgery - Global Open

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Background: An increase in the number and quality of randomized controlled trials (RCTs) and trends toward higher levels of evidence (LOE) in the plastic surgery literature has been reported; however, there has not been a specific focus on the LOE of presentations at scientific meetings. The purpose of this study was to ascertain trends in the LOE of studies presented at the annual meeting of the American Association of Plastic Surgeons. Methods: A hand search was conducted identifying all abstracts of podium presentations from 2009 to 2019. LOE, using American Society of Plastic Surgeons guidelines, were ascribed to each presentation, along with identification of any corresponding journal publications. RCTs were further analyzed using the 12-item Modified Consolidated Standard of Reporting Trials checklist. Results: Four hundred forty-one studies with a median LOE of 3 were included in the study. A non-significant improvement in the mean level of evidence was noted over time ( P = 0.09) along with an increase in the number of level 2 studies ( P = 0.589) and RCTs ( P = 0.717). Level 1 studies were rare (0.91%) and of fair quality (median checklist score 8 out of 12). Seventy-two percent of abstracts resulted in publication, and the mean lag time to publication was 422 days. Conclusions: A favorable trend is observed with respect to the mean LOE as well as the number of level 2 studies and RCTs over time. The importance of research meeting attendance to maintain up-to-date information is noteworthy, given the long lag time from presentation to publication.

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Section: Discussionmentioning

confidence: 99%

AAPS Podium Presentations—Has the Level of Evidence Changed over the Past Decade?

Chattopadhyay¹,

Wan²,

Momeni³

2021

Plastic and Reconstructive Surgery - Global Open

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“…Evidence-Based Medicine (EBM) uses an interdisciplinary approach with the most current research in the field to determine the best care for each patient and establish guidelines for treatment. 7 The Level of Evidence Pyramid (hierarchy of evidence) is assigned to studies based on the quality of methodology, study design, validity and application to patient care, and…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…Evidence-based medicine (EBM) uses an interdisciplinary approach with the most current research in the field to determine the best care for each patient and establish guidelines for treatment. 7 The Level of Evidence Pyramid (hierarchy of evidence) is assigned to studies based on the quality of methodology, study design, validity, and application to patient care, and gives each study a grade on the strength of the study conclusions and recommendations. 8 In addition, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system has been used to assess the strength of recommendations for articles that address clinical practice guidelines and management options.…”

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confidence: 99%

“…9 The increased utilization of EBM in the field of plastic surgery had led to an improvement of the quality of published studies. 7 However, there is a paucity of literature that reviews the latest research and the microsurgical treatment options for lymphedema. The purpose of this study is to analyze the most cited literature for the micro-surgical treatment of lymphedema and determine its associated level of evidence.…”

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confidence: 99%

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The Top 100 Cited Articles in the Microsurgical Treatment for Lymphedema

Cordero

Eidelson

Frediani

et al. 2022

J Reconstr Microsurg

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Background: Evidence-based medicine uses the current best evidence for decisions about patient care. Lymphedema is a chronic debilitating medical condition caused by a dysfunctional lymphatic system. This study analyzes the most cited articles, including the levels of evidence, for the surgical treatment of lymphedema. Methods: The Web of Science Sci-Expanded Index was utilized to search for surgical treatment of lymphedema. Articles were examined by three independent reviewers and the top 100 articles were determined. The corresponding author, citation count, publication year, topic, study design, level of evidence, journal, country, and institution were analyzed. Results: Since 1970, the top 100 articles have been cited 7,300 times. The average citation count was 68 and standard deviation was 55. The majority were case series (71), followed by retrospective cohort (8), prospective cohort (7), retrospective case-control (5), and randomized controlled trials (2). Based on the “Level of Evidence Pyramid”, 71 articles were level IV, 13 articles were level III, and 9 articles were level II. On the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Scale, there were 71 articles with “very low,” 20 articles with “low,” and 2 articles with “moderate” quality of evidence. Conclusion: The top 100 cited articles were mostly case series and lacked high levels of evidence. Most studies are retrospective case series with short-term outcomes. However, low level evidence for new surgical procedures is to be expected. Current trends suggest the treatment and understanding of lymphedema will continue to improve.

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“…7 Not every question can be answered by high LOE investigations 7 and most of plastic surgery's landmark papers would be considered "low LOE" case series and expert opinions. 8,9 This is explained in part by the high costs of surgical interventions, difficulties in enrolling surgical patients in a placebo control, and the subjective nature of outcomes. It is hard to justify randomizing patients to an investigative arm when a surgeon has had positive experiences with the control group technique.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Senior Author Profile on Publication Level of Evidence in Plastic and Reconstructive Surgery

Blum¹,

Kota²,

Villavisanis³

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: Plastic and Reconstructive Surgery (PRS) incorporated the level of evidence (LOE) pyramid in 2011 to highlight evidence-based medicine in plastic surgery. This study aimed to assess the relationship between the profile of senior authors publishing in PRS and the LOE of publications. Methods: All accepted publications by American senior authors to PRS between January 2018 and March 2020 were classified by LOE. Demographic, educational, and career data on all senior authors were collected using publicly available online resources. Results: A total of 1030 articles were screened‚ of which 266 (25.8%) were eligible for LOE classification with the following distribution: I, 0.8%; II, 14.3%; III, 45.1%; IV, 33.1%; and V, 7.1%. Senior author demographic factors, including gender and race/ethnicity, did not significantly impact LOE (P > 0.05 for all). An advanced degree was associated with more publications per year, and only a PhD (P = 0.022) and board certification (P = 0.012) were associated with a higher LOE of publications (P = 0.022). Physicians working in an academic setting were significantly more likely to publish level III evidence than their private/community-based counterparts (P = 0.006). Breast papers constituted the highest proportion of level III evidence (41.4%; P < 0.001). Conclusions: Most publications in PRS contain level III-IV evidence. Senior author gender, race, and ethnicity did not impact LOE of publications. Plastic surgery board certification, possession of a PhD, and academic practice setting were associated with higher LOE of publications.

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How “Low-Level” Evidence Has Changed Plastic Surgery

Cited by 8 publications

References 37 publications

AAPS Podium Presentations—Has the Level of Evidence Changed over the Past Decade?

AAPS Podium Presentations—Has the Level of Evidence Changed over the Past Decade?

The Top 100 Cited Articles in the Microsurgical Treatment for Lymphedema

The Impact of Senior Author Profile on Publication Level of Evidence in Plastic and Reconstructive Surgery

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