“Spin” in Observational Studies in Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Systematic Review

Abstract

Breast reconstruction after mastectomy in breast cancer patients is known to provide significant improvements in psychological well-being. 1 Among various techniques available, the deep inferior epigastric perforator (DIEP) flap is considered to be the gold standard for autologous breast reconstruction. 2 Despite the clinical importance and high regard of the DIEP flap technique, most research studies in leading plastic surgery journals are nonrandomized and observational in nature. 3 Nonrandomized observational studies on DIEP flap breast reconstruction have shown high risk of bias in their methodology. 2 Nonrandomized observational studies are generally considered to be of lesser quality evidence compared with randomized controlled trials (RCT) and systematic reviews/meta-analyses of RCTs. Nonetheless, observational studies are commonplace in plastic surgery. The prevalence of observational research, in part, is due to being less resource intensive and easier to conduct. 4 Other Breast Original articleBackground: The deep inferior epigastric artery perforator (DIEP) flap is widely used in autologous breast reconstruction. However, the technique relies heavily on nonrandomized observational research, which has been found to have high risk of bias. "Spin" can be used to inappropriately present study findings to exaggerate benefits or minimize harms. The primary objective was to assess the prevalence of spin in nonrandomized observational studies on DIEP reconstruction. The secondary objectives were to determine the prevalence of each spin category and strategy. Methods: MEDLINE and Embase databases were searched from January 1, 2015, to November 15, 2022. Spin was assessed in abstracts and full-texts of included studies according to criteria proposed by Lazarus et al. Results: There were 77 studies included for review. The overall prevalence of spin was 87.0%. Studies used a median of two spin strategies (interquartile range: 1-3). The most common strategies identified were causal language or claims (n = 41/77, 53.2%), inadequate extrapolation to larger population, intervention, or outcome (n = 27/77, 35.1%), inadequate implication for clinical practice (n = 25/77, 32.5%), use of linguistic spin (n = 22/77, 28.6%), and no consideration of the limitations (n = 21/77, 27.3%). There were no significant associations between selected study characteristics and the presence of spin. Conclusions:The prevalence of spin is high in nonrandomized observational studies on DIEP reconstruction. Causal language or claims are the most common strategy. Investigators, reviewers, and readers should familiarize themselves with spin strategies to avoid misinterpretation of research in DIEP reconstruction.

‘Spin’ in urology non‐randomised studies comparing therapeutic interventions: a temporal analysis

“…Both studies identified a similar prevalence of spin strategies in their included studies (Lazarus et al 84%, Kim et al 85.7%). In terms of level of spin, Lazarus et al [7] found 67% of their included studies used moderate to high levels in their conclusions, while Kim et al [10] found 86.9%.…”

“…Of the 235 included studies, 81.3% contained spin, with 54.9% containing moderate or high levels of spin in their conclusions. To date, there are only two studies that have assessed spin in observational studies: the initial study by Lazarus et al [7] that defined the spin criteria for observational studies, and a recent study by Kim et al [10] assessing spin in observational studies about deep inferior epigastric perforator flap breast reconstruction. Both studies identified a similar prevalence of spin strategies in their included studies (Lazarus et al 84%, Kim et al 85.7%).…”

“…[7] found 67% of their included studies used moderate to high levels in their conclusions, while Kim et al. [10] found 86.9%.…”

“…[7] that defined the spin criteria for observational studies, and a recent study by Kim et al. [10] assessing spin in observational studies about deep inferior epigastric perforator flap breast reconstruction. Both studies identified a similar prevalence of spin strategies in their included studies (Lazarus et al.…”