Purpose: The purpose of this study is to assess the achievements of outcomes studies in plastic surgery since the initiation of the 1988 outcomes movement and to identify future directions.
Methods: A systematic review of health outcomes research in plastic surgery was conducted. Studies were extracted from Plastic and Reconstructive Surgery and Annals of Plastic Surgery from 1988 - 2004, yielding 3520 articles. Studies were analyzed with respect to area of interest, study design, endpoint of results, and level of impact on health outcomes, which is rated on a scale from one to four using a revised version of the Agency for Healthcare Research and Quality’s outcomes impact scale. A level four study demonstrates the greatest direct impact on patient outcomes.
Results: 79% of studies had level one impact, while 20% of studies had level four impact. Breast surgery was most represented, comprising 31% of studies. Morbidity and quality-of-life data were the most frequent endpoints, cited in 53% and 28% of studies respectively. Economic data were the least frequently cited endpoint, represented in only 8% of studies.
Conclusions: The majority of studies in this review had a level one impact, signifying that most outcomes studies in plastic surgery do not show a direct policy impact in patient outcomes. However, these studies are important in confirming the effectiveness of interventions already in clinical practice or raising new research questions. With cost being a large factor in public policy, there is need for more economic analysis research in plastic surgery outcomes studies.