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Level of Evidence in Plastic Surgery Research

Sinno, Hani M.D.C.M., M.Eng.; Neel, Omar Fouda M.D.; Lutfy, Justyn B.Sc.; Bartlett, Gillian Ph.D.; Gilardino, Mirko M.D.C.M., M.Sc.

Plastic and Reconstructive Surgery: February 2011 - Volume 127 - Issue 2 - p 974-980
doi: 10.1097/PRS.0b013e318200af74
Special Topics: Special Topics

Background: There has been a recent shift toward evidence-based medicine in the medical and surgical literature. The objective of this study was to determine the level of evidence of published plastic surgery articles.

Methods: A review of the following four major plastic surgery journal publications was performed to determine the level of evidence utilized in the published studies: Plastic and Reconstructive Surgery (PRS), Annals of Plastic Surgery (Annals), Journal of Plastic, Reconstructive, and Aesthetic Surgery (JPRAS), and American Journal of Aesthetic Surgery (Aesthetic) from January 1 to December 31, 2007.

Results: Of the 1759 articles reviewed, 726 (41 percent) were included (animal studies, cadaver studies, basic science studies, review articles, instructional course lectures, and correspondence were excluded). The articles were ranked according to their level [level I (highest evidence, e.g., randomized-controlled trials) to level IV (lowest evidence, e.g., case reports)]. The average level of evidence in each journal was as follows: PRS, 3.05; Aesthetic, 3.11; JPRAS, 3.35; and Annals, 3.31. The evidence differed significantly between journals (p < 0.05), except when JPRAS was compared with the Aesthetic journal. Only 2.2 percent of articles were level I evidence.

Conclusions: The average level of evidence in four major plastic surgery journals was 3.2 (level III). In order for the plastic surgery profession to become a participant in higher-level evidence-based medicine, greater emphasis must be placed on prospective randomized blinded trials.

Montreal, Quebec, Canada

From the Division of Plastic and Reconstructive Surgery, Department of Surgery, the Faculty of Medicine, and the Research Division, Department of Family Medicine, McGill University.

Received for publication January 17, 2010; accepted May 27, 2010.

Presented at the 11th European Society of Plastic Reconstructive and Aesthetic Surgery, European Section of IPRAS Scientific Meeting, in Rhodes, Greece. September of 2009; the 78th Annual American Society of Plastic Surgeons, in Seattle, Washington, October of 2009; and 63rd Annual Meeting for the Canadian Society of Plastic Surgeons, in Kelowna, British Columbia, Canada, June of 2009.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Mirko Gilardino, M.D.C.M., M.Sc., Montreal Children's Hospital, Suite C1139, 2300 Tupper Street, Montreal, Quebec, Canada, H3H 1P3,

©2011American Society of Plastic Surgeons