Evidenzbasierte Forschung in der Plastischen und Ästhetischen Chirurgie: Querschnittsanalyse von Forschungsarbeiten im Zeitraum 2019–2021

Zusammenfassung

Hintergrund Im Fachgebiet der Plastischen und Ästhetischen Chirurgie wird jährlich kontinuierlich international publiziert. Die Publikationsleistung wird jedoch nicht regelmäßig auf das Evidenzlevel untersucht. In Anbetracht der starken Publikationsleistung ist die regelmäßige Beurteilung des Evidenzlevels der aktuellen Publikationsjahre sinnvoll und war Zielsetzung dieser Arbeit.

Material und Methoden Es erfolgte die Auswertung der Publikationen des Journals of Hand Surgery/JHS (European Volume Journal), des Journals Plastic and Reconstructive Surgery/PRS, sowie des Journals Handchirurgie, Mikrochirurgie und Plastische Chirurige/HaMiPla von Januar 2019 bis Dezember 2021. Hierbei wurden die Affiliation der Autoren, die Art der Publikation, die Anzahl der untersuchten Patienten sowie das Evidenzlevel mit bestehenden Interessenkonflikten analysiert.

ErgebnisseInsgesamt wurden 1341 Publikationen ausgewertet. Von diesen wurden 334 Originalarbeiten im JHS, 896 im PRS, sowie 111 im HaMiPla veröffentlicht. Der größte Anteil waren retrospektive Arbeiten (53,5%, n=718). Die weitere Verteilung ergab 18% (n=237) klinisch prospektive Arbeiten, 3,4% (n=47) randomisiert klinische Studien (RCT), 12,5% (n=168) experimentelle Arbeiten und 6,5% (n=88) anatomische Studien. Die Verteilung der Evidenzlevel aller untersuchten Studien ergab Stufe I: 1,6% (n=21), Stufe II: 8,7% (n=116), Stufe III: 20,3% (n=272), Stufe IV: 25,2% (n=338), Stufe V: 2,3% (n=31). Bei 42% (n=563) der Arbeiten gab es keine Angabe des Evidenzlevels. Die meisten Evidenzlevels I stammten zu 76,2% aus Unikliniken (n=16) (χ²-Test 0,619, > 0,05, 95%-Konfidenzintervall).

Schlussfolgerung Auch wenn RCTs für viele chirurgische Fragestellungen nicht geeignet sind, könnten gut konzipierte und durchgeführte Kohorten- oder Fallkontrollstudien die Evidenzlage verbessern. Viele der derzeitigen Studien sind eher retrospektive Arbeiten und haben keine Kontrollgruppe. Forscher auf dem Gebiet der Plastischen Chirurgie sollten in Erwägung ziehen, ein Kohorten- oder Fall-Kontroll-Design zu verwenden, wenn eine RCT nicht möglich ist.

Abstract

Background In the field of plastic and aesthetic surgery, continuous international publication is seen annually. However, the publication output is not regularly assessed for its level of evidence. In view of the strong publication activity, a regular assessment of the evidence level of the current publication years is reasonable and was the objective of this work.

Material and Methods We evaluated the Journal of Hand Surgery/JHS (European Volume Journal), the journal Plastic and Reconstructive Surgery/PRS and the journal Handchirurgie, Mikrochirurgie und Plastische Chirurige/HaMiPla from January 2019 to December 2021. The authors’ affiliation, the type of publication, the number of patients examined and the level of evidence with existing conflicts of interest were considered.

Results A total of 1341 publications were evaluated. Of these, 334 original papers were published in JHS, 896 in PRS, and 111 in HaMiPla. The largest share were retrospective papers (53.5%, n=718). The further distribution was as follows: 18% (n=237) clinical prospective papers, 3.4% (n=47) randomised clinical trials (RCT), 12.5% (n=168) experimental papers and 6.5% (n=88) anatomic studies. The distribution of evidence levels of all studies was as follows: Level I: 1.6% (n=21), Level II: 8.7% (n=116), Level III: 20.3% (n=272), Level IV: 25.2% (n=338), Level V: 2.3% (n=31). In 42% (n=563) of the papers, there was no indication of the level of evidence. Most level I evidence was from university hospitals (n=16) in 76.2% (χ²-test 0.619, >0.05, 95% confidence interval).

Conclusion Although RCTs are inappropriate for many surgical questions, well-designed and conducted cohort or case-control studies could improve the evidence base. Many of the current studies tend to be retrospective and do not have a control group. Researchers in the field of plastic surgery should consider using a cohort or case-control design when an RCT is not feasible.

Schlüsselwörter

Plastische Chirurgie - Ästhetische Chirurgie - Forschung - Evidenzbasierte Medizin - Grad der Evidenz - EBM

Key words

plastic surgery - aesthetic surgery - research - evidence-based medicine

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