Level of evidence in plastic surgery research

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.

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.

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.

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.