Adherence to practice guidelines based on American Board of Plastic Surgery Maintenance of Certification data

The American Board of Plastic Surgery Maintenance of Certification program includes the submission of 10 consecutive cases in one of 20 tracer modules for Performance in Practice evaluation. This has resulted in a wealth of data on the practice patterns of Board diplomates. The specific aim of this project was to examine these data to determine whether diplomates are adhering to evidence-based practice guidelines.

The authors searched the Agency for Healthcare Research and Quality National Guideline Clearinghouse for guidelines. Once the guidelines were identified, the authors compared the recommendations with data entered by Board diplomates for the tracer modules in question. It is important to note that guidelines are recommendations based on the best available evidence and that all guidelines are subject to change, pending periodic reexamination of the evidence.

Diplomates are adhering to guidelines regarding age of cosmetic breast augmentation patients, use of prophylactic antibiotics and deep venous thrombosis prophylaxis in abdominoplasty patients, and use of carpal tunnel release in the treatment of carpal tunnel syndrome. Half the diplomates, however, are using splints following carpal tunnel release, despite recommendations to the contrary. In addition, only half the diplomates are following guidelines recommending mammography before breast augmentation. Furthermore, 90 percent of diplomates are not following recommendations against the use of deep venous thrombosis prophylaxis for patients with acute lower limb trauma.

This study revealed that there were few guidelines with which to compare diplomate performance. Steps should be taken to increase the number of evidence-based practice guidelines for plastic surgery procedures.