The Need for Higher Levels of Evidence in Plastic Surgery

Evidence-based medicine in plastic surgery is essential to provide optimal care to individual patients. Level of evidence (LOE) and number of citations are metrics used to gauge quality of research and impact within a field, respectively. The objective of this study was to determine an association between LOE and number of citations within recently published articles in Plastic and Reconstructive Surgery (PRS).

A review of original research articles published in PRS from January 2018 to June 2022 was performed. LOE was identified through the PRS website, and the number of citations identified via PubMed. Articles were further divided into sections of their corresponding topic.

A total of 965 articles were reviewed, of which 21 (2.2%) were articles assigned level I evidence. There were 147 (15.2%) level II articles, 360 (37.3%) level III articles, 377 (39.1%) level IV articles, and 60 (6.2%) level V articles. The average number of citations per article was 2.72, and the average LOE of all included articles was 3.31. Level I articles had an average of 4.95 citations, whereas level II, III, IV, and V articles had averages of 2.95, 2.54, 2.64, and 2.71, respectively. Breast articles were cited on average 3.85 times each, more than any other type of article.

Our data show that articles assigned level I evidence in PRS trend toward higher numbers of citations compared with articles assigned lower LOEs. These findings should encourage investigators to publish high-quality research to advance the field of plastic surgery.