Retrospective Clinical Studies in Microsurgery – Has the Quality of Reporting Changed in the Last Two Decades?

Background: The bulk of published original articles in plastic surgery continue to represent low-level evidence. While the level of evidence is an important parameter during critical appraisal, quality of reporting is similarly relevant. Surprisingly, no objective analysis of the quality of reporting of the most common group of studies (i.e. evidence level 4) has been performed to date.

Methods: A hand search was conducted including all issues of Plastic and Reconstructive Surgery, British Journal of Plastic Surgery, Journal of Plastic Reconstructive and Aesthetic Surgery, Annals of Plastic Surgery and Microsurgery for the years 1992, 2002, and 2012. All evidence level 4 studies with a focus on microsurgical reconstruction were included for analysis. Parameters of interest included country affiliation of the first author, number of patients, and anatomic focus. In order to assess the quality of reporting a modification of an established quality assessment scale for retrospective clinical studies was used. This instrument generates a total possible score of 32, with a score of <11, 12-21, and 22-32 representing ‘poor’, ‘fair’, and ‘good’ quality of reporting, respectively.

Results: 223 studies were included for final analysis. A progressive increase in the number of published case series was noted over time (46, 73, and 104 in 1992, 2002, and 2012, respectively). Similarly, an increase in the median number of patients was seen over time (8 [range, 2 - 165], 11 [range, 2 - 660], and 16 [range, 2 - 819] patients in 1992, 2002, and 2012, respectively) (p=0.03). The majority of studies were conducted in Asia (85 studies [38.1 %]) and North America (68 studies [30.5 %]) and predominantly focused on head and neck (68 studies [30.5 %]) as well as lower extremity reconstruction (48 studies [21.5 %]). While the quality of reporting was ‘poor’ in 1992 and 2002 (median score: 10 [range, 3 – 19] in both years), a significant improvement was noted in 2012 (median score: 13 [range, 4 – 24]) (p=0.0001).

Conclusion: The trend to publish an increasing number of case series with a focus on microsurgical reconstruction is paralleled by an improvement in the quality of reporting. Although a favorable trend is seen, increased efforts are indicated to further improve the quality of case series in microsurgery.