LETTER TO THE EDITOR
Outcome assessment in plastic surgery—tools,
techniques and the future
Received: 28 June 2014 /Accepted: 24 July 2014 /Published online: 26 August 2014
Springer-Verlag Berlin Heidelberg 2014
The assessment of outcomes following plastic surgery, apart
from enabling the surgeon to judge the success of a particular
operation and enabling him or her to improve their surgical
practice, also enables the patient to make an informed choice
about their care. Furthermore, it provides healthcare funders
with important information regarding the benefits of an oper-
ation. Thus, the accurate measurement of the success of an
operation is a vital undertaking.
Yet, a number of issues lie at the heart of accurate outcomes
analysis in plastic surgery. Firstly, what exactly do we mea-
sure? Different operations aim to improve different aspects of
the human anatomy, so how does one decide which are and
which are not the important factors in a particular operation?
Surgeons and patients may have completely separate notions
of what is considered a successful operation and may priori-
tize functionality over aesthetics and vice versa. Furthermore,
once we have developed a sufficiently rigorous idea of which
factors maybe important, how does one measure these factors?
Do we use the frequency of surgical complications encoun-
tered following the operation? Do we measure the patient’s
quality of life or psychosocial outcome following the opera-
tion? Or do we use condition-specific measures which are a
combination of the above to include factors important to both
the surgeon and the patient? Following this is the question of
when is the most appropriate timeframe within which to assess
the outcome? Should it be done soon after the operation or
should it be done months to years after the operation? Last, but
not least, this data needs to be gathered in a form amenable to
statistical analysis with amelioration of the biases inherent in
the techniques employed.
The above questions are only some of the considerations
when assessing outcomes within plastic surgery. Historically,
the vast majority of literature assessed outcomes in terms of
the complication rates following an operation . This in-
volved the performance of a particular operation for a specific
condition on a number of patients by one or a group of
surgeons. The complication rate would then be assessed (most
commonly retrospectively and less commonly prospectively)
and as long as the complication rate was kept to a minimum,
the operation was considered a success by the surgical team.
Even to this day, the vast majority of outcome analysis within
plastic surgery (and surgery in general) follows this model.
Advantages of this technique include its ease of application,
the relatively short period required to complete the study and
providing data which is considered important to the surgeon.
Yet, the drawbacks of this technique are obvious, such as a
complete absence of factors considered important by the pa-
tient. In the last two decades, there has been a drive to
understand surgical success from the patient and funder per-
spective. This has lead to the development of techniques to
assess functional outcomes, quality of life, psychosocial func-
tion and economic outcomes which have been cited as possi-
bly more important than merely the complication rate [2, 3].
However, the complicated nature of measuring these out-
comes, the extra time and cost involved, and the lack of
sufficient numbers of patients has meant that only a small
number of surgeons are involved in this type of outcome
analysis. More recently, over the last decade or so,
condition-specific patient-reported outcome measures
(PROMs) have come to the fore in assessing outcomes in
plastic surgery . A number of these instruments have been
developed and undergone psychometric validation [5, 6]. Yet,
again, the same problems highlighted above constrain these
techniques as well.
S. Jabir (*)
St. Andrews Centre for Plastic Surgery and Burns, Broomfield
Hospital, Chelmsford CM1 7ET, UK
Eur J Plast Surg (2014) 37:699–700