Epidemiological Research in Plastic Surgery: Barriers and Opportunities for Growth

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Plastic surgery is distinct from other surgical specialties as it encompasses a diverse range of pathologies over the entirety of the human body, each with their own unique aspects of care. Conducting innovative research studies with sound methodology and practicing evidence-based medicine supported by data derived from said studies is key to advancing the field of plastic surgery and optimizing patient outcomes.1 Much of plastic surgery research is outcome-based; however, these studies are highly granular and are limited in their ability to extract broader, population-level insights regarding clinical and demographic factors that influence patient care. Epidemiologic studies, by nature of their design, provide this information, but are rarely conducted by plastic surgeons. Epidemiologic studies primarily serve to describe trends in clinical and demographic data and, as a result, have significant utility to health care providers. Researchers who conduct epidemiologic studies do so to identify areas that require further investigation to increase their understanding of various disease processes and improve patient care (Fig. 1). Some subspecialties, such as infectious disease, are highly active in epidemiologic research given their heavy reliance on antimicrobial resistance trends to guide antibiotic selection. Plastic surgeons primarily use findings of outcomes studies to guide the management of their patients given the nature of the field. Despite this, epidemiologic studies have limitless potential in plastic surgery and may be used to further understanding of risk factors for rare disease processes, such as congenital anomalies, and barriers to readily accessible care.Fig. 1.: Role of epidemiologic research in health care.Despite this potential, several logistical barriers limit plastic surgeons’ ability to conduct epidemiologic studies. First, epidemiologic studies require expansive amounts of data to power the study. Data typically are obtained from large patient registries or health insurance claims databases.2 Data entry into these databases requires significant resources and is prone to human error, with many high-volume institutions requiring dedicated staff. In addition, diagnostic codes used to organize data, such as those in the International Classification of Diseases coding system, have their own limitations. Diagnostic codes frequently group conditions, such as congenital craniofacial defects, into singular diagnoses, thereby limiting the precision of available data.3 Despite these limitations, plastic surgeons have developed high-quality, standardized databases to conduct outcomes and epidemiologic research.4,5 For example, plastic surgeons have developed the Patient Registry and Outcomes for Breast Implants and Anaplastic Large Cell Lymphoma Etiology and Epidemiology (PROFILE) database to better understand breast implant–associated anaplastic large cell lymphoma and have steadily increased data collection since its inception.5 Epidemiologic studies exhibit significant potential to improve health care. The advent of more precise iterations of diagnostic coding systems and increased participation from plastic surgeons to contribute to patient databases can serve as a sound foundation for future research studies. The future of epidemiologic research in plastic surgery is bright; however, it requires further resources, widespread adoption, and time to realize its full potential. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. There were no sources of support for this work.

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