Study outlines tools to assess facial plastic surgery outcomes

Objective, validated measures for assessing outcomes following facial plastic surgery have become more prevalent over the past decade, according to a review of previous studies published in the May/June issue of Archives of Facial Plastic Surgery, one of the JAMA/Archives journals. Outcomes studies can be broadly grouped into three categories, according to background information in the article. Patient-reported outcomes studies assess patient satisfaction, typically using a quality-of-life instrument that has been validated or corroborated. Clinical efficacy outcomes studies use objective scales such as physician reports to measure the effectiveness of a given treatment or intervention. Finally, actuarial or financial outcomes studies gauge results based on cost measures.

John S. Rhee, M.D., M.P.H., and Brian T. McMullin, M.D., of the Medical College of Wisconsin and the Zablocki Veteran Affairs Medical Center, Milwaukee, reviewed studies published in English between 1806 and 2007 to identify instruments used to measure outcomes for certain facial plastic surgery procedures. The instruments were classified as either patient-reported or clinical efficacy measures, then further categorized based on the type of intervention, whether they were independently validated and whether they were subsequently used again.

A total of 68 separate instruments were identified, including 23 patient-reported measures and 45 clinical efficacy measures (35 that were observer-reported and 10 that were objective). “Most patient-reported measures (76 percent) and half of observer-reported instruments (51 percent) were developed in the past 10 years,” the authors write. “The rigor of validation varied widely among measures, with formal validation being most common among the patient-reported outcome measures.”

As more attention has been focusing on improving patient outcomes, the use of validated measures has become more important for physicians and researchers, the authors note. “The use of validated tools allows for true comparisons among different interventions or different techniques within a single intervention,” they write. “Such tools can also reliably assist in identifying good surgical candidates and approaches, as well as identifying patients unlikely to benefit from surgery. Finally, they can serve to help demonstrate treatment efficacy and establish legitimacy for third-party payers and government oversight bodies charged with the allocation of resources.”

“Our comprehensive review of the literature for existing outcome measures for an assortment of common facial plastic and reconstructive procedures has revealed a growing abundance of well-constructed and validated outcome measures,” they conclude. “However, a wide range in the rigor of validation for some measures and controversy in the universal acceptance of some clinical efficacy measures still remain.”

Source: JAMA and Archives Journals