Back to 2014 Annual Meeting Abstracts

BACKGROUND:
Evidence-based medicine dictates that clinical decision-making be guided by high-quality research and evidence. Plastic surgery involves lifelong learning and improvement from prior mistakes. It is important for institutions, attendings, and residents to track their records, cases, and outcomes in order to practice evidence based learning. While outcome improvement will benefit physician practice and patient care, it also has future reimbursement implications as insurance companies move towards an outcome weighted payment system.
It is difficult to analyze an institution’s or an individual surgeon’s practice without keeping a record of the cases that have been performed, techniques that have been used, and outcomes obtained. An institutional prospectively maintained database allows an institution or program to publish evidence-based results from their long term collected data in order to improve patient care.
We propose an algorithm on how to start and create a prospectively maintained database, which can then be used to analyze prospective data in a retrospective fashion. Our algorithm provides future researchers a road map on how to set up, maintain, and use a database to improve future clinical outcomes for the medical community as a whole.
METHODS:
Data fields were created for data collection, which included demographic information, socioeconomic information, intraoperative and post operative details entered into Microsoft Access. Standardized drop down menus were organized in either a Boolean, categorical, or numerical fashion dependent on the variable. A printed out form from the Microsoft Access template was given to each surgeon to be completed after each case. The physician or the PA then entered the case information into the database. During postoperative visits, physicians and PAs had access to the database for continued follow up (figure 1).
RESULTS:
Our database was compliant with HIPPA as all pt identifiers were removed. Also, the database was on a secure password protected server that underwent routine back-ups by IT. By utilizing straightforward data input fields we permitted data collection to be easy and efficient. Data was then transcribed to Microsoft access. Collecting a wide variety of data allowed us the freedom to evolve our clinical interests, while the platform also permitted new categories to be added at will.
CONCLUSION:
The majority of plastic surgery research falls within level III and level IV evidence. The reasons for the lower grade of evidence include the need to customize reconstructions, the lack of dedicated full-time plastic surgery researchers, and the difficulty in establishing clinical trials in surgery. We have proposed a reproducible method for institutions to create a database, which will then allow senior and junior surgeons to analyze their outcomes and compare them to others in an effort to improve patient care and outcomes. Concomitantly, it provides the opportunity for residents and medical students to learn how to collect and organize data. This is a cost efficient way to create and maintain a database without additional software.