An Update on the Level of Evidence for Plastic Surgery Research Published in Plastic and Reconstructive Surgery

Evidence-based medicine (EBM), which incorporates research outcomes into clinical decision making, came into common practice in the 1990s when more resources, such as those described by the Evidenced-Based Medicine Working Group, became available.1 During the 1960s and 1970s, notable figures, including Dr. Feinstein2 and Dr. Cochrane,3 had begun to question the validity of surgical practices that had previously been thought to be effective. After careful assessment, they discovered considerable variation in practice policies from provider to provider and a dearth of reliable research to substantiate many clinical decisions. On the basis of their findings, they stressed the need for additional research trials that could scientifically prove the efficacy of treatments. In 1979, levels of evidence (LOE) were first described by the Canadian Task Force on the Periodic Health Examination.4 The 1980s then saw a dramatic shift in the practice of medicine across specialties, with more and more clinicians basing care and clinical decisions on sound study outcomes.