Zusammenfassung
Die zunehmende Bedeutung der Evidenz-basierten Medizin (EbM) hat als eine Ursache
die immer lauter werdende Forderung nach rationalen Begründungen für das ärztliche
Handeln. Es ist erkannt worden, dass lediglich 15–40 % medizinischer Entscheidungen
eine solide wissenschaftliche Basis haben. Umso mehr ist dies von Bedeutung, da in
Zeiten knapper finanzieller Ressourcen das Vergütungsverhalten für erbrachte ärztliche
Leistungen immer mehr davon abhängen wird, wie „Evidenz-basiert” die jeweils durchgeführte
Behandlung ist. Die Anwendung von EBM in der plastisch-chirurgischen Praxis ist keine
Option mehr. Die Forderung nach Anwendung der besten Evidenz auf die jeweilige klinische
Situation setzt jedoch ein Grundverständnis über die existierende Hierarchie hinsichtlich
der Qualität von Studien voraus. In dem vorliegenden Beitrag werden Prinzipien der
EBM vorgestellt, sowie die Bedeutung von randomisiert kontrollierten Studien und systematischen
Übersichtsarbeiten für die plastische Chirurgie diskutiert. Die Qualität plastisch-chirurgischer
Publikationen wird anhand von Ergebnissen systematischer Analysen vorgestellt. Zusammenfassend
lässt sich festhalten, dass die plastische Chirurgie die Zeichen der Zeit erkannt
hat und zunehmend bestrebt ist, klinische Forschung mit höherem Evidenzlevel durchzuführen.
Eine Verbesserung der Qualität der Berichterstattung von Studienergebnissen ist in
diesem Rahmen jedoch unabdingbar.
Abstract
The increasing importance of evidence-based medicine (EBM) is the result of an increasing
demand for a rational decision-making process in healthcare. It has been demonstrated
that 15–40% of decisions made in healthcare do not have a solid scientific basis.
This is particularly problematic in times of limited financial resources, when reimbursement
increasingly depends on how “evidence-based” a particular treatment is. Application
of EBM principles in plastic surgery is therefore no longer an option. This, however,
requires a basic understanding of the existing levels of evidence. In the present
article, principles of EBM will be presented. The importance of randomized controlled
trials and systematic reviews for plastic surgery will be highlighted along with a
discussion of the quality of the plastic surgical literature based on results of recent
systematic analyses. The plastic surgical community has appreciated the need for higher
quality clinical studies. Improvement of the quality of reporting is, however, critical.
Schlüsselwörter
plastische Chirurgie - Evidenz-basierte Medizin - randomisiert kontrollierte Studien
- systematische Übersichtsarbeiten
Key words
plastic surgery - evidence-based medicine - randomised controlled trials - systematic
reviews
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Korrespondenzadresse
Dr. med. Arash Momeni
Stanford University Medical
Center
Division of Plastic and
Reconstructive Surgery
770 Welch Road, Suite 400
Palo Alto, CA 94304-5714
USA
Email: amomeni@stanford.edu
