Summary
Introduction
The deep inferior epigastric perforator (DIEP) flap is regarded as the gold standard
for autologous breast reconstruction. However, due to difficulty designing and conducting
randomized controlled trials in surgical interventions, the majority of literature
on DIEP flap breast reconstructions are observational studies. As such, it is pivotal
that these studies are performed with high internal validity.
Methods
A literature search was performed using MEDLINE, Embase, and CENTRAL from January
1, 2015 to October 23, 2021. Studies identified as observational studies about DIEP
breast reconstruction and published in a journal with a Web of Science impact factor
above 1.0 were included. Screening and risk of bias (RoB) assessment using the ROBINS-I
tool were performed independently and in duplicate by two authors.
Results
From 12,371 studies, 66 observational studies were included. The majority were found
at RoB, with 11 at moderate, 26 at serious, and 6 at critical RoB. Only two studies
had low RoB. The bias most commonly arose due to Domain 1 (confounding variables),
Domain 3 (classification of interventions), and Domain 6 (measurement of outcomes).
Conclusions
In this review, we demonstrate the high RoB of observational studies evaluating DIEP
breast reconstruction, which may jeopardize the validity of findings. We recommend
that authors consult the ROBINS-I tool not only when assessing observational studies
for systematic reviews but also when designing or conducting these studies. In our
study, we present additional considerations for each domain to provide researchers
with guidance on assessing and conducting surgical observational studies.
Keywords
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Article info
Publication history
Published online: June 28, 2022
Accepted:
June 21,
2022
Received:
January 24,
2022
Identification
Copyright
© 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
