Guideline Awareness Disparities in Plastic Surgery: A Survey of American Society of Plastic Surgeons

The American Society of Plastic Surgeons (ASPS) clinical practice guidelines were constructed to help direct evidence-based surgical management in plastic surgery. Societal member awareness of the recommendations for breast reconstruction has yet to be studied among ASPS members. METHODS: Univariate and multivariate analyses were performed using electronic survey data from 243 ASPS members. Characteristics, including respondent demographics, practice distribution, and geographic locations, were correlated to the awareness of autologous and expander/implant-based reconstruction guidelines. RESULTS: Of the respondents, 52% and 35.7% reported awareness for autologous breast reconstruction and expander/implant-based reconstruction guidelines, respectively. Surgeons who performed more general and autologous breast reconstruction were more likely to be aware of autologous breast reconstruction and expander/implant-based guidelines (P = 0.0034 and 0.032). Autologous breast reconstruction guideline awareness was geographically disparate (P = 0.031), with greater awareness in the Northeast (OR, 4.5; 95% CI, 1.63–12.53; P = 0.01) and Southwest (OR, 3.91; 95% CI, 1.18–13.83; P = 0.01). Respondents with larger practice percentages of breast reconstruction and those with higher annual academic meeting attendance reported greater awareness of expander/implant-based guidelines (P = 0.044 and 0.040). Meeting attendance (OR, 2.14; 95% CI, 1.15–8.91; P = 0.022) and practice-based (OR, 3.14; 95% CI, 1.52–8.91; P = 0.027) awareness disparities were also appreciated on multivariate analysis. CONCLUSIONS: Guideline awareness in plastic surgery varies by practice composition and geography. These findings can be used to help inform more targeted educational and implementation strategies in breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Quality Improvement/Level IV