A Systematic Review of Questionnaires Assessing Patient Satisfaction in Plastic Surgery: Tools, Topics, and Surgical Types

Abstract

Background:

Patient satisfaction is crucial for evaluating healthcare services, including plastic surgery. This systematic review aims to analyze questionnaires assessing patient satisfaction in plastic surgery, identifying their strengths and weaknesses to improve outcomes and enhance the quality of care.

Methods:

A comprehensive literature search was conducted using electronic databases. Studies were included if they were original research articles, written in English, and focused on patient satisfaction questionnaires in plastic surgery. Data extraction and descriptive statistics were used to summarize the data.

Results:

A total of 105 studies were included. General/overall satisfaction was the most common topic addressed (99.04%). Cosmetic outcomes were the most frequently assessed category (34.3%). Breast reconstruction was the most common procedure (33.3%). Most studies used a combination of generic and procedure-specific questionnaires (45.71%). The most frequently used measurement tools were BREAST-Q and self-developed questionnaires, each accounting for 28.57% and 27.61%.

Conclusions:

This review provides a comprehensive analysis of patient satisfaction questionnaires in plastic surgery, emphasizing the importance of a holistic approach and well-established, validated tools. The findings contribute to improving plastic surgery outcomes and enhancing the quality of care. Future research should refine assessment tools to address patients’ needs and promote patient-centered outcomes in plastic surgery.

Takeaways

Question: This study analyzes patient satisfaction questionnaires in plastic surgery to identify strengths and weaknesses, aiming to enhance outcomes and quality of care.

Findings: Our systematic review included 97 studies. General/overall satisfaction was the most common topic addressed (65.63%), followed by cosmetic outcomes (29.1%). Breast reconstruction was the most common procedure (37.8%). Most studies used a combination of generic and procedure-specific questionnaires (49.1%). BREAST-Q and nonspecific tools were predominant (34.5% each).

Meaning: This analysis highlights the importance of validated tools and a holistic approach in improving patient satisfaction in plastic surgery, leading to better outcomes and enhanced care quality.

INTRODUCTION

Patient satisfaction serves as a crucial indicator of healthcare quality and plays a vital role in evaluating healthcare services, including plastic surgery.^1,2 The growing demand for plastic surgery in recent years has underscored the importance of assessing patient satisfaction for both patients and surgeons.³ This has prompted the development of a myriad of questionnaires designed to evaluate different aspects of patient satisfaction within the realm of plastic surgery. However, the vast array of available tools, topics, and surgical types poses a challenge in selecting the most suitable instrument for specific contexts.

Conducting a systematic review of the literature on questionnaires that assess patient satisfaction in plastic surgery is essential to pinpoint the strengths and limitations of existing tools, ultimately providing guidance for their use in clinical practice and research. Earlier reviews predominantly concentrated on the psychometric properties of these questionnaires, with limited focus on their content or suitability for surgical types.^4,5 The current systematic review seeks to bridge this gap by offering an in-depth analysis of the available questionnaires, considering their topics, tools, and surgical types, as well as their applicability to various facets of patient satisfaction.

Grasping the subtleties of these questionnaires is crucial for accurately gauging patient satisfaction, which can lead to improved plastic surgery outcomes. Moreover, this review will aid in the development of new instruments that cater more effectively to the needs of both patients and surgeons. By consolidating existing knowledge on patient satisfaction questionnaires in plastic surgery, this systematic review aspires to enhance the overall quality of care and foster patient-centered outcomes within the field.⁶

METHODS

Literature Search Strategy

A comprehensive literature search was conducted using the electronic databases Google Scholar, PubMed/MEDLINE, Ovid, Embase, and Web of Science to identify studies relevant to patient satisfaction questionnaires in plastic surgery. The search was conducted from inception to September 2022. The following search terms were used: (“patient satisfaction” OR “patient-reported outcome measures” OR “PROMs” OR “quality of life” OR “QOL”) AND (“plastic surgery” OR “cosmetic surgery” OR “reconstructive surgery” OR “aesthetic surgery” OR “breast surgery” OR “facial surgery” OR “body contouring” OR “abdominoplasty” OR “liposuction” OR “rhinoplasty” OR “mastectomy” OR “mastopexy” OR “breast reduction” OR “breast augmentation” OR “breast reconstruction” OR “nipple-areola complex reconstruction” OR “gender-affirming surgery” OR “chest reconstruction” OR “lipectomy” OR “lipolysis” OR “tummy tuck” OR “lipoplasty” OR “body-lift”).

Study Selection Criteria

Studies were included in this systematic review if they met the following criteria: (1) original research articles, (2) written in English, (3) published between inception and December 2022, (4) focused on patient satisfaction questionnaires in plastic surgery, and (5) reported primary data related to patient-reported outcomes.

Data Extraction

Two reviewers independently reviewed the articles to determine eligibility for inclusion in the systematic review. Disagreements were resolved by consensus. The following data were extracted from each study: study design, patient characteristics, type of plastic surgery procedure, questionnaire type, outcome categories and combinations, measurement tools used, and reported results.

Statistical Analysis

Descriptive statistics were used to summarize the extracted data. Frequencies and percentages were calculated for each category and subcategory in the extracted data.

Included Studies

The search yielded a total of 1639 potentially relevant studies. After screening the titles and abstracts, 211 full-text articles were assessed for eligibility. Of these, 105 studies met the inclusion criteria and were included in the systematic review. Figure 1 presents the flowchart and reasons for exclusion through each screening phase.

Fig. 1.

PRISMA flowchart.

Table Presentations

The extracted data are presented in tables. Table 1 summarizes the frequency of topics addressed in patient satisfaction questionnaires in plastic surgery. Table 2 presents the frequency of outcome categories and combinations in patient satisfaction questionnaires in plastic surgery. Table 3 summarizes the frequency and percentage of types of plastic surgery procedures in patient satisfaction studies. Table 4 presents the frequency and percentage of questionnaire types used in patient satisfaction studies. Supplemental Digital Content 3 summarizes the frequency and percentage of measurement tools used in patient satisfaction studies.

Table 1.

Frequency of Topics Addressed in Patient Satisfaction Questionnaires in Plastic Surgery

Topic	Frequency	Percentage
General/overall satisfaction alone	72	68.6%
General/overall satisfaction in combination	32	30.04%
Satisfaction with relationships/social life	16	15.2%
Satisfaction with sex-life/libido	18	17.14%
Satisfaction with rate of recovery	10	9.5%
Satisfaction with educational/support resources	11	10.47%

Table 2.

Frequency of Outcome Categories and Combinations in Patient Satisfaction Questionnaires in Plastic Surgery

Outcome Categories/Combinations	Frequency	Percentage
Cosmetic (aesthetic) outcomes	36	34.3%
Functional outcomes	1	1.0%
Psychological outcomes	1	1.0%
Provider (surgeon)-related issues	1	1.0%
Cosmetic & functional outcomes	9	8.6%
Cosmetic & psychological outcomes	16	15.2%
Cosmetic & provider (surgeon)-related issues	2	1.9%
Functional & psychological outcomes	2	1.9%
Cosmetic, functional & provider (surgeon)-related issues	1	1.0%
Cosmetic, psychological & provider (surgeon)-related issues	7	6.6%
Cosmetic, functional & psychological outcomes	18	17.1%
Cosmetic, functional, psychological outcomes & provider (surgeon)-related issues	11	10.4%

Table 3.

Frequency and Percentage of Types of Plastic Surgery Procedures in Patient Satisfaction Studies

Type of Procedure	Frequency	Percentage
Breast reconstruction	35	33.3%
Breast reduction	15	14.3%
Breast augmentation	6	5.7%
Cosmetic facial surgery	14	13.3%
Abdominoplasty	2	1.9%
Other reconstructive operations	6	5.7%
Body contouring	7	6.6%
Breast augmentation, reconstruction, and reduction	3	2.8%
Breast augmentation and body contouring	2	1.9%
Breast reconstruction and augmentation	1	1.0%
Breast reconstruction and reduction	1	1.0%
Breast reconstruction, augmentation, reduction, body contouring, and cosmetic facial surgery	1	1.0%
Body contouring and others	2	1.9%
Breast reconstruction and other reconstructive operations	2	1.9%
Others	7	6.7%
Breast reconstruction, cosmetic facial surgery, and body contouring	1	1.0%

Table 4.

Frequency and Percentage of Questionnaire Types Used in Patient Satisfaction Studies

Questionnaire Type	Frequency	Percentage
Ad hoc questionnaires only	21	20.0%
Combination of generic AND well-developed, procedure-specific questionnaire	48	45.71%
Well-developed, procedure-specific questionnaire only	23	21.90%
Generic questionnaire only	7	6.7%
Combination of ad hoc questionnaires AND well-developed, procedure-specific questionnaire	4	3.80%
Combination of ad hoc questionnaires AND generic questionnaires	1	1.0%
Interviewed the patients without structured questionnaire	1	1.9%

Quality Assessment

To guarantee the authenticity and dependability of the evidence compiled, we conducted a thorough quality evaluation of all the included studies. Applying the Methodological Index for Non-Randomized Studies (MINORS) criteria for nonrandomized, noncomparative studies and taking extra variables into account for comparative studies allowed us to carefully assess every study in a variety of areas vital for study validity and credibility.

The MINORS instrument was used to evaluate eight critical domains for the 83 nonrandomized, noncomparative studies that were part of our analysis: the clarity of aims, the inclusion of consecutive patients, the prospective nature of data collection, the suitability of the follow-up period, the rate of loss to follow-up, the appropriateness of study endpoints, and the impartial assessment of these endpoints. The degree to which each study satisfied these requirements determined the score, which ranged from a low of 4 to a high of 14 out of the maximum 16 points. The included studies’ strengths and areas for development were highlighted by this ranking system, which also frequently pointed out flaws in the computation of sample size and prospective data collecting.

For comparative studies, which were 22 in number, the comparative quality assessment was used, which involves 12 criteria to take into account the added complexities inherent in comparative studies. The criteria included the adequacy of control groups, the contemporaneity of groups, baseline equivalence, and the comprehensiveness of statistical analyses, with a minimum score of 8 and a maximum of 20 out of the potential 24 points. This careful assessment made it possible to analyze the methodological integrity of the comparison studies and the possible implications of their findings for clinical practice. Further details of each study and their scores can be found in Supplemental Digital Content 1 and 2. (See table, Supplemental Digital Content 1, which displays the quality assessment for nonrandomized noncomparative studies using the MINORS instrument, http://links.lww.com/PRSGO/D492.) (See table, Supplemental Digital Content 2, which displays the quality assessment for nonrandomized comparative studies using the MINORS instrument, http://links.lww.com/PRSGO/D493.)

RESULTS

A total of 105 studies were reviewed in this systematic analysis to investigate patient satisfaction outcomes in the different fields of aesthetic plastic surgery.^7–111 The results are organized into five tables, each highlighting specific aspects of the patient satisfaction questionnaires and the context in which they were used.

General/Overall Satisfaction and Other Topics Addressed

In the analyzed studies, general/overall satisfaction was the most common topic, addressed in 104 out of 105 questionnaires (99.04%). General/overall satisfaction alone was reported in 72 out of 105 questionnaires (68.6%), whereas it was reported in combination with other topics in 32 out of 105 questionnaires (30.04%). Other topics included satisfaction with sex-life/libido (17.14%), satisfaction with relationships/social life (15.2%), satisfaction with educational/support resources (10.47%), and satisfaction with rate of recovery (9.5%). The details of the frequency and percentage of these topics can be found in Table 1.

Outcome Categories and Combinations

Cosmetic (aesthetic) outcomes were the most frequently assessed category, appearing in 36 questionnaires (34.3%). Other outcome categories included functional outcomes (1.0%), psychological outcomes (1.0%), and provider (surgeon)-related issues (1.0%). Several combinations of outcome categories were also reported, with cosmetic, functional, and psychological outcomes being the most common (17.1%). Table 2 summarizes the frequency and percentage of outcome categories and combinations in patient satisfaction questionnaires.

Types of Plastic Surgery Procedures

Breast reconstruction was the most common procedure, appearing in 35 studies (33.3%). Other procedures included breast reduction (14.3%), breast augmentation (5.7%), cosmetic facial surgery (13.3%), and various others. The frequency and percentage of the types of plastic surgery procedures featured in the patient satisfaction studies are presented in Supplemental Digital Content 3. (See table, Supplemental Digital Content 3, which displays frequency and percentage of measurement tools used in patient satisfaction studies, http://links.lww.com/PRSGO/D494.)

Questionnaire Types Used in Patient Satisfaction Studies

The majority of the studies (45.71%) used a combination of generic and well-developed, procedure-specific questionnaires. Other questionnaire types included ad hoc questionnaires only (20.0%), well-developed procedure-specific questionnaires only (21.90), and generic questionnaires only (6.7%). Some studies also combined ad hoc questionnaires with other types of questionnaires (4.80%) or interviewed the patients without using a structured questionnaire (1.9%). Supplemental Digital Content 3 provides the frequency and percentage of the different questionnaire types used in the studies. (See table, Supplemental Digital Content 3, http://links.lww.com/PRSGO/D494.)

Measurement Tools Used in Patient Satisfaction Studies

The measurement tools used in the studies varied, with the most frequently used tools being BREAST-Q and self-developed questionnaires, each accounting for 28.57% and 27.61% of the studies, respectively. Other tools included FACE-Q (6.67%), Michigan Breast Reconstruction Outcome Survey (5.71%), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Breast-Cancer Specific Module (2.85%), Short Form 36 (2.85%), Rosenberg Self-Esteem Scale (1.9%), and several others. The frequency and percentage of the measurement tools used in patient satisfaction studies are detailed in Supplemental Digital Content 3. (See table, Supplemental Digital Content 3, http://links.lww.com/PRSGO/D494.)

DISCUSSION

This systematic review examined 105 studies to explore patient satisfaction outcomes in aesthetic plastic surgery, focusing on the questionnaires used and the context in which they were applied. A wide range of topics, outcome categories, and surgical types were addressed, reflecting the diversity of aesthetic surgery procedures and the various aspects of patient satisfaction that are pertinent to the field.¹

General/overall satisfaction emerged as the most common topic in the studies, aligning with previous research that highlights its significance as a critical indicator of healthcare quality.^2,3 However, the review also identified other important satisfaction topics, such as relationships/social life, sex-life/libido, rate of recovery, and educational/support resources. These findings emphasize the need to consider a holistic approach to patient satisfaction that encompasses various aspects of patients’ lives, as well as the importance of developing questionnaires that address these diverse topics.^4,5

The review’s identification that cosmetic (aesthetic) outcomes were the most frequently assessed outcome category is consistent with the primary goal of many plastic surgery procedures to enhance patients’ appearance.⁶ However, the fact that the examined questionnaires included functional and psychological outcomes indicates that the importance of these dimensions in determining patient satisfaction is becoming increasingly acknowledged. This emphasizes for physicians the significance of using a multifaceted assessment strategy in preoperative consultations and postoperative assessments to guarantee precise management of patients’ expectations and comprehensive attention to recovery and satisfaction.^112,113

Breast reconstruction emerged as the most common procedure in the reviewed studies, demonstrating the profound effects of cosmetic surgery on individuals’ psychological well-being and quality of life.^114,115 The variety of other procedures, such as breast reduction, breast augmentation, and cosmetic facial surgery, highlights the diverse range of plastic surgery procedures that can influence patient satisfaction. These findings imply that to properly assess and manage expectations, physicians should have thorough preoperative discussions with patients, especially those undergoing life-altering procedures like breast reconstruction. The variety of techniques examined further highlights the significance of customized satisfaction questionnaires, which help clinicians pinpoint certain areas of patient care and outcomes that have the potential to be improved.

The use of both generic and well-developed, procedure-specific questionnaires was the most common approach in the studies. This combination allows for a comprehensive assessment of patient satisfaction, capturing both general aspects of care and those specific to procedures.¹¹⁶ However, the use of ad hoc questionnaires or unstructured interviews in some studies raises concerns about the validity and reliability of the findings.¹¹⁷ Prioritizing well-established and validated instruments can improve the caliber of patient satisfaction research and its practicality in clinical settings for researchers and clinicians.¹¹⁸

The review identified a variety of measurement tools, with BREAST-Q being the most frequently used. This underscores the tool’s validity and reliability for assessing patient satisfaction in breast surgery.^119,120 However, addressing the absence of standardized measurement tools in other studies suggests a need for further development and validation of instruments for various surgical types and satisfaction topics, especially those that were self-developed, as the standardization of these instruments will help guide future studies to report critical data on these topics and increase the accuracy of satisfaction assessments.¹²¹

This systematic review highlights the diverse range of questionnaires, topics, and surgical types used to assess patient satisfaction in plastic surgery. The findings underscore the need for a comprehensive and holistic approach to evaluating patient satisfaction, incorporating a variety of outcome categories and addressing different aspects of patients’ lives. To enhance the quality of patient satisfaction research and ultimately improve plastic surgery outcomes, it is crucial to develop and promote the use of well-established and validated questionnaires tailored to the unique needs of plastic surgery patients and procedures.

The findings of this systematic review yield several recommendations for future research and clinical practice in the field of plastic surgery. First, it is essential to develop and validate questionnaires addressing a diverse range of topics and outcome categories, such as functional, psychological, and provider-related issues, in addition to cosmetic outcomes. This comprehensive approach will capture the multifaceted nature of plastic surgery outcomes and ensure a more accurate assessment of patient satisfaction. Second, researchers and clinicians should be encouraged to use well-established and validated questionnaires to enhance the quality and comparability of patient satisfaction data across studies.

Moreover, there is a need to prioritize the development of procedure-specific questionnaires to assess patient satisfaction more effectively in various plastic surgery procedures. This focus will allow for a more precise evaluation of patient satisfaction, helping to identify areas for improvement in specific surgical contexts. It is also crucial to promote collaboration among researchers, clinicians, and patient advocacy groups to pinpoint additional topics of importance for patient satisfaction in plastic surgery and integrate these topics into future questionnaires and assessment tools. Finally, implementing training and education programs for plastic surgeons and healthcare professionals will emphasize the importance of patient satisfaction and the appropriate use of patient-reported outcome measures in clinical practice.

Although this systematic review offers valuable insights into patient satisfaction questionnaires in plastic surgery, it is important to acknowledge certain limitations. The heterogeneity of the included studies, particularly with respect to study design, patient populations, and surgical types, may have impacted the comparability and generalizability of the findings. Furthermore, the quality assessment of the included studies has shown that scores varied greatly across studies, this is likely owing to the absence of a standardized tool for evaluating the quality of patient-reported outcome studies. This limitation should be considered when interpreting the results of the scores and this review, especially when applying the recommendations to clinical practice.

Additionally, although a comprehensive literature search was conducted, it is possible that some relevant studies may have been missed due to publication bias, database restrictions, or the use of different search terms. The review was also limited to studies published in English, which may have excluded important findings from non-English-language publications. Finally, as the knowledge in the field evolves, new questionnaires and assessment tools may emerge, necessitating regular updates to this systematic review to ensure its continued relevance and accuracy.

CONCLUSIONS

This systematic review offers a comprehensive analysis of patient satisfaction questionnaires in various aesthetic surgery disciplines, emphasizing the importance of a holistic approach and well-established, validated tools. The findings contribute to improving aesthetic plastic surgery outcomes and enhancing the quality of care by identifying areas for improvement and fostering collaboration among researchers, clinicians, and patient advocacy groups. Future research should continue refining assessment tools to better address patients’ needs and promote patient-centered outcomes in plastic surgery.

DISCLOSURE

The authors have no financial interest to declare in relation to the content of this article.