SA1 - What is the Quality of the Evidence in the Craniomaxillofacial Surgery Literature? A 10-Year Follow-Up

Abstract: Evidence-based medicine (EBM) has become the gold standard for modern clinical decision-making, medical education, as well as population-based practices. As part of this movement, there has been a push to improve the quality of evidence published in the literature as it directly informs practice guidelines and thus impacts patient care. One measure of quality for studies is their level of evidence, with articles with higher levels of evidence having more validity.

It has taken time for medical and surgical specialties to incorporate these goals of EBM. For craniomaxillofacial surgery (CMS) in particular, Susarla et al. found in 2015 that the level of evidence in the CMS literature remained relatively low, consisting of primarily case series and case reports with few randomized clinical trials, systematic reviews, or meta-analyses.¹ Since then, follow-up studies from 2021 investigating the quality of oral and maxillofacial surgery and craniomaxillofacial trauma literature have noted some improvements in levels of evidence.² Now, 10 years later, it is worth re-investigating the quality of CMS literature overall to evaluate progress since 2015 and, by extension, progress of the specialty as a whole in providing high-quality, evidence-based patient care.

This was a retrospective cohort study of patient-oriented articles published in the Journal of Oral and Maxillofacial Surgery. The primary predictor variable was the year of publication (September 2007 to August 2008, September 2012 to August 2013, September 2017 to August 2018, or September 2023 to August 2024). Secondary predictor variables were journal, impact factor, subject (eg, reconstruction, esthetic surgery), and funding. The outcome variable was the level of evidence (levels 1 to 4), evaluated using the Center for Evidence-Based Medicine criteria.

Data were entered into a statistical database (IBM SPSS Statistics for Macintosh, Version 30.0.0.0 Armonk, NY: IBM Corp). Descriptive, bivariate, and regression statistics were computed.

The study sample included 429 new articles from 2017 to 2024. The most frequent subject area was orthognathic or temporomandibular joint (26.3%). Twenty percent of studies were funded. There were 30 (7.0%) level 1, 205 (47.8%) level 2, 31 (7.2%) level 3, and 163 (38.0%) level 4 studies. In a multiple regression model, year of publication (odds ratio [OR] = 1.75 per year, P < .001) was associated with higher-quality evidence.

The quality of evidence has increased over time with an increased fraction of level 1 and level 2 studies, but the number of level 1 studies remains a small proportion.

References:
1. Susarla SM, Mundinger GS, Swanson EW, Basile LE, Redett RJ, Dodson TB. What Is the Quality of the Evidence in the Craniomaxillofacial Surgery Literature? Journal of Oral and Maxillofacial Surgery. 2015;73(10):2017-2023. doi:10.1016/j.joms.2015.03.030
2. Nabil S, Samman N. Levels of evidence and journal impact factor in oral and maxillofacial surgery: a 15-year follow-up. International Journal of Oral and Maxillofacial Surgery. 2021;50(10):1394-1399. doi:10.1016/j.ijom.2020.11.021