BACKGROUND: In the field of plastic and aesthetic surgery, continuous international publication is seen annually. However, the publication output is not regularly assessed for its level of evidence. In view of the strong publication activity, a regular assessment of the evidence level of the current publication years is reasonable and was the objective of this work.

MATERIAL AND METHODS: We evaluated the Journal of Hand Surgery/JHS (European Volume Journal), the journal Plastic and Reconstructive Surgery/PRS and the journal Handchirurgie, Mikrochirurgie und Plastische Chirurige/HaMiPla from January 2019 to December 2021. The authors' affiliation, the type of publication, the number of patients examined and the level of evidence with existing conflicts of interest were considered.

RESULTS: A total of 1341 publications were evaluated. Of these, 334 original papers were published in JHS, 896 in PRS, and 111 in HaMiPla. The largest share were retrospective papers (53.5%, n=718). The further distribution was as follows: 18% (n=237) clinical prospective papers, 3.4% (n=47) randomised clinical trials (RCT), 12.5% (n=168) experimental papers and 6.5% (n=88) anatomic studies. The distribution of evidence levels of all studies was as follows: Level I: 1.6% (n=21), Level II: 8.7% (n=116), Level III: 20.3% (n=272), Level IV: 25.2% (n=338), Level V: 2.3% (n=31). In 42% (n=563) of the papers, there was no indication of the level of evidence. Most level I evidence was from university hospitals (n=16) in 76.2% (χ²-test 0.619, >0.05, 95% confidence interval).

CONCLUSION: Although RCTs are inappropriate for many surgical questions, well-designed and conducted cohort or case-control studies could improve the evidence base. Many of the current studies tend to be retrospective and do not have a control group. Researchers in the field of plastic surgery should consider using a cohort or case-control design when an RCT is not feasible.