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The Johns Hopkins Hospital and R Adams Cowley Shock Trauma Center Expertise: microvascular reconstruction; adult and pediatric craniofacial surgery for congenital, oncological and traumatic conditions; facial reanimation; orthognathic surgery; aesthetic facial plastic surgery Accomplishments: House of Delegates and Senate of Maryland recognition for fullface transplant; Best Clinical Paper Award and Best Normal Case Award by the World Society of Reconstructive Microsurgery and the American Background: Psychoactive drug use is on the rise in the United States, with plastic surgery patients a potentially susceptible group. This study aimed to determine the incidence of cosmetic and reconstructive patients in our practice taking psychoactive drugs and to compare those values with the national average. Furthermore, we discuss the patient safety concerns when patients withhold their medical history information over the course of their treatment. Methods: Urban private plastic practice patients who underwent surgery in a closed practice from 2009 to 2016 were divided into cosmetic and reconstructive cohorts. Review for drug use was medical scripts, history, and Surescripts drug reporting. Extracted information includes age, race, procedure, psychoactive medications, and whether or not they stated a mental health diagnosis on their medical history forms. Only patients with complete records were included. Results: A total of 830 patients were included in statistical analysis. Due to minimal cohort number, 70 men were excluded, as there were no comparative national data. Our analysis found that 33.6% cosmetic patients and 46.3% reconstructive patients used at least one psychoactive drug. Conclusion: There is a statistically significant difference between psychoactive drug use at our practice compared with the general population and a significantly larger percentage of reconstructive patients taking drugs compared with the cosmetic cohort. There is a precipitous increase in the number of patients on psychoactive drugs, which we define here as chemical substances that alter perception, mood, and thoughts of those who take them. This includes antidepressants, stimulants, anxiolytics, mood stabilizers, and antipsychotic medications. A report by Medco found that the number of American women taking psychoactive drugs has increased from 21% in 2001 to 26% in 2010.1 The influence of these drugs in plastic surgery has recently come to the fore.2 This is a significant issue, as a plastic surgeon often must decide if a patient would benefit more from surgery or from therapy.3 In our urban, private plastic surgery practice, we have found an explosion in the number of patients taking psychoactive drugs, prompting us to investigate potential risks for surgical patients, such as bleeding or anesthetic interactions, and the risks of temporarily stopping the medications perioperatively. These are important drugs to be reported to the anesthetist or the surgeon supervising the anesthesiologist to avoid harmful interactions. Given the current prevalence of psychoactive drug usage among plastic surgery patients, this article aims to explore the following issues: What is the prevalence of psychoactive drug use in practice and is there a difference between cosmetic and reconstructive patients? Is there is a difference between plastic surgery patients and the general population in psychoactive drug use? social or professional life is also a common concern. There are also certain common emotional or mental qualities that transcend the satisfaction with any of these procedures. The individual’s confidence and happiness with her appearance, and whether or not she desires some change are qualities that are important components of satisfaction, whether it is related to a rhinoplasty, facelift, blepharoplasty, or laser resurfacing. In contrast, there are also very specific physical factors that contribute to the assessment of each individual treatment outcome. For example, nasal airway functioning should be a concern for any rhinoplasty surgeon and clearly affects the quality of life of the rhinoplasty patient. The appearance of being tired is a specific complaint of the preoperative blepharoplasty patient that should be addressed with eyelid surgery. Measuring Effectiveness Outcomes can be defined in many ways, depending upon the interests of the investigating clinician and the patient population being evaluated. Most authors agree that an assessment of patient-related quality of life should inFig. 1. Quality of life instrument. 194 Outcomes in Facial Plastic Surgery clude components of physical, mental, and social functioning and should reflect the satisfaction and opportunity of the individual subject [1,2]. In order to compare patient-related outcomes for different sorts of procedures or among different surgeons, it is important to have a standardized instrument that can be used to measure patient quality of life or satisfaction. Such an instrument should tap each of the different domains of an individual’s quality of life and represent an assessment that captures the overall satisfaction with a given intervention. Four new quality of life instruments have been developed and are presented here for the common procedures of facial plastic surgery: the Rhinoplasty Outcomes Evaluation (ROE), Facelift Outcomes Evaluation (FOE), Blepharoplasty Outcomes Evaluation (BOE), and the Skin Rejuvenation Outcomes Evaluation (SROE) (Figs. 1–4) The goal of these instruments is to provide a starting point for individual facial plastic surgeons to evaluate the outcomes of these common procedures in a quantitative fashion. This will allow further assessment of patient satisfaction as well as provide the means by which new or innovative procedures can be compared with more traditional approaches. Scoring of each of these instruments is straightforward and designed to allow the surgeon to easily compare preand postoperative measurements. Each of the six items is scored on a 0–4 scale, with 0 representing the most negative response and 4 representing the most positive response. Dividing the total score for each instrument by 24 and multiplying by 100 yields the scaled instrument score. This range is 0–100, with 0 representing the least patient satisfaction and 100 representing the most patient satisfaction. These four instruments have not yet been pilot tested Fig. 2. Quality of life instrument. R. Alsarraf 195 to assess their reliability and validity, however, these tests are currently planned. If the reader is interested in participating in these pilot tests, as well as the modification or amending of these questionnaires as this testing proceeds, he or she is encouraged to contact the author to be involved in this process. The ease and simplicity of instrument administration should allow efficient validation of these instruments, and hopefully provide the facial plastic surgeon with a quantitative method of outcome assessment. Conclusions Outcomes research attempts to quantitate patient-related results of treatment that are otherwise subjective and difficult to understand or study in a comprehensive fashion. The use of standardized instruments specific to the treatment or illness in question allows the outcomes researcher the method to measure patient satisfaction, functionality, and quality of life and use these measurements to compare the results for an individual subject, across different surgical approaches, or between different surgeons. The development and testing of such instruments is an important step that establishes the foundation on which further studies may be based. In facial plastic and reconstructive surgery, there are currently no reliable or validated instruments that are widely used for outcomes assessment. The subjective evaluation of patient satisfaction in the basic measure of success of most facial plastic surgery procedures, yet most surgeons have no quantitative means of this assessment. This paper attempts to outline the basic steps in evaluating outcomes in the realm of facial plastic and reconstructive surgery, similar to the outcomes research that is Fig. 3. Quality of life instrument. 196 Outcomes in Facial Plastic Surgery ongoing in other fields of Otolaryngology-Head and Neck Surgery. Four new instruments are presented for the measurement of patient-related outcomes of rhinoplasty, facelift, blepharoplasty, and skin rejuvenation procedures. These instruments provide a simple and expedient assessment of the individual’s quality of life related to the procedure of interest that the surgeon may find useful in the quantitative evaluation of postoperative facial plastic surgery outcomes. References 1. Wilkins EG, Lowery JC, Smith DJ: Outcomes research: A primer for plastic surgeons. Ann Plast Surg 37(1):1, 1996 2.
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