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Many patients, doctors disagree about severity of post-surgical scars

Patient's scar after surgery, after one week, and after three months. Photo by Zhang et al, courtesy of The University of Pennsylvania

Patients and doctors assess post-surgical scars differently, and disagree on severity nearly one-third of the time, researchers report in a paper published in JAMA Facial Plastic Surgery (Feb. 1, 2018, online ahead of print).

Researchers from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia found patients and physicians disagreed in their scar evaluations 28% of the time. Interestingly, patients were more likely to focus on scar depth while physicians were more likely to emphasize colouration and texture.

“Our analysis includes results across multiple specialties and using multiple methods, which shows this patient-surgeon discrepancy is not limited to any particular discipline or intervention,” said the study’s senior author Dr. Joseph F. Sobanko, an assistant professor of dermatology and director of dermatologic surgery education at the University of Pennsylvania, in a press release.

The research team looked at studies published between 1972 and 2015 that specifically examined assessment of surgical scars, for which surgeons had tried two different methods—either incising or suturing the skin using two different techniques. Overall, the paper included data from 29 studies totalling some 4,485 patients.

In the 72% of cases in which doctors and patients had similar evaluations of scar severity, the two groups were indifferent in preference regarding the intervention used. However, in the 28% of studies where patients and doctors disagreed, six out of eight patient cohorts (75%) rated one intervention as superior, while the physicians rated the interventions as equivalent. There were no studies where patients preferred one method while physicians preferred another.

“It is somewhat common for patients to have post-surgical scars that are considered clinically acceptable but patients may still feel disfigured,” Dr. Sobanko said. “Many of the scales currently used to evaluate scars are insufficient to measure subtle scar features and patient satisfaction.”

Dr. Sobanko notes that scar evaluation scales were generally developed to evaluate burn scars, not surgical scars. The scales also do not take into account the difference in points of emphasis between patients and physicians. In the release, the authors note that in studies using the Patient and Observer Scar Assessment Scale (POSAS) to rate scars, patients weighted scar depth as more important, while physicians emphasized scar pigmentation and texture or surface irregularities. They say that by taking these priorities into account, surgeons can better set patient expectations.

“These findings may help to improve pre-operative counselling and highlight the importance of developing scar measures that balance the perceptions of patients and physicians,” Dr. Sobanko said.

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