The Impact of Conflicts of Interest in Plastic Surgery: An Analysis of Acellular Dermal Matrix, Implant-based Breast Reconstruction
Joseph Lopez, MD MBA1, Erin Prifogle, BS2, Theodore T. Nyame, MD3, Jacqueline Milton, PhD4, James W. May, Jr., MD3.
1Johns Hopkins Hospital, Baltimore, MD, USA, 2TEI Biosciences, Boston, MA, USA, 3Massachusetts General Hospital, Boston, MA, USA, 4Boston University School fo Public Health, Boston, MA, USA.
PURPOSE: Although “conflicts of interest” (COI) in biomedical research have received significant attention, the impact of COI on surgical outcomes has not been fully explored.
METHODS: A systematic electronic search of the literature was performed for studies that evaluated surgical outcomes in “acellular dermal matrix” (ADM) and non-ADM implant-based breast reconstruction. Surgical complications including infection, seroma, hematoma, necrosis, and explantation were used as outcome metrics and extracted from studies. Surgical outcomes were then pooled and compared between studies that disclosed COI and those that did not disclose COI.
RESULTS: A total of 776 abstracts were identified, of which only 35 fulfilled our inclusion criteria. COI were reported in 14 (40%) of these abstracts. The pooled data from studies that reported no COI and studies that reported a COI included a total of 8241 and 5384 breasts and 2852 and 1864 patients, respectively. Taken collectively, surgical complications were less common in studies that reported a COI than in studies that reported no COI. When surgical outcome data was further stratified by ADM use, surgical complications were less common in studies with COI when ADM was used. However, when ADM was not used, surgical complications were similar between authors that reported a COI and those that did not report a COI.
CONCLUSION: Self-reported COI are common in implant-based breast reconstruction research. Studies authored by groups with COI are significantly associated with reporting lower surgical complications and therefore describing positive research findings, especially when
industry-marketed products are being utilized in the study.
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