Patients and doctors often disagree in evaluation of surgical scarring

PHILADELPHIA - When it comes to the physical scars surgery leaves behind, a new study shows patients and doctors often don't assess their severity the same way. Researchers from the Perelman School of Medicine at the University of Pennsylvania found patients and physicians disagreed in their scar evaluations 28 percent of the time, with patients more likely to focus on the depth of the scar while physicians were more likely to emphasize coloration and texture. The study's authors say these findings point to the need for better evaluation methods and improved preoperative counseling.

JAMA Facial and Plastic Surgery published the results today.

About 230 million surgical procedures are performed worldwide each year overall. That includes surgeries that are gender-specific like cesarean sections or breast reconstruction, as well as procedures that are the same for all patients such as skin cancer surgery. In addition to the type of procedure, there are multiple other factors that impact the scars various procedures leave on a person's body, such as method of skin incision, method of wound closure, suturing technique, or postoperative wound care.

"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 Joseph F. Sobanko, MD, an assistant professor of Dermatology and director of Dermatologic Surgery Education at Penn.

Sobanko and his team used studies from 1972 through 2015 that specifically looked at assessment of surgical scars for which surgeons tried two different methods of intervention, either incising the skin or suturing the skin with two different methods. They ended up with 29 studies involving 4,485 patients.

In the 72 percent of cases in which doctors and patients had similar scar evaluations, the two groups were indifferent in terms of the intervention used. However, in the 28 percent of studies with disagreement, six out of eight patient cohorts (75 percent) 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," Sobanko said. "Many of the scales currently used to evaluate scars are insufficient to measure subtle scar features and patient satisfaction."; they ."

Sobanko says one problem with the scales is that they were not originally designed to measure surgical scars. Several of them were developed to evaluate burn scars instead. They also don't take into account the difference in points of emphasis between patients and physicians. In studies using patient and observer scar assessment scale (POSAS) to rate scars, patients weighted scar depth as more important, while physicians emphasized scar pigmentation and texture/surface irregularities. By taking these priorities into account, surgeons can better set expectations.

"These findings may help to improve preoperative counseling and highlight the importance of developing scar measures that balance the perceptions of patients and physicians," Sobanko said.

To that end, Sobanko said further research is needed to understand patient and physician expectations during initial visits, as well as how the anatomic location of the scar affects perception.

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The study was supported by the Dermatology Foundation and the Penn Center for Human Appearance.

Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $6.7 billion enterprise.

The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 20 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $392 million awarded in the 2016 fiscal year.

The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center -- which are recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report -- Chester County Hospital; Lancaster General Health; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2016, Penn Medicine provided $393 million to benefit our community.

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