The basis for ensuring the quality of medical care for plastic surgery is the order of delivery of medical care by types, profiles, individual diseases and conditions, as well as standards of medical care [6]. The orders of delivery of medical care have been approved by the Ministry of Health of the Russian Federation and are the same for all healthcare facilities registered in the country [7]. They are also a basis for the functional departmentalization of medical institutions. In turn, plastic surgeon’s qualification, as well as doctors of other specialties, should be confirmed by certificates. the current system of certification, though, is a subject of criticism in the medical community [8]. A new accreditation system is hoped to encourage continuing medical education and help doctors attain an equally high level of professional skills [9] by training them in all subspecialties plastic surgeon receives full access to the activities of the specialty, and not to its part. An important part in accreditation is played by the specialist’s portfolio, which should reflect the doctor’s success in expanding the skills and improving professional skills. However, it is not obligatory to specify in the current model of portfolio the range or extent of performed surgeries and training programs that the surgeon has completed [10]. The lack of unified requirements for the portfolio diminishes the value of accreditation as a tool to ensure the same high level of qualification of plastic surgeons. Our study aimed to investigate a few aspects of plastic surgeons’ performance, including the range and extent of surgical interventions, in order to provide rationale for unified requirements for the plastic surgeon’s portfolio.

METHODS

Data were collected from official reports of private healthcare providers authorized to perform plastic surgeries at in- and outpatient facilities. The reports contained information about the number and diversity of medical services delivered to patients per year. We shortlisted data relevant for our study (pertaining to the delivery of plastic surgery). Because the computed coefficient of variance V was 257.2 %, which is above 33 % and suggests heterogeneity of the range, and the Kolmogorov–Smirnov test proved that distribution was non-uniform (р < 0.001), we estimated significance of differences between the samples using the Mann–Whitney U. Differences were considered significant at p < 0.05. Correlation between the rankings was considered significant if empirical Spearman’s r_S was above the critical threshold at р = 0.05 and p < 0.05. The Kruskal–Wallis (K) test was used to determine differences in distributions; sample diversity was considered significant at p < 0.05. Data were analyzed using Microsoft Excel 2016 Analysis ToolPack and IBM SPSS Statistics 23.

The list of areas of expertise was proposed in another our ongoing study and included 9 categories: skin/soft tissue plasty, rhinoplasty, breast plasty (mammaplasty), blepharoplasty, otoplasty, lip and palate repair, craniofacial plasty, repair of urogenital defects, and hand surgery.

RESULTS

In total, 46 plastic surgeons conducted 5,184 medical procedures during the year, with a mean of 112.7 ± 289.9 procedures per surgeon. The minimal number of delivered services per surgeon was 1, the maximum — 1,760 (Мо = 2, Ме = 10), with 36 (78.3 %) doctors performing below the average and 10 (21.7 %) doctors carrying out more than 112 procedures a year. On the whole, 4,329 (83.5 %) of all services provided to the customers during the year were done by 7 (15.2 %) surgeons.

All services were divided into 9 categories depending on the areas of surgeons’ expertise. Skin/soft tissue plasty accounted for 51.1 % of all services provided. Blepharoplasty ranked second (5.7 %), and rhinoplasty ranked third (2.8 %). No hand surgeries were performed during the year (tab. 1).

Among “other procedures” were initial consultations, application of aseptic dressings, management of clean wounds, follow-up examinations of postoperative patients, and removal of sutures (for patients who had received treatment at other healthcare facilities). These procedures made 36.5 % of the total services provided. It should be noted that 1,820 services (35.1 % of their total number) falling into this category were initial consultations, meaning that per one initial consultation of a plastic surgeon there were 1.8 invasive (including surgical) interventions. The total number of such procedures as clean wound management, application of aseptic dressings and postoperative follow-ups accounted for 55 (1.1 %), i. e. per one surgery there were only 0.017 follow-up care services.

Of 5,184 medical services delivered in total, 3,145 were surgical interventions, with a mean of 112.3 ± 326.4 procedures per plastic surgeon a year (Мо = 1, Ме = 8). The smallest number of interventions per doctor was 1, the largest — 1,758. Of 46 surgeons, 14 (30.4 %) performed 1 to 10 surgeries a year, 4 (8.7 %) — between 14 and 50 surgeries, 6 (13.0 %) — between 64 and 134, 2 (4.3 %) — over 200, 1 (2.2 %) — 1,758 surgeries. Eighteen doctors conducted no surgical interventions at all in the studied period.

The majority of plastic surgeons (19 out of 46 people) dealt with skin/soft tissue plasty, 14 — rhinoplasty, 14 — blepharoplasty, 9 — mammoplasty, another 9 — otoplasty, 3 — craniofacial plasty, 3 — urogenital plasty, and 2 — lip plasty. None of the doctors covered the whole range of 9 types of operations. One doctor was able to perform 7 types of surgeries, another one — 6 types; 3 doctors were qualified in 5 types of surgical interventions, 3 doctors — in 3 types and another 3 — in 2 types; 4 surgeons were able to carry out 4 types of operations, and 13 surgeons — only 1 type. Table 2 presents data on the number of different types of operations performed by the surgeons with different academic titles and grades.