We have read the comments of Economopoulos and wish to reply by highlighting a number of points that we feel are relevant to the issues that he raised. Evaluation of patient scar satisfaction is limited by the subjective nature of the outcome being measured. It requires the use of specifically devised measurement scales that allow quantification of satisfaction between groups to be compared so that statistical analysis of differences between groups can be calculated. Given the subjective nature of the outcome being analyzed, any measurement technique used will be potentially limited in terms of its reliability because different individual patients will consider specific components of a scar to be of different importance (eg, thickness, color, itch).1 The paucity of validated scar assessment tools used to evaluate patient satisfaction after minimal-access parathyroid surgery has been reported before2 and is acknowledged in our article. We have been unable to identify any reports in the literature of an “administrator” bias relating to this questionnaire completion by proxy. Also, the number of patients who completed their questionnaire was small in terms of the overall size of both groups and was similar in size within each group. Therefore, we believe that if such administrator bias is a limitation of the observer scar scale, it is unlikely to have influenced the main outcomes of our study because of the small numbers of patients involved and their similar distribution in each group.
Casserly, MRCSI, MCh P, Kirby, MRCSI R, Timon, FRCSI, MD C. Completion of the Patient Scar Assessment Scale via a Telephone Interview—Reply. Arch Otolaryngol Head Neck Surg. 2011;137(6):642. doi:10.1001/archoto.2011.78