What 113 surgeons who use the technique report
This is the study the often-quoted 2.65% figure comes from, and it is worth reading carefully: it is the proportion of surveyed surgeons who reported ever having had a serious complication, not a per-patient rate. 113 plastic surgeons practising rib remodeling by puncture were surveyed.
What was asked, and of whom
A survey was distributed among 113 plastic surgeons already practising the technique, and their answers were analysed retrospectively. Alongside complications, variables about how they operate were recorded:
- how they learned the technique
- accumulated practice time
- whether they use ultrasound guidance
- which instrument they use
The underlying question was whether any of those variables was associated with fewer major complications, defined as pneumothorax or hemothorax.
The finding that cuts against expectation
Here is the interesting part, and it is a result that does not favour the author's own instrument:
No statistically significant association was found between using a piezotome and having fewer serious complications (P = 1.0). The logistic regression model likewise found no significant difference in risk by instrument used.
Put plainly: the study set out to show the piezotome was safer and could not show it. Publishing that result, under your own name, says something about how the study was done.
How to read the 2.65%
It is not a per-operation risk. Of 113 surgeons who responded, 2.65% reported ever having had a serious complication. A surgeon with hundreds of cases and one with twenty count the same in that percentage.
For a per-patient figure you need a different study: the 3,805-patient cohort, which reports 5 major complications across that total.
And it is a survey. It depends on what each surgeon recalls and chooses to report. The authors themselves conclude the technique «appears to be well adopted and safe according to the surgeons who practice it» — that last qualifier is theirs.
Who signs it
Five authors, led by Dr. Raúl Manzaneda Cipriani, the creator of the technique. This is not an independent study, and that should be said.