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Nguyen N, Doan L, Jiang F, Chu MW, Liu YY, Francis SH, Kim H, Lee JC. Ambulatory facial feminization surgery: a comparative analysis of outcomes and complications. J Plast Reconstr Aesthet Surg 2024; 93:30-35. [PMID: 38631083 DOI: 10.1016/j.bjps.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/18/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND To date, there are no studies investigating the safety and outcomes of facial feminization surgery (FFS) as an outpatient procedure. This is the first study of its kind analyzing the outcomes of ambulatory FFS based on a comparison of complications, post-operative emergency department or urgent care (ED/UC) visits, and readmissions between patients who underwent FFS with admission versus same-day surgery. METHODS A retrospective analysis was conducted on all patients who underwent FFS in a single integrated healthcare system. Patient charts were reviewed for operative details, complications, post-operative ED/UC visits, readmission, and demographic factors. Major outcomes including complications, readmissions, and ED/UC visits were compared between groups with same-day discharge and post-operative hospital admission. RESULTS Of 242 patients included in the study, ED/UC visits were comparable between patients discharged same-day (18.2%) and patients admitted post-operatively (21.6%, p = 0.52). Logistic regression showed no significant difference in the composite outcomes of minor complications, major complications, and readmissions (15.6% for ambulatory versus 19.3% for admission, p = 0.46). Temporary nerve palsy, infection, and hematoma were the most common post-operative complications. However, covariates of a lower face procedure and operative time were shown to have significant differences in the composite complication outcome (p = 0.04 and p = 0.045, respectively). CONCLUSION Ambulatory FFS is a safe practice with no associated increase in adverse outcomes including complications, ED/UC visits, and readmission when compared to post-operative admission. Adoption of same-day FFS should be considered by high-volume gender health centers to potentially benefit from increased scheduling flexibility and efficiency, increased access to care, and lower healthcare costs.
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Affiliation(s)
- Nghiem Nguyen
- Kaiser Permanente Bernard J. Tyson School of Medicine, Los Angeles, CA, USA
| | - Leandra Doan
- Kaiser Permanente Bernard J. Tyson School of Medicine, Los Angeles, CA, USA
| | - Fang Jiang
- Southern California Permanente Medical Group, Los Angeles, CA, USA
| | - Michael W Chu
- Kaiser Permanente Bernard J. Tyson School of Medicine, Los Angeles, CA, USA; Southern California Permanente Medical Group, Los Angeles, CA, USA; Division of Plastic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Yuan Y Liu
- Southern California Permanente Medical Group, Los Angeles, CA, USA
| | - Stacey H Francis
- Kaiser Permanente Bernard J. Tyson School of Medicine, Los Angeles, CA, USA; Southern California Permanente Medical Group, Los Angeles, CA, USA; Division of Plastic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Holly Kim
- Kaiser Permanente Bernard J. Tyson School of Medicine, Los Angeles, CA, USA; Southern California Permanente Medical Group, Los Angeles, CA, USA
| | - James C Lee
- Kaiser Permanente Bernard J. Tyson School of Medicine, Los Angeles, CA, USA; Southern California Permanente Medical Group, Los Angeles, CA, USA; Division of Plastic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA.
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Sergesketter AR, Shammas RL, Geng Y, Levinson H, Matros E, Phillips BT. Tracking Complications and Unplanned Healthcare Utilization in Aesthetic Surgery: An Analysis of 214,504 Patients Using the TOPS Database. Plast Reconstr Surg 2023; 151:1169-1178. [PMID: 36728533 PMCID: PMC10790563 DOI: 10.1097/prs.0000000000010148] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Tracking surgical complications and unplanned healthcare utilization is essential to inform quality initiatives in aesthetic surgery. This study used the Tracking Operations and Outcomes for Plastic Surgeons database to characterize rates and predictors of surgical complications and unplanned healthcare utilization across common aesthetic surgery procedures. METHODS The Tracking Operations and Outcomes for Plastic Surgeons database was queried for all patients undergoing breast augmentation, liposuction, blepharoplasty, rhinoplasty, and abdominoplasty from 2008 to 2019. Incidence and risk factors for complications and unplanned readmission, reoperation, and emergency room visits were determined. RESULTS A total of 214,504 patients were identified. Overall, 94,618 breast augmentations, 56,756 liposuction procedures, 29,797 blepharoplasties, 24,946 abdominoplasties, and 8387 rhinoplasties were included. A low incidence of perioperative complications was found, including seroma (1.1%), hematoma (0.7%), superficial wound complication (0.9%), deep surgical-site infection (0.2%), need for blood transfusion (0.05%), and deep venous thrombosis/pulmonary embolism (0.1%). Incidence of unplanned readmission, emergency room visits, and reoperation were 0.34%, 0.25%, and 0.80%, respectively. Patients who underwent an abdominoplasty more commonly presented to the emergency room and had unplanned readmissions or reoperations compared with other studied procedures. Furthermore, increased age, diabetes, higher body mass index, American Society of Anesthesiologists class, longer operative times, and pursuit of combined aesthetic procedures were associated with increased risk for unplanned health care use. CONCLUSIONS There is a low incidence of perioperative complications and unplanned healthcare utilization following common aesthetic surgery procedures. Continued entry into large national databases in aesthetic surgery is essential for internal benchmarking and quality improvement. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
| | - Ronnie L. Shammas
- Division of Plastic, Oral, and Maxillofacial Surgery, Duke University, Durham, NC
| | | | - Howard Levinson
- Division of Plastic, Oral, and Maxillofacial Surgery, Duke University, Durham, NC
| | - Evan Matros
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Brett T. Phillips
- Division of Plastic, Oral, and Maxillofacial Surgery, Duke University, Durham, NC
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Nasser JS, Chung KC. Implementation Science in Surgery: Translating Outcomes to Action. Plast Reconstr Surg 2023; 151:237-243. [PMID: 36696301 DOI: 10.1097/prs.0000000000009822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Jacob S Nasser
- From The George Washington School of Medicine and Health Sciences
| | - Kevin C Chung
- Section of Plastic Surgery, University of Michigan Medical School
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Kuuskeri M, Suorsa ET, Luukkaala TH, Palve JS. Day surgery in reduction mammaplasty - saving money or increasing complications? J Plast Reconstr Aesthet Surg 2023; 76:174-179. [PMID: 36521263 DOI: 10.1016/j.bjps.2022.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/21/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The benefits of reduction mammoplasty procedures have been reported previously. However, to control the rise in public healthcare costs, we need to find ways of conducting these procedures safely and more cost-effectively. Our aim was to examine whether reduction mammaplasty performed in an outpatient setting has comparable surgical complication rates to those performed in an inpatient setting. We also investigated whether any savings gained from day surgery are still present after any possible indirect costs are considered. METHODS The study population comprised 276 patients who underwent reduction mammaplasty in a single center between January 2019 and February 2021. Data were collected from patient medical records. The costs associated with the primary procedure and any possible additional expenses were calculated. Basic statistical comparisons were performed for propensity score-matched data. RESULTS Complication rates, readmissions, number of contacts to the health care system, and need for additional surgical interventions were comparable between outpatients and inpatients. The basic costs for outpatients were 2990 euros per patient and 3923 euros for inpatients. Total costs after possible extra expenses were lower in day surgery as it was markedly more cost-effective than patients treated as inpatients. CONCLUSIONS Reduction mammaplasties can be safely performed in an outpatient setting. Moreover, the emergence of complications is comparable to those performed in an inpatient setting. An outpatient setting produced significant cost savings not only in the immediate costs of primary surgery but also in the costs associated with possible complications and extra contacts to the healthcare system.
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Affiliation(s)
- Mmh Kuuskeri
- Department of Plastic Surgery, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Elämänaukio 2, Tampere 33521, Finland.
| | - E T Suorsa
- Department of Plastic Surgery, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Elämänaukio 2, Tampere 33521, Finland
| | - T H Luukkaala
- Research, Development and Innovation Center, Faculty of Social Sciences, Tampere University Hospital and Unit of Health Sciences, Tampere University, Finland
| | - J S Palve
- Department of Plastic Surgery, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Elämänaukio 2, Tampere 33521, Finland
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Office-based Plastic Surgery-Evidence-based Clinical and Administrative Guidelines. Plast Reconstr Surg Glob Open 2022; 10:e4634. [PMID: 36381487 PMCID: PMC9645793 DOI: 10.1097/gox.0000000000004634] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/08/2022] [Indexed: 12/15/2022]
Abstract
Outpatient procedures are extremely prevalent in plastic surgery, with an estimated 82% of cosmetic plastic surgery occurring in this setting. Given that patient safety is paramount, this practical review summarizes major contemporary, evidence-based recommendations regarding office-based plastic surgery. These recommendations not only outline clinical aspects of patient safety guidelines, but administrative, as well, which in combination will provide the reader/practice with a structure and culture that is conducive to the commitment to patient safety. Proper protocols to address potential issues and emergencies that can arise in office-based surgery, and staff familiarity with thereof, are also necessary to be best prepared for such situations.
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ElAbd R, AlMojel M, AlSabah S, AlRashid A, AlNesf M, Alhallabi B, Burezq H. Complications Post Abdominoplasty After Surgical Versus Non-surgical Massive Weight Loss: a Comparative Study. Obes Surg 2022; 32:3847-3853. [PMID: 36208387 DOI: 10.1007/s11695-022-06309-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 09/24/2022] [Accepted: 09/28/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aims to investigate the rate of short- and long-term complications as well as the need for operative revisions after abdominoplasty for patients following surgical versus non-surgical weight loss methods. METHODS This is a retrospective chart review that enrolled consecutive patients undergoing abdominoplasty across a 5-year period, aged 18 years and above, opting for abdominoplasty after weight loss achieved through bariatric surgery or diet and exercise alone. RESULTS A total of 364 patients lost weight through bariatric surgery and 106 by diet and exercise alone. There were no significant differences in comorbidity status, but past body mass index (BMI) was higher for the surgical weight loss (SW) group (47.6 ± 10.2 and 40.4 ± 8.6, respectively; p value < 0.0001). Percent excess weight loss (EWL) was 68 ± 14.5 for the SW group and 55.7 ± 19.4 for the NSW group, p value < 0.0001. Pre- and postoperative blood hemoglobin levels were significantly lower in the SW group (p < 0.05). Neither short-term complications (thromboembolic events, wound complications, or infections) nor long-term complications (umbilical deformity, delayed wound healing, or infection) and operative revisions were significantly different across both groups (p > .05). CONCLUSION Bariatric surgery does not increase the risk of short- or long-term complications or the need for operative revision after abdominoplasty.
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Affiliation(s)
- Rawan ElAbd
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, QC, Canada
- Department of Surgery, Jaber Al Ahmed Hospital, Kuwait City, Kuwait
| | - Malak AlMojel
- Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Salman AlSabah
- Department of Surgery, Jaber Al Ahmed Hospital, Kuwait City, Kuwait.
- Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.
| | - Abdulaziz AlRashid
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Meshari AlNesf
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Becher Alhallabi
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, QC, Canada
- Division of Plastic and Reconstructive Surgery, Hôpital De Saint-Jérôme, Saint-Jérôme, QC, Canada
| | - Hisham Burezq
- Al-Babtain Center for Burns and Plastic Surgery, Shuwaikh City, Kuwait
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Sergesketter AR, Geng Y, Shammas RL, Denis GV, Bachelder R, Hollenbeck ST. The Association Between Metabolic Derangement and Wound Complications in Elective Plastic Surgery. J Surg Res 2022; 278:39-48. [PMID: 35588573 PMCID: PMC9329200 DOI: 10.1016/j.jss.2022.03.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 02/17/2022] [Accepted: 03/19/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The incidence of metabolically unhealthy obesity is rising nationally. In this study, we compare wound and overall complications between metabolically unhealthy obese and healthy patients undergoing elective plastic surgery and model how operative time influences a complication risk. METHODS Patients undergoing elective breast and body plastic surgery procedures in the 2009-2019 National Surgical Quality Improvement Program (NSQIP) dataset were identified. Complications were compared between metabolically unhealthy obese (body mass index [BMI] > 30 with diabetes and/or hypertension) versus metabolically healthy obese patients (BMI > 30 without diabetes or hypertension). Logistic regression was used to model the probability of wound complications across operative times stratified by metabolic status. RESULTS Of 139,352 patients, 13.4% (n = 18,663) had metabolically unhealthy obesity and 23.8% (n = 33,135) had metabolically healthy obesity. Compared to metabolically healthy patients, metabolically unhealthy patients had higher incidence of wound complications (6.9% versus 5.6%; P < 0.001) and adverse events (12.4% versus 9.6%; P < 0.001), in addition to higher 30-d readmission, returns to the operating room, and length of stay (all P < 0.001). After adjustment, BMI (Odds ratio [OR] 7.86), hypertension (OR 1.15), and diabetes (OR 1.25) were independent risk factors for wound complications (all P < 0.001). Among metabolically unhealthy patients, the operative time was log-linear with a wound complication risk (OR 1.21; P < 0.001). CONCLUSIONS Diabetes and hypertension are additive risk factors with obesity for wound complications in elective plastic surgery. Among patients with metabolically unhealthy obesity, a risk of wound complications increases logarithmically with operative time. This distinction with regard to metabolic state might explain the unclear impact of obesity on surgical outcomes within existing surgical literature.
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Affiliation(s)
- Amanda R Sergesketter
- Division of Plastic, Oral, and Maxillofacial Surgery, Duke University, Durham, North Carolina
| | | | - Ronnie L Shammas
- Division of Plastic, Oral, and Maxillofacial Surgery, Duke University, Durham, North Carolina
| | - Gerald V Denis
- Section of Hematology/Oncology, Boston University School of Medicine, Boston, Massachusetts
| | - Robin Bachelder
- Division of Plastic, Oral, and Maxillofacial Surgery, Duke University, Durham, North Carolina
| | - Scott T Hollenbeck
- Division of Plastic, Oral, and Maxillofacial Surgery, Duke University, Durham, North Carolina.
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Nationally Validated Scoring System to Predict Unplanned Reoperation and Readmission after Breast Reduction. Aesthetic Plast Surg 2022; 46:2140-2151. [PMID: 35764811 DOI: 10.1007/s00266-022-02966-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/19/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Reduction mammoplasty continues to be a commonly sought procedure with complication rates ranging from 4.3 to 8.2%. In the current study, we sought to identify the clinical and preoperative risk factors for unplanned reoperation and readmission within the first postoperative month on a national scale. METHODS Patients who underwent reduction mammoplasty from the ACS-NSQIP 2012-2019 database were analyzed to determine rates of reoperation and readmission within 30 days of the initial breast surgery. The cohort was divided into 60 and 40% random testing and validation samples. A multivariable logistic regression analysis was then performed to isolate independent factors of unplanned readmission and reoperation using the testing sample (n = 22,743). The predictors were weighted according to beta coefficients to develop an integer-based clinical risk score predictive of complications. This system was then validated using receiver operating characteristics (ROC) analysis of the validation sample (n = 15,162). RESULTS A total of 37,905 reduction mammoplasties were analyzed. 1.3% of patients had an unplanned readmission. Independent risk factors for unplanned readmission included age older than the median of 44 years (p < 0.01), inpatient procedure (p < 0.01), smoking (p < 0.01), hypertension (p = 0.01), COPD (p < 0.05), BMI ≥ 35 (p < 0.01), and operation time greater than the median of 142 minutes ( p < 0.01). The factors were integrated into a scoring system, ranging from 0 to 36, and an ROC analysis revealed an area under the curve of 0.66. 1.9% of patients underwent unplanned reoperation. Independent risk factors for unplanned reoperation in this population included age older than the median of 44 years (p < 0.01), inpatient status (p < 0.01), and a history of bleeding disorders (p < 0.05). The factors were integrated into a scoring system, ranging from 0 to 25, and the ROC analysis revealed an area under the curve of 0.61. CONCLUSIONS We present a validated scoring system to better inform patients about their risk for unplanned reoperation and readmission following reduction mammoplasty. This system will enable surgeons to optimize patient selection and interventions in order to decrease morbidity and unnecessary health-care expenditure. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Massada KE, Baltodano PA, Webster TK, Elmer NA, Zhao H, Lu X, Kaplunov BS, Araya S, Brebion R, Coronado M, Patel SA. Optimizing Abdominoplasty Surgical Site Morbidity Profiling Through an Effective and Nationally Validated Risk Scoring System. Ann Plast Surg 2022; 88:S274-S278. [PMID: 35513330 DOI: 10.1097/sap.0000000000003115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Abdominoplasty complication rates are among the highest for cosmetic surgery. We sought to create a validated scoring system to predict the likelihood of wound complications after abdominoplasty using a national multi-institutional database. METHODS Patients who underwent abdominoplasty in the American College of Surgeons National Surgical Quality Improvement Program 2007-2019 database were analyzed for surgical site complications, a composite outcome of wound disruption, and surgical site infections. The cohort was randomly divided into a 60% testing and a 40% validation sample. Multivariable logistic regression analysis was performed to identify independent predictors of complications using the testing sample (n = 11,294). The predictors were weighted according to β coefficients to develop an integer-based clinical risk score. This system was validated using receiver operating characteristic analysis of the validation sample (n = 7528). RESULTS A total of 18,822 abdominoplasty procedures were identified. The proportion of patients who developed a composite surgical site complication was 6.8%. Independent risk factors for composite surgical site complication included inpatient procedure (P < 0.01), smoking (P < 0.01), American Society of Anesthesiologists class ≥3 (P < 0.01), and body mass index ≥25.0 and ≤18.0 kg/m2 (P < 0.01). African American race was a protective factor against surgical site complications (P < 0.01). The factors were integrated into a scoring system, ranging from -5 to 42, and the receiver operating characteristic analysis revealed an area under the curve of 0.71. CONCLUSIONS We present a validated scoring system for postoperative 30-day surgical site morbidity after abdominoplasty. This system will enable surgeons to optimize patient selection to decrease morbidity and unnecessary healthcare expenditure.
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Affiliation(s)
- Karen E Massada
- From the Department of General Surgery, Mercy Catholic Medical Center
| | - Pablo A Baltodano
- Fox Chase Cancer Center/Division of Plastic and Reconstructive Surgery, Temple University
| | - Theresa K Webster
- Fox Chase Cancer Center/Division of Plastic and Reconstructive Surgery, Temple University
| | | | - Huaqing Zhao
- Biostatistics and Bioinformatics Facility, Temple University Health System, Philadelphia, PA
| | - Xiaoning Lu
- Biostatistics and Bioinformatics Facility, Temple University Health System, Philadelphia, PA
| | - Briana S Kaplunov
- Fox Chase Cancer Center/Division of Plastic and Reconstructive Surgery, Temple University
| | - Sthefano Araya
- Fox Chase Cancer Center/Division of Plastic and Reconstructive Surgery, Temple University
| | - Rohan Brebion
- Fox Chase Cancer Center/Division of Plastic and Reconstructive Surgery, Temple University
| | - Michael Coronado
- Fox Chase Cancer Center/Division of Plastic and Reconstructive Surgery, Temple University
| | - Sameer A Patel
- Fox Chase Cancer Center/Division of Plastic and Reconstructive Surgery, Temple University
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ElHawary H, Hintermayer MA, Alam P, Brunetti VC, Janis JE. Decreasing Surgical Site Infections in Plastic Surgery: A Systematic Review and Meta-analysis of Level 1 Evidence. Aesthet Surg J 2021; 41:NP948-NP958. [PMID: 33693462 DOI: 10.1093/asj/sjab119] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although many interventions are implemented to prevent surgical site infections (SSIs) in plastic surgery, their supporting evidence is inconsistent. OBJECTIVES The goal of this study was to assess the efficacy of methods for decreasing SSIs in plastic surgery. METHODS A systematic review and meta-analysis were performed to compare the effects of SSI prevention methods. All the studies were assessed for quality of evidence according to the GRADE assessment. RESULTS Fifty Level 1 randomized controlled trials were included. The most common interventions for preventing SSIs were antibiotic prophylaxis, showering, prepping, draping, and the use of dressings. Current evidence suggests that antibiotic prophylaxis is largely unnecessary and overused in many plastic surgical procedures, with the exception of head and neck oncologic, oral craniofacial, and traumatic hand surgeries. CONCLUSIONS Efficacy of antibiotic prophylaxis in plastic surgery is dependent on surgery type. There is a lack evidence that showering and prepping with chlorohexidine and povidone reduces SSIs. LEVEL OF EVIDENCE: 1
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Affiliation(s)
- Hassan ElHawary
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Canada
| | | | - Peter Alam
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Canada
| | | | - Jeffrey E Janis
- Department of Plastic and Reconstructive Surgery, Ohio State University Wexner Medical Center, Columbus, OH, USA
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Impact on Abdominal Skin Perfusion following Abdominoplasty. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3343. [PMID: 33564578 PMCID: PMC7858225 DOI: 10.1097/gox.0000000000003343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/11/2020] [Indexed: 11/25/2022]
Abstract
Wound healing problems following abdominoplasty may be a result of impaired tissue perfusion. This study evaluated the impact a standard abdominoplasty may have on abdominal skin perfusion.
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12
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Systematic Review of Complications and Recurrences After Surgical Interventions in Hidradenitis Suppurativa. Dermatol Surg 2020; 46:914-921. [PMID: 32049703 DOI: 10.1097/dss.0000000000002323] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The possible connection between hidradenitis suppurativa (HS) patients undergoing surgery and higher complications/recurrences has been implied, but inconsistent results reported. OBJECTIVE To assess the complication and recurrence rates for HS patients undergoing surgery and to evaluate whether known HS comorbidities and habits (smoking, obesity and diabetes) have an effect on the complication and recurrence rates. MATERIALS AND METHODS A systematic review was conducted by 2 reviewers. PubMed and Embase were searched using a predefined search string created in collaboration between the authors and a librarian on January 23, 2019. RESULTS Of the 271 references in the original search, 54 relevant articles were identified. This systematic review indicates an overall mean complication rate of 24% and a mean recurrence rate of 20.1% for HS patients undergoing surgery. CONCLUSION No significant association between the known surgical risk factors and surgical complications-or recurrence rates in this patient group was found. This review revealed a lack of quality and quantity data in studying the complications/recurrences. The heterogeneity of the studies created limitations, and the presented mean complication/recurrence rates should be interpreted with the consequences thereof. It elucidates the need for better studies and a necessity for a standardized definition of postsurgical HS recurrence.
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Unplanned 30-day readmission rates after plastic and reconstructive surgery procedures: a systematic review and meta-analysis. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-020-01731-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Teja B, Raub D, Friedrich S, Rostin P, Patrocínio MD, Schneider JC, Shen C, Brat GA, Houle TT, Yeh RW, Eikermann M. Incidence, Prediction, and Causes of Unplanned 30-Day Hospital Admission After Ambulatory Procedures. Anesth Analg 2020; 131:497-507. [DOI: 10.1213/ane.0000000000004852] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Chen CL, Most SP, Branham GH, Spataro EA. Postoperative Complications of Paramedian Forehead Flap Reconstruction. JAMA FACIAL PLAST SU 2020; 21:298-304. [PMID: 30869737 DOI: 10.1001/jamafacial.2018.1855] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Paramedian forehead flaps are commonly used to reconstruct facial defects caused by skin cancers. Data are lacking on the complications from this procedure, postoperative outcomes, and association of cancer diagnosis with rate of deep venous thrombosis (DVT). Objectives The primary objective was to determine complication rates after paramedian forehead flap reconstruction for defects resulting from resection of facial cancers; and the secondary objective was to determine patient factors and complications that are associated with readmission. Design, Setting, and Participants Retrospective cohort study of patients who underwent paramedian forehead flap reconstruction for skin cancer reconstruction from January 1, 2007, through December 31, 2013. Data analysis took place between October 1, 2017, and June 1, 2018. Main Outcomes and Measures Complication rates including DVT, emergency department visits, and hospital readmissions. Results A total of 2175 patient were included in this study; mean (SD) age, 70.3 (13.4) years; 1153 (53.5%) were men. Postoperative DVT occurred in 10 or fewer patients (≤0.5%); postoperative bleeding in 30 (1.4%), and postoperative infection in 63 (2.9%). Most patients went home on the day of surgery (89.6%; n = 1949), while 10.4% stayed one or more days in the hospital (n = 226). Overnight admission was associated with tobacco use (odds ratio [OR], 1.65; 95% CI, 1.11-2.44), hypothyroidism (OR, 1.93; 95% CI, 1.10-3.39), hypertension (OR, 1.82; 95% CI, 1.29-2.57), ear cartilage graft (OR, 2.20; 95% CI, 1.51-3.21), and adjacent tissue transfer (OR, 1.88; 95% CI, 1.33-2.67). Risk factors strongly associated with immediate return to the emergency department or readmission within 48 hours of surgery included postoperative bleeding (OR, 13.05; 95% CI, 4.24-40.16), neurologic disorder (OR, 4.11; 95% CI, 1.12-15.09), and alcohol use (OR, 7.70; 95% CI, 1.55-38.21). Conclusions and Relevance In this study, the most common complication of paramedian forehead flap reconstruction was infection. Risk factors for readmission included development of postoperative bleeding, having a neurologic disorder, and alcohol use. Deep venous thrombosis was a rare complication. Because bleeding is a more common complication in this patient population, discretion should be used when deciding to administer anticoagulation medication to low- to medium-risk patients prior to surgery. Level of Evidence NA.
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Affiliation(s)
- Collin L Chen
- Division of Facial Plastic and Reconstructive Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Sam P Most
- Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California.,Associate Editor
| | - Gregory H Branham
- Division of Facial Plastic and Reconstructive Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Emily A Spataro
- Division of Facial Plastic and Reconstructive Surgery, Washington University School of Medicine, St Louis, Missouri
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Riddle KR, Malhotra R, Ayyala HS, Datiashvili RO. The Impact of Metabolic Syndrome on Patients Undergoing Breast Reduction Surgery. Obes Surg 2019; 30:2434-2436. [PMID: 31858396 DOI: 10.1007/s11695-019-04360-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Metabolic syndrome affects 35% of individuals in the USA and has been correlated with increased complications following certain surgical procedures. There has been an increase of 11% in breast reduction procedures from 2016 to 2017 making it the seventh most common reconstructive procedure in the USA. Previous studies have identified an increase in demand for breast reduction among obese patients with BMI ≥ 30 but have not defined the role of metabolic syndrome in surgical outcomes. The authors aim to investigate the impact of metabolic syndrome on 30-day postoperative morbidity and mortality in patients who underwent reduction mammoplasty.
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Affiliation(s)
- Kristin R Riddle
- Rutgers - New Jersey Medical School, Division of Plastic and Reconstructive Surgery, Department of Surgery, 140 Bergen St Suite E1620, Newark, NJ, 07103, USA
| | - Radhika Malhotra
- Rutgers - New Jersey Medical School, Division of Plastic and Reconstructive Surgery, Department of Surgery, 140 Bergen St Suite E1620, Newark, NJ, 07103, USA
| | - Haripriya S Ayyala
- Rutgers - New Jersey Medical School, Division of Plastic and Reconstructive Surgery, Department of Surgery, 140 Bergen St Suite E1620, Newark, NJ, 07103, USA.
| | - Ramazi O Datiashvili
- Rutgers - New Jersey Medical School, Division of Plastic and Reconstructive Surgery, Department of Surgery, 140 Bergen St Suite E1620, Newark, NJ, 07103, USA
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Risk Factors for Surgical Site Infections After Orthopaedic Surgery in the Ambulatory Surgical Center Setting. J Am Acad Orthop Surg 2019; 27:e928-e934. [PMID: 30608278 DOI: 10.5435/jaaos-d-17-00861] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION This study was designed to determine the incidence of surgical site infections (SSIs) after orthopaedic surgery in an ambulatory surgery center (ASC) and to identify patient and surgical risk factors associated with SSI. METHODS Patients who underwent orthopaedic surgery at an ASC over a 6.5-year period were reviewed for evidence of SSI. Data on patient and surgical factors were collected, and stepwise multivariate logistic regression determined the risk factors for SSI. RESULTS The incidence of SSIs was 0.32%. Five independent factors were associated with SSI: anatomic area (odds ratio [OR] = 18.60, 11.24, 6.75, and 4.01 for the hip, foot/ankle, knee/leg, and hand/elbow versus shoulder, respectively), anesthesia type (OR = 4.49 combined general and regional anesthesia versus general anesthesia), age ≥70 (OR = 2.85), diabetes mellitus (OR = 2.27), and tourniquet time (OR = 1.01 per minute tourniquet time). DISCUSSION The risk of infection after orthopaedic surgery in ASCs is low, but patient and surgical factors are independently associated with SSIs.
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Hunecke P, Toll M, Mann O, Izbicki JR, Blessmann M, Grupp K. Clinical outcome of patients undergoing abdominoplasty after massive weight loss. Surg Obes Relat Dis 2019; 15:1362-1366. [PMID: 31296446 DOI: 10.1016/j.soard.2019.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/20/2019] [Accepted: 06/04/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Abdominoplasty is one of the most commonly performed surgical procedures to reshape the body contour in patients who have undergone massive weight loss. OBJECTIVES This study was undertaken to assess the clinical outcome, complication rates, and risk factors for complications of patients undergoing abdominoplasty after massive weight loss. SETTING University Medical Centre Hamburg-Eppendorf, Hamburg, Germany. METHOD Clinical outcome was retrospectively analyzed in 121 patients, who underwent abdominoplasty. The retrospective analysis included demographic data of patients, such as sex, age, body mass index (BMI), and pre-existing illnesses. Moreover, postoperative complications including seroma, hematoma, wound infection, and tissue necrosis were analyzed. RESULTS In our study cohort, the median age was 43.7 years, the median weight was 94.7 kg, and the median BMI was 32.3 kg/m2. The majority of included patients were women (70.3%). Death occurred in none of the patients. Among individuals, wound infection occurred in 3.3%, tissue necrosis in 1.7%, seroma in 7.4%, and hematoma in 3.3% of patients during the postoperative course. Reoperations were necessary in 2 patients (1.7%) due to postoperative bleeding and tissue necrosis of the navel. Tissue necrosis was significantly more often seen in a subset individual with type 2 diabetes (P = .006). Moreover, the rate of reoperations was significantly higher in patients with pre-existing cardiovascular illnesses compared with cardiovascular healthy patients (P = .036). Multivariate analysis analyzing risk factors for postoperative complications, including sex, age, BMI, diabetes, pulmonary disease, and cardiovascular disease, revealed strong independent relevance for type 2 diabetes (P = .024). CONCLUSIONS We found that abdominoplasty is a safe operative procedure. In addition, the risk for complications is significantly increased in the subgroup of diabetic patients and patients with cardiovascular diseases.
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Affiliation(s)
- Pauline Hunecke
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Marianne Toll
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Mann
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob Robert Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Marco Blessmann
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Grupp
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
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Rosenfield LK, Davis CR. Evidence-Based Abdominoplasty Review With Body Contouring Algorithm. Aesthet Surg J 2019; 39:643-661. [PMID: 30649214 DOI: 10.1093/asj/sjz013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abdominal contour deformities are an aesthetic challenge to the plastic surgeon. Patients present with diverse clinical histories, multiple comorbidities, and unique aesthetic demands. Weight loss, previous pregnancy, and aging are 3 principal indications for abdominoplasty. Bariatric surgery has increased demand for body contouring procedures. This heterogeneous patient cohort means a "one-size-fits-all" abdominoplasty is not appropriate. Precise evaluation, evidence-based decision-making, and artistic acumen are required while balancing patient goals with safe, realistic, and long-lasting aesthetic outcomes. This article reviews surgical options for abdominal body contouring, providing an evidence-based treatment algorithm for selecting the appropriate procedure for each patient to maximize clinical and patient reported outcomes.
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Affiliation(s)
- Lorne K Rosenfield
- University of California, San Francisco, CA
- Stanford University, Stanford, CA
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Rothenberg KA, Stern JR, George EL, Trickey AW, Morris AM, Hall DE, Johanning JM, Hawn MT, Arya S. Association of Frailty and Postoperative Complications With Unplanned Readmissions After Elective Outpatient Surgery. JAMA Netw Open 2019; 2:e194330. [PMID: 31125103 PMCID: PMC6632151 DOI: 10.1001/jamanetworkopen.2019.4330] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Ambulatory surgery in geriatric populations is increasingly prevalent. Prior studies have demonstrated the association between frailty and readmissions in the inpatient setting. However, few data exist regarding the association between frailty and readmissions after outpatient procedures. OBJECTIVE To examine the association between frailty and 30-day unplanned readmissions after elective outpatient surgical procedures as well as the potential mediation of surgical complications. DESIGN, SETTING, AND PARTICIPANTS In this retrospective cohort study of elective outpatient procedures from 2012 and 2013 in the National Surgical Quality Improvement Program (NSQIP) database, 417 840 patients who underwent elective outpatient procedures were stratified into cohorts of individuals with a length of stay (LOS) of 0 days (LOS = 0) and those with a LOS of 1 or more days (LOS ≥ 1). Statistical analysis was performed from June 1, 2018, to March 31, 2019. EXPOSURE Frailty, as measured by the Risk Analysis Index. MAIN OUTCOMES AND MEASURES The main outcome was 30-day unplanned readmission. RESULTS Of the 417 840 patients in this study, 59.2% were women and unplanned readmission occurred in 2.3% of the cohort overall (LOS = 0, 2.0%; LOS ≥ 1, 3.4%). Frail patients (mean [SD] age, 64.9 [15.5] years) were more likely than nonfrail patients (mean [SD] age, 35.0 [15.8] years) to have an unplanned readmission in both LOS cohorts (LOS = 0, 8.3% vs 1.9%; LOS ≥ 1, 8.5% vs 3.2%; P < .001). Frail patients were also more likely than nonfrail patients to experience complications in both cohorts (LOS = 0, 6.9% vs 2.5%; LOS ≥ 1, 9.8% vs 4.6%; P < .001). In multivariate analysis, frailty doubled the risk of unplanned readmission (LOS = 0: adjusted relative risk [RR], 2.1; 95% CI, 2.0-2.3; LOS ≥ 1: adjusted RR, 1.8; 95% CI, 1.6-2.1). Complications occurred in 3.1% of the entire cohort, and frailty was associated with increased risk of complications (unadjusted RR, 2.6; 95% CI, 2.4-2.8). Mediation analysis confirmed that complications are a significant mediator in the association between frailty and readmissions; however, it also indicated that the association of frailty with readmission was only partially mediated by complications (LOS = 0, 22.8%; LOS ≥ 1, 29.3%). CONCLUSIONS AND RELEVANCE These findings suggest that frailty is a significant risk factor for unplanned readmission after elective outpatient surgery both independently and when partially mediated through increased complications. Screening for frailty might inform the development of interventions to decrease unplanned readmissions, including those for outpatient procedures.
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Affiliation(s)
- Kara A. Rothenberg
- Stanford–Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Jordan R. Stern
- Stanford–Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
- Surgical Service, Veterans Affairs Palo Alto Health System, Palo Alto, California
| | - Elizabeth L. George
- Stanford–Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Amber W. Trickey
- Stanford–Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Arden M. Morris
- Stanford–Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Daniel E. Hall
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Wolffe Center at UPMC, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jason M. Johanning
- Department of Surgery, University of Nebraska College of Medicine, Omaha
| | - Mary T. Hawn
- Stanford–Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Shipra Arya
- Stanford–Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
- Surgical Service, Veterans Affairs Palo Alto Health System, Palo Alto, California
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21
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Augustine HFM, Hu J, Najarali Z, McRae M. Scoping Review of the National Surgical Quality Improvement Program in Plastic Surgery Research. Plast Surg (Oakv) 2019; 27:54-65. [PMID: 30854363 DOI: 10.1177/2292550318800499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The National Surgical Quality Improvement Program (NSQIP) is a robust, high-quality surgical outcomes database that measures risk-adjusted 30-day outcomes of surgical interventions. The purpose of this scoping review is to describe how the NSQIP is being used in plastic surgery research. Methods A comprehensive electronic literature search was completed in PubMed, Embase, MEDLINE, and CINAHL. Two reviewers independently reviewed articles to determine their relevance using predefined inclusion criteria. Articles were included if they utilized NSQIP data to conduct research in a domain of plastic surgery or analyzed surgical procedures completed by plastic surgeons. Extracted information included the domain of plastic surgery, country of origin, journal, and year of publication. Results A total of 106 articles met the inclusion criteria. The most common domain of plastic surgery was breast reconstruction representing 35% of the articles. Of the 106 articles, 95% were published within the last 5 years. The Plastic and Reconstructive Surgery journal published most of the (59%) NSQIP-related articles. All of the studies were retrospective. Of note, there were no articles on burns and only one study on trauma as the domain of plastic surgery. Conclusion This scoping review describes how NSQIP data are being used to analyze plastic surgery interventions and outcomes in order to guide quality improvement in 106 articles. It demonstrates the utility of NSQIP in the literature, however also identifies some limitations of the program as it applies to plastic surgery.
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Affiliation(s)
- Haley F M Augustine
- Department of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jiayi Hu
- Department of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Zainab Najarali
- Department of Family Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Matthew McRae
- Department of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
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Malard O, Michel G, Espitalier F. Outpatient management in plastic and reconstructive head and neck surgery in France. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:29-32. [DOI: 10.1016/j.anorl.2018.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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National Surgical Quality Improvement Program Analysis of 9110 Reduction Mammaplasty Patients: Identifying Risk Factors Associated With Complications in Patients Older Than 60 Years. Ann Plast Surg 2019; 82:S446-S449. [PMID: 30694846 DOI: 10.1097/sap.0000000000001804] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to identify preoperative risk factors in patients undergoing reduction mammoplasty as well as identify any increased complication risk in patients older than 60 years undergoing reduction mammoplasty. METHODS The American College of Surgeons National Surgical Quality Improvement Program data from years 2013-2015 was reviewed. Patients were identified using Current Procedural Terminology code 19318 specific for reduction mammoplasty. Only patients undergoing bilateral procedures were included, and no reconstructive procedures were included. Patient demographics, comorbidities, and 30-day complications were analyzed. Comparative analysis was performed between patients younger than 60 years and patients 60 years and older, identifying risk factors associated with complications in the geriatric population. RESULTS A total of 9110 patients undergoing reduction mammoplasty were identified. Of these 1442 (15.83%) were patients older than 60 years. Mean age of all patients was 42 years (range, 18-85 years). Eighty hundred fifty-nine patients were active smokers. Four hundred eighty-two patients were diabetic. Overall, 798 complications occurred with an incidence of 8.7%. Group 1 (<60 years) mean age was 39 years (range, 18-59). Group 2 (>60 years) mean age was 66 years (range, 60-85 years). The geriatric population showed a higher risk of cerebral vascular accidents (P < 0.00006), myocardial infarction (P < 0.02), and readmission (P < 0.03). Smoking was found to be a statistically significant risk factor for superficial surgical site infection, and deep space infection. Diabetes was found to be a statistically significant risk factor for readmission. CONCLUSIONS Reduction mammoplasty is a common surgical procedure. It is not uncommon for patients older than 60 years to undergo elective reduction mammoplasty (15.83% incidence), resulting in a cumulative complication rate of 11.65% in the geriatric population compared with 8.89% in the group of patients younger than 60 years. Smoking and diabetes were found to be independent risk factors for complications, regardless of age.
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Kaoutzanis C, Winocour J, Yeslev M, Gupta V, Asokan I, Roostaeian J, Grotting JC, Higdon KK. Aesthetic Surgical Procedures in Men: Major Complications and Associated Risk Factors. Aesthet Surg J 2018; 38:429-441. [PMID: 29045566 DOI: 10.1093/asj/sjx161] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/08/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The number of men undergoing cosmetic surgery is increasing in North America. OBJECTIVES To determine the incidence and risk factors of major complications in males undergoing cosmetic surgery, compare the complication profiles between men and women, and identify specific procedures that are associated with higher risk of complications in males. METHODS A prospective cohort of patients undergoing cosmetic surgery between 2008 and 2013 was identified from the CosmetAssure database. Gender specific procedures were excluded. Primary outcome was occurrence of a major complication in males requiring emergency room visit, hospital admission, or reoperation within 30 days of the index operation. Univariate and multivariate analysis evaluated potential risk factors for major complications including age, body mass index (BMI), smoking, diabetes, type of surgical facility, type of procedure, and combined procedures. RESULTS Of the 129,007 patients, 54,927 underwent gender nonspecific procedures, of which 5801 (10.6%) were males. Women showed a higher mean age (46.4 ± 14.1 vs 45.2 ± 16.7 years, P < 0.01). Men had a higher BMI (27.2 ± 4.7 vs 25.7 ± 4.9 kg/m2, P < 0.01), and were more likely to be smokers (7.1% vs 5.7%, P < 0.01) when compared to women. Men demonstrated similar overall major complication rates compared to women (2.1% vs 2.1%, P = 0.97). When specific complications were analyzed further, men had higher hematoma rates, but lower incidence of surgical site infection. Additionally, major complications after abdominoplasty, facelift surgery, and buttock augmentation were noted to preferentially affect males. On multivariate analysis, independent predictors of major complications in males included BMI (RR 1.05), hospital or ambulatory surgery center procedures (RR 3.47), and combined procedures (RR 2.56). CONCLUSIONS Aesthetic surgery in men is safe with low major complication rates. Modifiable predictors of complications included BMI and combined procedures. LEVEL OF EVIDENCE 2
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Affiliation(s)
| | - Julian Winocour
- Department of Surgery, Division of Plastic Surgery, University of California, Los Angeles, CA
| | - Max Yeslev
- Southeast Permanente Medical Group, Atlanta, GA
| | - Varun Gupta
- Prima Center for Plastic Surgery, Duluth, GA
| | - Ishan Asokan
- Vanderbilt University School of Medicine, Vanderbilt University, Nashville, TN
| | - Jason Roostaeian
- Department of Surgery, Division of Plastic Surgery, University of California, Los Angeles, CA
| | - James C Grotting
- Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL
- CME/MOC Section Editor for Aesthetic Surgery Journal
| | - K Kye Higdon
- Department of Plastic Surgery, Vanderbilt University, Nashville, TN
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Kingery MT, Cuff GE, Hutzler LH, Popovic J, Davidovitch RI, Bosco JA. Total Joint Arthroplasty in Ambulatory Surgery Centers: Analysis of Disqualifying Conditions and the Frequency at Which They Occur. J Arthroplasty 2018; 33:6-9. [PMID: 28870744 DOI: 10.1016/j.arth.2017.07.048] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 07/13/2017] [Accepted: 07/29/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The frequency of total joint arthroplasties (TJAs) performed in ambulatory surgery centers (ASCs) is increasing. However, not all TJA patients are healthy enough to safely undergo these procedures in an ambulatory setting. We examined the percentage of arthroplasty patients who would be eligible to have the procedure performed in a free-standing ASC and the distribution of comorbidities making patients ASC-ineligible. METHODS We reviewed the charts of 3444 patients undergoing TJA and assigned ASC eligibility based on American Society of Anesthesiologists (ASA) status, a set of exclusion criteria, and any existing comorbidities. RESULTS Overall, 70.03% of all patients undergoing TJA were eligible for ASC. Of the ASA class 3 patients who did not meet any exclusion criteria but had systemic disease (51.11% of all ASA class 3 patients), 53.69% were deemed ASC-eligible because of sufficiently low severity of comorbidities. The most frequent reasons for ineligibility were body mass index >40 kg/m2 (32.66% of ineligible patients), severity of comorbidities (28.00%), and untreated obstructive sleep apnea (25.19%). CONCLUSION A large proportion of TJA patients were found to be eligible for surgery in an ASC, including over one-third of ASA class 3 patients. ASC performed TJA provides an opportunity for increased patient satisfaction and decreased costs, selecting the right candidates for the ambulatory setting is critical to maintain patient safety and avoid postoperative complications.
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Affiliation(s)
- Matthew T Kingery
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Germaine E Cuff
- Department of Anesthesiology, NYU Langone Medical Center, Perioperative Care and Pain Medicine, New York, New York
| | - Lorraine H Hutzler
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Jovan Popovic
- Department of Anesthesiology, NYU Langone Medical Center, Perioperative Care and Pain Medicine, New York, New York
| | - Roy I Davidovitch
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Joseph A Bosco
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
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10 Years Later: Lessons Learned from an Academic Multidisciplinary Cosmetic Center. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1459. [PMID: 29062640 PMCID: PMC5640337 DOI: 10.1097/gox.0000000000001459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 07/06/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND In 2006, a Centers for Medicare and Medicaid Services-accredited multidisciplinary academic ambulatory surgery center was established with the goal of delivering high-quality, efficient reconstructive, and cosmetic services in an academic setting. We review our decade-long experience since its establishment. METHODS Clinical and financial data from 2006 to 2016 are reviewed. All cosmetic procedures, including both minimally invasive and operative cases, are included. Data are compared to nationally published reports. RESULTS Nearly 3,500 cosmetic surgeries and 10,000 minimally invasive procedures were performed. Compared with national averages, surgical volume in abdominoplasty is high, whereas rhinoplasty and breast augmentation is low. Regarding trend data, breast augmentation volume has decreased by 25%, whereas minimally invasive procedural volume continues to grow and is comparable with national reports. Similarly, where surgical revenue remains steady, minimally invasive revenue has increased significantly. The majority of surgical cases (70%) are reconstructive in nature and insurance-based. Payer mix is 71% private insurance, 18% Medicare and Medicaid, and 11% self-pay. Despite year-over-year revenue increases, net profit in 2015 was $6,120. Rent and anesthesia costs exceed national averages, and employee salary and wages are the highest expenditure. CONCLUSION Although the creation of our academic cosmetic ambulatory surgery center has greatly increased the overall volume of cosmetic surgery performed at the University of Wisconsin, the majority of surgical volume and revenue is reconstructive. As is seen nationwide, minimally invasive cosmetic procedures represent our most rapidly expanding revenue stream.
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Vieira BL, Dorfman R, Turin S, Gutowski KA. Rates and Predictors of Readmission Following Body Contouring Procedures: An Analysis of 5100 Patients From The National Surgical Quality Improvement Program Database. Aesthet Surg J 2017; 37:917-926. [PMID: 28200103 DOI: 10.1093/asj/sjx012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hospital readmissions can be a major contributor to increased healthcare costs and are a salient current topic in healthcare. There is a paucity of large, prospective studies that evaluate rates and risk factors of readmission within the aesthetic subset of plastic surgery. OBJECTIVES The authors propose to determine the rates of unplanned readmission following body contouring procedures and to analyze the predictors associated with it. METHODS The 2011 and 2012 National Surgical Quality Improvement Program Database was queried for body contouring procedures using the appropriate Current Procedural Terminology codes. The rate of unplanned readmission, preoperative risk factors, comorbidities, and medical and surgical postoperative complications data were analyzed using multivariate regression models to determine predictors of readmission after these procedures. RESULTS We identified 5100 patients who underwent body contouring procedures, of which 142 (2.8%) experienced an unplanned readmission. Forty-eight per cent of readmitted patients experienced at least one surgical complication, and 23.9% experienced at least one medical complication. Multivariate regression analyses identified several independent predictors of unplanned readmission: increasing age (odds ratio [OR] 1.018 per year, P = 0.039), bleeding disorders (OR 3.674, P = 0.039), increased operative time (each additional hour conferring a 20% increased risk), surgical complications (OR 19.179, P < 0.001), and medical complications (OR 10.240, P < 0.001). CONCLUSIONS The unplanned readmission rate for body contouring procedures is low overall (2.8%). We identified age, bleeding disorders, operative duration, and postoperative complication as independent risk factors for unplanned readmission. These data can help guide preoperative risk stratification and future interventions in high-risk patient populations. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Brittany L Vieira
- Ms Vieira is a Medical Student, Mr Dorfman is a Research Fellow, and Dr Turin is a Resident, Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL. Dr Gutowski is an Adjunct Associate Professor of Surgery, Division of Plastic and Reconstructive Surgery, University of Illinois – Chicago, Chicago, IL
| | - Robert Dorfman
- Ms Vieira is a Medical Student, Mr Dorfman is a Research Fellow, and Dr Turin is a Resident, Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL. Dr Gutowski is an Adjunct Associate Professor of Surgery, Division of Plastic and Reconstructive Surgery, University of Illinois – Chicago, Chicago, IL
| | - Sergey Turin
- Ms Vieira is a Medical Student, Mr Dorfman is a Research Fellow, and Dr Turin is a Resident, Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL. Dr Gutowski is an Adjunct Associate Professor of Surgery, Division of Plastic and Reconstructive Surgery, University of Illinois – Chicago, Chicago, IL
| | - Karol A Gutowski
- Ms Vieira is a Medical Student, Mr Dorfman is a Research Fellow, and Dr Turin is a Resident, Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL. Dr Gutowski is an Adjunct Associate Professor of Surgery, Division of Plastic and Reconstructive Surgery, University of Illinois – Chicago, Chicago, IL
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Evidence-Based Strategies to Reduce Postoperative Complications in Plastic Surgery. Plast Reconstr Surg 2017; 138:51S-60S. [PMID: 27556775 DOI: 10.1097/prs.0000000000002774] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Reconstructive plastic surgery is vital in assisting patients with reintegration into society after events such as tumor extirpation, trauma, or infection have left them with a deficit of normal tissue. Apart from performing a technically sound operation, the plastic surgeon must stack the odds in the favor of the patient by optimizing them before and after surgery. The surgeon must look beyond the wound, at the entire patient, and apply fundamental principles of patient optimization. This article reviews the evidence behind the principles of patient optimization that are commonly used in reconstructive surgery patients.
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Sforza M, Husein R, Atkinson C, Zaccheddu R. Unraveling Factors Influencing Early Seroma Formation in Breast Augmentation Surgery. Aesthet Surg J 2017; 37:301-307. [PMID: 28207027 DOI: 10.1093/asj/sjw196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background It is often assumed that seroma formation trails closely behind with incidence rates reported at 1 to 2%. Seroma is highly problematic for both the surgeon and patient and results in both patient anxiety and discomfort, succeeded by frequent outpatient visits, follow-up treatment, increased costs, and potentially hampered aesthetic outcomes. Consequently, it is now more important than ever to study seroma and to assess its pathophysiology and mechanisms of prevention. Objectives The aim of this study was to isolate and identify risk factors that may be associated with early seroma formation. Methods The authors reviewed 539 female patients who had undergone bilateral breast augmentation with silicone cohesive gel implants in a period of 12 months. Five possible risk factors were isolated for analysis: patient’s age, body mass index (BMI), smoking habit, implant pocket position, and implant size. A total of 15 patients developed early seromas within the one-year postoperative period. Results Using exact logistic regression with the independent variables treated as binary variables, we found that smoking, BMI, and pocket are associated with increased risk of seroma while we cannot reject the hypothesis that pocket size and age do not affect the development of seroma at 5% significance level. Conclusions A high BMI, large implant size, submammary pocket, and smoking are factors significantly associated with seroma development whilst age is not. Smoking however was found to be the most detrimental factor as it significantly amplified the effects of other variables. Level of Evidence 2
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Affiliation(s)
- Marcos Sforza
- Prof. Sforza is responsible for the Elective Internship in Plastic Surgery, Dolan Park Hospital, Bromsgrove, UK; and is an Examiner of the Royal College of Surgeons of Edinburgh
| | - Rodwan Husein
- Mr. Husein is a Senior House Officer, Royal Salford Hospital, Manchester, UK
| | - Connor Atkinson
- Mr. Atkinson is a medical student, Leeds Medical School, Leeds, UK
| | - Renato Zaccheddu
- Dr Zaccheddu is a Plastic Surgeon, Dolan Park Hospital, Bromsgrove, UK
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Nguyen L, Gupta V, Afshari A, Shack RB, Grotting JC, Higdon KK. Incidence and Risk Factors of Major Complications in Brachioplasty: Analysis of 2,294 Patients. Aesthet Surg J 2016; 36:792-803. [PMID: 27217588 DOI: 10.1093/asj/sjv267] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Brachioplasty is a popular procedure to correct upper arm ptosis. However, current literature on complications and risk factors is scant and inconclusive. OBJECTIVES Using a large, prospective, multicenter database, we report the incidence of major complications and risk factors in patients undergoing brachioplasty. METHODS Patients who underwent brachioplasty between 2008 and 2013 were identified from the CosmetAssure (Birmingham, AL) database. The primary outcome was the occurrence of major complication(s), defined as complications requiring emergency room visit, hospital admission, or reoperation within 30 days of the procedure. Risk factors including age, gender, body mass index (BMI), smoking, diabetes, combined procedures, and type of surgical facility were evaluated using univariate and multivariate analysis. RESULTS Within the 129,007 patients enrolled in CosmetAssure, 2294 (1.8%) underwent brachioplasty. Brachioplasty patients were more likely to be older than 50 years (50.1%), obese (36.3%), diabetic (5.5%), but less likely smokers (5.5%). Major complications occurred in 3.4% brachioplasties with infection (1.7%) and hematoma (1.1%) being most common. Combined procedures, performed in 66.8% cases, had a complication rate of 4.4%, in comparison to 1.3% for brachioplasties performed alone. Combined procedures (RR = 3.58), males (RR = 3.44), and BMI ≥ 30 kg/m(2) (RR = 1.92) were identified as independent risk factors for the occurrence of any complication. Combined procedures (RR = 12.42), and the male gender (RR = 8.89) increased the risk of hematoma formation. CONCLUSIONS Complication rates from brachioplasty are much lower than previously reported. Hematoma and infection are the most common major complications. Combined procedures, male gender, and BMI ≥ 30 kg/m(2) are independent risk factors for complications. LEVEL OF EVIDENCE 2: Risk.
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Affiliation(s)
- Lyly Nguyen
- Drs Nguyen and Afshari are Plastic Surgery Research Fellows, Drs Gupta and Higdon are Assistant Professors, and Dr Shack is the Chair, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Afshari is also a General Surgery Resident, Department of General Surgery, University of South Carolina, Columbia, SC. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - Varun Gupta
- Drs Nguyen and Afshari are Plastic Surgery Research Fellows, Drs Gupta and Higdon are Assistant Professors, and Dr Shack is the Chair, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Afshari is also a General Surgery Resident, Department of General Surgery, University of South Carolina, Columbia, SC. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - Ashkan Afshari
- Drs Nguyen and Afshari are Plastic Surgery Research Fellows, Drs Gupta and Higdon are Assistant Professors, and Dr Shack is the Chair, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Afshari is also a General Surgery Resident, Department of General Surgery, University of South Carolina, Columbia, SC. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - R Bruce Shack
- Drs Nguyen and Afshari are Plastic Surgery Research Fellows, Drs Gupta and Higdon are Assistant Professors, and Dr Shack is the Chair, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Afshari is also a General Surgery Resident, Department of General Surgery, University of South Carolina, Columbia, SC. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - James C Grotting
- Drs Nguyen and Afshari are Plastic Surgery Research Fellows, Drs Gupta and Higdon are Assistant Professors, and Dr Shack is the Chair, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Afshari is also a General Surgery Resident, Department of General Surgery, University of South Carolina, Columbia, SC. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
| | - K Kye Higdon
- Drs Nguyen and Afshari are Plastic Surgery Research Fellows, Drs Gupta and Higdon are Assistant Professors, and Dr Shack is the Chair, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Afshari is also a General Surgery Resident, Department of General Surgery, University of South Carolina, Columbia, SC. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL; and CME/MOC Section Editor for Aesthetic Surgery Journal
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Bamba R, Gupta V, Shack RB, Grotting JC, Higdon KK. Evaluation of Diabetes Mellitus as a Risk Factor for Major Complications in Patients Undergoing Aesthetic Surgery. Aesthet Surg J 2016; 36:598-608. [PMID: 27069242 DOI: 10.1093/asj/sjv241] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2015] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Diabetes mellitus has been linked with a variety of perioperative adverse events across surgical disciplines. There is a paucity of studies systematically examining risk factors, including diabetes, and complications of aesthetic surgical procedures. OBJECTIVES The purpose of this study was to compare incidence and type of complications between diabetic and non-diabetic patients undergoing various aesthetic surgical procedures, to identify specific procedures where diabetes significantly increases risk of complications, and to study diabetes as an independent risk factor for major complications following aesthetic surgery. METHODS A prospective cohort of 129,007 patients who enrolled into the CosmetAssure insurance program and underwent cosmetic surgical procedures between May 2008 and May 2013 were reviewed. Diabetes was evaluated as risk factor for major complications, requiring hospital admission, emergency room visit, or a reoperation within 30 days after surgery. Multivariate regression analysis was performed controlling for the effects of age, smoking, obesity, gender, type of procedures, and surgical facility. RESULTS Overall, 2506 patients (1.9%) had a major complication. Diabetics had significantly more complications compared to non-diabetics (3.1% vs 1.9%, P < 0.01). In univariate analysis, infectious (1.1% vs 0.5%, P < 0.01) and pulmonary (0.3% vs 0.1%, P < 0.01) complications were significantly higher among diabetics. Notably, diabetics had higher risks of complication in body cases (4.3% vs 2.6%, P < 0.01) and specifically abdominoplasty (6.1% vs 3.0%, P < 0.01). In multivariate analysis, diabetes was found to be an independent risk factor of any complication (relative risk 1.31, P = 0.03) and infection (relative risk 1.70, P < 0.01). CONCLUSIONS Diabetes is an independent risk factor of major complications, particularly infection, after aesthetic surgical procedures.
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Affiliation(s)
- Ravinder Bamba
- Dr Bamba is a Research Fellow, Department of Plastic Surgery, Vanderbilt University, Nashville, TN; and a Resident, Department of Surgery, Georgetown University, Washington, DC. Drs Gupta and Higdon are Assistant Professors, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL, and is CME/MOC Section Editor for Aesthetic Surgery Journal
| | - Varun Gupta
- Dr Bamba is a Research Fellow, Department of Plastic Surgery, Vanderbilt University, Nashville, TN; and a Resident, Department of Surgery, Georgetown University, Washington, DC. Drs Gupta and Higdon are Assistant Professors, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL, and is CME/MOC Section Editor for Aesthetic Surgery Journal
| | - R Bruce Shack
- Dr Bamba is a Research Fellow, Department of Plastic Surgery, Vanderbilt University, Nashville, TN; and a Resident, Department of Surgery, Georgetown University, Washington, DC. Drs Gupta and Higdon are Assistant Professors, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL, and is CME/MOC Section Editor for Aesthetic Surgery Journal
| | - James C Grotting
- Dr Bamba is a Research Fellow, Department of Plastic Surgery, Vanderbilt University, Nashville, TN; and a Resident, Department of Surgery, Georgetown University, Washington, DC. Drs Gupta and Higdon are Assistant Professors, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL, and is CME/MOC Section Editor for Aesthetic Surgery Journal
| | - K Kye Higdon
- Dr Bamba is a Research Fellow, Department of Plastic Surgery, Vanderbilt University, Nashville, TN; and a Resident, Department of Surgery, Georgetown University, Washington, DC. Drs Gupta and Higdon are Assistant Professors, and Dr Shack is a Professor and Chairman, Department of Plastic Surgery, Vanderbilt University, Nashville, TN. Dr Grotting is a Clinical Professor, Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL, and is CME/MOC Section Editor for Aesthetic Surgery Journal
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Goyal KS, Jain S, Buterbaugh GA, Imbriglia JE. The Safety of Hand and Upper-Extremity Surgical Procedures at a Freestanding Ambulatory Surgery Center: A Review of 28,737 Cases. J Bone Joint Surg Am 2016; 98:700-4. [PMID: 27098330 DOI: 10.2106/jbjs.15.00239] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND More procedures are being completed on an outpatient basis at freestanding ambulatory surgery centers. The purpose of our study was to determine the safety and rate of adverse events in outpatient hand and upper-extremity surgical procedures. METHODS A retrospective review of cases at a single, freestanding ambulatory surgery center over an eleven-year period was performed. In our analysis, 28,737 cases were performed and were included. Adverse events were defined as serious complications causing harm to a patient or leading to additional treatment. Using state-reportable adverse events criteria as a guideline, we divided the adverse events into seven categories: infection requiring intravenous antibiotics or return to the operating room, postoperative transfer to a hospital, wrong-site surgical procedure, retention of a foreign object, postoperative symptomatic thromboembolism, medication error, and bleeding complications. These adverse events were then analyzed to determine if they led to additional laboratory testing, hospital admission, return to the operating room, emergency department visits, or physical or mental permanent disability. RESULTS There were fifty-eight reported adverse events, for an overall rate of 0.20%. There were no deaths. There were fourteen infections, eighteen postoperative transfers to a hospital, twenty-one hospital admissions after discharge, one medication error, and four postoperative hematomas. There were no cases of wrong-site surgical procedures or retained foreign bodies. CONCLUSIONS Our study shows that, with a selected patient population, a very low adverse event rate (0.20%) can be achieved. Our review showing few adverse events, no deaths, and no wrong-site surgical procedures supports our view that hand and upper-extremity surgical procedures can be completed safely in the outpatient setting at a freestanding ambulatory surgery center. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kanu S Goyal
- Department of Orthopaedic Surgery, Division of Hand and Upper Extremity, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sameer Jain
- Hand & UpperEx Center, Wexford, Pennsylvania
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Evidence-Based Strategies to Reduce Postoperative Complications in Plastic Surgery. Plast Reconstr Surg 2016; 137:351-360. [DOI: 10.1097/prs.0000000000001882] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
PURPOSE Ureteroscopy is increasingly used to manage nephrolithiasis, upper urinary tract urothelial carcinoma and other urological conditions. In this study we determine the rate of readmission and emergency department visits after ureteroscopy in an underserved population, as well as factors associated with these unplanned visits. MATERIALS AND METHODS A retrospective chart review from 2010 to 2014 of all elective ureteroscopies was conducted at a single tertiary hospital serving an underserved population in a major metropolis. Demographic, operative and discharge characteristics were collected and analyzed. RESULTS A total of 276 ureteroscopies were performed with 15.6% presenting to the emergency department within 30 days. Overall 5.8% were readmitted. Readmitted patients were more likely to have hypertension (OR 3.64, p=0.02), asthma or chronic obstructive pulmonary disease (OR 5.54, p=0.001), 2 or more comorbidities (OR 3.65, p=0.12), or a complication associated with ureteroscopy (OR 7.27, p=0.007). The patients who sought care in the emergency department after ureteroscopy were less likely to have had a ureteral stent in place before ureteroscopy (OR 0.35, p=0.017) or an endoscopic urological procedure within the last 30 days (OR 0.35, p=0.045). About two-thirds of patients who presented to the emergency department complained of pain alone, while the most common complaints for readmitted patients were fever and pain (43.8%). CONCLUSIONS The majority of emergency department visits after ureteroscopy were due to pain. These patients were less likely to have a preoperative ureteral stent placed or a history of recent urological procedures. Readmission rates were associated with overall comorbidities and complications.
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Gunnarson GL, Frøyen JK, Sandbu R, Thomsen JB, Hjelmesæth J. Plastic surgery after bariatric surgery. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2015; 135:1044-9. [PMID: 26080780 DOI: 10.4045/tidsskr.14.0814] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Massive weight loss after bariatric surgery often results in excess skin, which can lead to stigma due to appearance and pronounced physical and psychological impairments. This review considers the evidence base for post-bariatric plastic surgery and the treatment options that are available. METHOD The article is based on a literature search in PubMed with the keywords «bariatric surgery» AND «plastic surgery», in addition to the authors' experience with a large number of patients. RESULTS Body contouring surgery after massive weight loss is offered primarily for the treatment of troublesome skin conditions. The surgery can help to improve quality of life and functional status. However, there is little scientific evidence regarding indications for surgery, choice of surgical techniques and risk of complications, and the surgeon's own opinions and clinical experience often play a major role. Many plastic surgeons limit body contouring surgery to those with BMI < 28 kg/m². However, most patients who have undergone bariatric surgery have BMI ≥ 30 kg/m², and requests for body contouring surgery for these individuals are often denied, except when there are compelling medical grounds. INTERPRETATION Plastic surgery can lead to improved functioning and increased quality of life. The evidence base with respect to indications, treatment methods and outcomes should be strengthened through well-planned prospective studies and a patient registry. There is a particular need for documentation of treatment outcomes in the large group of patients with BMI ≥ 30 kg/m².
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Affiliation(s)
| | | | - Rune Sandbu
- Senter for sykelig overvekt i Helse Sør-Øst Sykehuset i Vestfold
| | - Jørn Bo Thomsen
- Avdeling for plastikkirurgi Odense Universitetshospital og Vejle Sykehus Lillebælt
| | - Jøran Hjelmesæth
- Senter for sykelig overvekt i Helse Sør-Øst Sykehuset i Vestfold og Avdeling for endokrinologi, sykelig overvekt og forebyggende medisin Medisinsk klinikk Institutt for klinisk medisin Universitetet i Oslo
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Quality and safety outcomes of ambulatory plastic surgery facilities in California. Plast Reconstr Surg 2015; 135:791-797. [PMID: 25719698 DOI: 10.1097/prs.0000000000001041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although most cosmetic surgery procedures are performed at outpatient surgery facilities, there is little published literature on the quality and safety of such facilities. Furthermore, regulation of such facilities varies widely and may leave room for poor outcomes. The authors sought to determine whether all outpatient surgery facilities that are licensed by the California Department of Public Health have similar rates of postoperative complications. METHODS A retrospective review was performed of all data collected from 2005 to 2010 by the California Office of Statewide Health Planning and Development. All outpatient surgery facilities licensed by the Department of Public Health must report encounter-level data to that office. Patients' subsequent inpatient admissions and emergency department visits were identified. Several cosmetic procedures were studied. Outcomes analyzed were the 30-day venous thromboembolism, hospital admission, and emergency department visit rates. RESULTS A total of 160,847 patients and 635 facilities were included. By facility, the range for 30-day venous thromboembolism rates was 0 to 3.4 percent, the range for 30-day admission rates was 0 to 7.7 percent, and the range for 30-day emergency department visits was 0 to 22.8 percent. CONCLUSIONS Analysis showed a significant variability in the rate of 30-day venous thromboembolism incidents, admissions, and emergency department visits. Some facilities had complication rates that were a significant deviation from the mean, whereas others had no complications. To ensure optimal quality and patient safety, it is necessary to analyze why outliers exist and identify ways to improve on the current system of licensure and outcomes reporting.
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Abstract
BACKGROUND The ability to study population-level outcomes of outpatient cosmetic procedures has been limited by a lack of longitudinal data. This study aimed to describe the rates of adverse events in patients who underwent an isolated cosmetic surgery procedure compared with those who had a combination of two procedures. METHODS Retrospective longitudinal analysis was performed of the 2005 to 2010 California Office of Statewide Health Planning and Development Ambulatory Surgery Database. Patients were included if they had undergone an abdominoplasty or any other procedure that was identified as frequently performed concurrently with abdominoplasty. Patients' subsequent in-patient admissions and emergency department visits were identified. Outcomes analyzed were the 30-day and 1-year venous thromboembolism rates, 30-day hospital admission rate, 30-day emergency department visit rate, and 30-day mortality rate. RESULTS A total of 477,741 patients were analyzed, of whom 16,893 had undergone two concurrent procedures. The 12-month venous thromboembolism rate was 0.57 percent for patients undergoing abdominoplasty, 0.20 percent for liposuction, 0.12 percent for breast procedures, 0.32 percent for hernia repair, 0.28 percent for face procedures, and 0.28 percent for thigh lift/brachioplasty. Greater than additive 30-day and 1-year venous thromboembolism rates were observed among patients who underwent an abdominoplasty and liposuction (0.68 percent and 0.81 percent, respectively) and those who underwent an abdominoplasty and hernia repair (0.93 percent). CONCLUSIONS Some combinations of elective outpatient procedures conferred an additive, and sometimes more than additive, venous thromboembolism risk. This is an important consideration when informing patients of potential postoperative complications and for venous thromboembolism prophylaxis.
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Variation in hospital-based acute care within 30 days of outpatient plastic surgery. Plast Reconstr Surg 2014; 134:370e-378e. [PMID: 24814423 DOI: 10.1097/prs.0000000000000442] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND When complications arise following outpatient plastic surgery, patients may require hospital-based acute care after discharge. The extent to which these events vary across centers may reflect the quality of care provided. The authors conducted this study to describe the frequency and variation of hospital-based acute care rates across ambulatory surgery centers. METHODS From the 2009 to 2010 California, Florida, Nebraska, and New York ambulatory surgery databases, the authors identified adult patients who underwent common outpatient plastic surgery procedures between July of 2009 and September of 2010. Hospital-based acute care was defined as any emergency department visit or hospital admission within 30 days of discharge. Performance across centers was assessed by calculating observed-to-expected ratios derived from multivariable logistic regression models. RESULTS The authors identified 72,308 discharges from 519 centers. Most were female patients (80.9 percent); self-pay patients (41.5 percent); and underwent blepharoplasty (36.9 percent), breast augmentation (14.2 percent), or multiple procedures (12.2 percent). The observed hospital-based, acute care rate was 42.8 encounters per 1000 discharges, with most managed in the emergency department for symptoms or complications of care. The median charges associated with these encounters were $2183 and $26,299 for emergency department visits and hospital admissions, respectively. Wide variation was noted in hospital-based acute care rates, with 15 centers (2.9 percent) performing significantly better and 27 (5.2 percent) performing significantly worse than expected after adjusting for case mix. CONCLUSIONS The overall rate of hospital-based acute care after common outpatient plastic surgery procedures is low but measurable. However, the frequency of these events varies across centers and may reflect the quality of care provided.
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A Cluster of Surgical Site Infections following Breast Augmentation and Face Lift Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2014; 2:e156. [PMID: 25289349 PMCID: PMC4174085 DOI: 10.1097/gox.0000000000000092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Predictors of readmission after inpatient plastic surgery. Arch Plast Surg 2014; 41:116-21. [PMID: 24665418 PMCID: PMC3961607 DOI: 10.5999/aps.2014.41.2.116] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 09/11/2013] [Accepted: 09/12/2013] [Indexed: 12/22/2022] Open
Abstract
Background Understanding risk factors that increase readmission rates may help enhance patient education and set system-wide expectations. We aimed to provide benchmark data on causes and predictors of readmission following inpatient plastic surgery. Methods The 2011 National Surgical Quality Improvement Program dataset was reviewed for patients with both "Plastics" as their recorded surgical specialty and inpatient status. Readmission was tracked through the "Unplanned Readmission" variable. Patient characteristics and outcomes were compared using chi-squared analysis and Student's t-tests for categorical and continuous variables, respectively. Multivariate regression analysis was used for identifying predictors of readmission. Results A total of 3,671 inpatient plastic surgery patients were included. The unplanned readmission rate was 7.11%. Multivariate regression analysis revealed a history of chronic obstructive pulmonary disease (COPD) (odds ratio [OR], 2.01; confidence interval [CI], 1.12-3.60; P=0.020), previous percutaneous coronary intervention (PCI) (OR, 2.69; CI, 1.21-5.97; P=0.015), hypertension requiring medication (OR, 1.65; CI, 1.22-2.24; P<0.001), bleeding disorders (OR, 1.70; CI, 1.01-2.87; P=0.046), American Society of Anesthesiologists (ASA) class 3 or 4 (OR, 1.57; CI, 1.15-2.15; P=0.004), and obesity (body mass index ≥30) (OR, 1.43; CI, 1.09-1.88, P=0.011) to be significant predictors of readmission. Conclusions Inpatient plastic surgery has an associated 7.11% unplanned readmission rate. History of COPD, previous PCI, hypertension, ASA class 3 or 4, bleeding disorders, and obesity all proved to be significant risk factors for readmission. These findings will help to benchmark inpatient readmission rates and manage patient and hospital system expectations.
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