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O'Hara NN, Gage MJ, Loudermilk C, Drogt C, Klazinga NS, Kringos DS, Mundy LR. Factors that Promote and Protect Against Financial Toxicity after Orthopaedic Trauma: A Qualitative Study. J Am Acad Orthop Surg 2024; 32:e542-e557. [PMID: 38652885 DOI: 10.5435/jaaos-d-23-01071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION Financial toxicity is highly prevalent in patients after an orthopaedic injury. However, little is known regarding the conditions that promote and protect against this financial distress. Our objective was to understand the factors that cause and protect against financial toxicity after a lower extremity fracture. METHODS A qualitative study was conducted using semi-structured interviews with 20 patients 3 months after surgical treatment of a lower extremity fracture. The interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis to identify themes and subthemes. Data saturation occurred after 15 interviews. The percentage of patients who described the identified themes are reported. RESULTS A total of 20 patients (median age, 44 years [IQR, 38 to 58]; 60% male) participated in the study. The most common injury was a distal tibia fracture (n = 8; 40%). Eleven themes that promoted financial distress were identified, the most common being work effects (n = 14; 70%) and emotional health (n = 12; 60%). Over half (n = 11; 55%) of participants described financial toxicity arising from an inability to access social welfare programs. Seven themes that protected against financial distress were also identified, including insurance (n = 17; 85%) and support from friends and family (n = 17; 85%). Over half (n = 13; 65%) of the participants discussed the support they received from their healthcare team, which encompassed expectation setting and connections to financial aid and other services. Employment protection and workplace flexibility were additional protective themes. CONCLUSION This qualitative study of orthopaedic trauma patients found work and emotional health-related factors to be primary drivers of financial toxicity after injury. Insurance and support from friends and family were the most frequently reported protective factors. Many participants described the pivotal role of the healthcare team in establishing recovery expectations and facilitating access to social welfare programs.
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Yesantharao P, Heron MJ, Lee E, Darrach H, Xun H, Mundy LR, Sacks JM, Broderick KP. Revisiting the nipple-areola complex: A study on aesthetic preferences. J Plast Reconstr Aesthet Surg 2024; 93:232-234. [PMID: 38714042 DOI: 10.1016/j.bjps.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/04/2024] [Accepted: 04/05/2024] [Indexed: 05/09/2024]
Affiliation(s)
- Pooja Yesantharao
- Department of Plastic & Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD 21205, USA
| | - Matthew J Heron
- Department of Plastic & Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD 21205, USA
| | - Erica Lee
- Department of Plastic & Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD 21205, USA
| | - Halley Darrach
- Department of Plastic & Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD 21205, USA
| | - Helen Xun
- Department of Plastic & Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD 21205, USA
| | - Lily R Mundy
- Department of Plastic & Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD 21205, USA
| | - Justin M Sacks
- Department of Plastic & Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD 21205, USA; Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St Louis, MO 63110, USA
| | - Kristen P Broderick
- Department of Plastic & Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD 21205, USA.
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Mundy LR, Klassen AF, Pusic AL, deJong T, Hollenbeck ST, Gage MJ. The LIMB-Q: Reliability and Validity of a Novel Patient-Reported Outcome Measure for Lower Extremity Trauma Patients. Plast Reconstr Surg 2024:00006534-990000000-02225. [PMID: 38232226 DOI: 10.1097/prs.0000000000011293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND The LIMB-Q is a novel patient-reported outcome measure for lower extremity trauma patients. The aim of this study was to perform a psychometric validation of the LIMB-Q based on the Rasch Measurement Theory. METHODS An international, multi-site convenience sample of patients with lower extremity traumatic injuries distal to the mid-femur were recruited via clinical sites (United States, Netherlands) and online platforms (English; Trauma Survivors Network, Prolific). A cross-sectional survey of the LIMB-Q was conducted with test-rest (TRT) measured 1-2 weeks after initial completion in a sub-group of patients. RESULTS The LIMB-Q was field-tested in 713 patients. The mean age was 41 years (standard deviation (SD) 17, range 18-85), mean time from injury was 7 years (SD 9, range 0-58), and there were variable injury and treatment characteristics (39% fracture surgery only, 38% flap or graft, 13% amputation, 10% amputation and flap/graft). Out of 382 items tested, 164 were retained across 16 scales. Reliability was demonstrated with person separation index values 0.80 and greater in 14 scales (0.78-0.79 in remaining 2 scales), Cronbach alpha values 0.83 and greater, and intraclass correlation coefficient values 0.70 and greater. Each scale was unidimensional, measurement invariance was confirmed across clinical and demographic factors, TRT showed adequate reliability, and construct validity was demonstrated. CONCLUSIONS The LIMB-Q is a patient reported outcome measure with 16 independently functioning scales (6-15 items per scale) developed and validated specifically for lower extremity trauma patients with fractures, reconstruction, and/or amputation.
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Affiliation(s)
- Lily R Mundy
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Andrea L Pusic
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
- Patient Reported Outcomes, Value & Experience Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Tim deJong
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Plastic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | - Scott T Hollenbeck
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University, Durham, NC, USA
| | - Mark J Gage
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA
- Section of Orthopaedic Trauma, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
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Burke CE, Mundy LR, Gupta J, Wong AL, Enobun B, O'Hara NN, Bangura A, O'Connor KC, Jauregui JJ, Miller NF, O'Toole RV, Pensy RA. Secondary Bony Defects after Soft Tissue Reconstruction in Limb-Threatening Lower Extremity Injuries: Does the Approach to Flap Elevation Matter? J Reconstr Microsurg 2024; 40:59-69. [PMID: 37186096 DOI: 10.1055/s-0043-1768219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Limb-threatening lower extremity injuries often require secondary bone grafting after soft tissue reconstruction. We hypothesized that there would be fewer wound complications when performing secondary bone grafting via a remote surgical approach rather than direct flap elevation. METHODS A retrospective cohort study was performed at a single Level 1 trauma center comparing complications after secondary bone grafting in patients who had undergone previous soft tissue reconstruction after open tibia fractures between 2006 and 2020. Comparing bone grafting via a remote surgical incision versus direct flap elevation, we evaluated wound dehiscence requiring return to the operating room as the primary outcome. Secondary outcomes were deep infection and delayed amputation. RESULTS We identified 129 patients (mean age: 40 years, 82% male) with 159 secondary bone grafting procedures. Secondary bone grafting was performed via a remote surgical approach in 54% (n = 86) and direct flap elevation in 46% (n = 73) of cases. Wound dehiscence requiring return to the operating room occurred in one patient in the flap elevation group (1%) and none of the patients in the remote surgical approach. The odds of deep wound infection (OR, 1.77; p = 0.31) or amputation (OR, 1.43; p = 0.73) did not significantly differ between surgical approaches. No significant differences were found in complications between the reconstructive surgeon elevating and re-insetting the flap and the orthopaedic trauma surgeon performing the flap elevation and re-inset. CONCLUSION Direct flap elevation for secondary bone grafting after soft tissue reconstruction for open tibia fractures did not result in more complications than bone grafting via a remote surgical approach. These findings should reassure surgeons to allow other clinical factors to influence the surgical approach for bone grafting.
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Affiliation(s)
- Cynthia E Burke
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Lily R Mundy
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jayesh Gupta
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Alison L Wong
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Blessing Enobun
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Nathan N O'Hara
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Abdulai Bangura
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Katherine C O'Connor
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Julio J Jauregui
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Nathan F Miller
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Robert V O'Toole
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Raymond A Pensy
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
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Wang SM, Njoroge MW, Mundy LR, Sergesketter AR, Stukes B, Shammas RL, Langdell HC, Geng Y, Hollenbeck ST. Evaluating Disparities in Pathways to Breast Reconstruction. J Reconstr Microsurg 2023; 39:671-680. [PMID: 37023769 DOI: 10.1055/s-0043-1764486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
BACKGROUND Rates of postmastectomy breast reconstruction have been shown to vary by racial, ethnic, and socioeconomic factors. In this study, we evaluated disparities across pathways toward breast reconstruction. METHODS All women who underwent mastectomy for breast cancer at a single institution from 2017 to 2018 were reviewed. Rates of discussions about reconstruction with breast surgeons, plastic surgery referrals, plastic surgery consultations, and ultimate decisions to pursue reconstruction were compared by race/ethnicity. RESULTS A total of 218 patients were included, with the racial/ethnic demographic of 56% white, 28% Black, 1% American Indian/Native Alaskan, 4% Asian, and 4% Hispanic/Latina. The overall incidence of postmastectomy breast reconstruction was 48%, which varied by race (white: 58% vs. Black: 34%; p < 0.001). Plastic surgery was discussed by the breast surgeon with 68% of patients, and referrals were made in 62% of patients. While older age (p < 0.001) and nonprivate insurance (p < 0.05) were associated with lower rates of plastic surgery discussion and referral, it did not vary by race/ethnicity. The need for an interpreter was associated with lower rates of discussion (p < 0.05). After multivariate adjustment, a lower reconstruction rate was associated with the Black race (odds ratio [OR] = 0.33; p = 0.014) and body mass index (BMI) ≥ 35 (OR = 0.14; p < 0.001). Elevated BMI did not disproportionately lower breast reconstruction rates in Black versus white women (p = 0.27). CONCLUSION Despite statistically equivalent rates of plastic surgery discussions and referrals, black women had lower breast reconstruction rates versus white women. Lower rates of breast reconstruction in Black women likely represent an amalgamation of barriers to care; further exploration within our community is warranted to better understand the racial disparity observed.
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Affiliation(s)
- Sabrina M Wang
- Duke University School of Medicine, Durham, North Carolina
| | | | - Lily R Mundy
- Department of Orthopaedic Surgery, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Amanda R Sergesketter
- Division of Plastic, Oral, and Maxillofacial Surgery, Duke University, Durham, North Carolina
| | - Bryanna Stukes
- Duke University School of Medicine, Durham, North Carolina
| | - Ronnie L Shammas
- Division of Plastic, Oral, and Maxillofacial Surgery, Duke University, Durham, North Carolina
| | - Hannah C Langdell
- 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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Mundy LR, Shammas RL, Truong T, Zingas N, Peskoe SB, Hollenbeck ST, Gage MJ. Does treatment at a level I trauma center reduce disparities in patient outcomes for open tibia fractures? A retrospective analysis of the National trauma Databank. J Clin Orthop Trauma 2023; 43:102209. [PMID: 37502096 PMCID: PMC10368930 DOI: 10.1016/j.jcot.2023.102209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 04/27/2023] [Accepted: 06/24/2023] [Indexed: 07/29/2023] Open
Abstract
Background Race and insurance status are independent predictors of healthcare outcomes following lower-extremity trauma. Level 1 trauma centers show better outcomes overall, but it is has not been extensively studied as to whether they specifically lower complication rates and shorten length of stay in those with Black race, with low socioeconomic status, and/or a lack of private health insurance. We performed a study with the objective of determining whether Level I trauma centers can improve the complication rate of those shown to be at high risk of experiencing adverse outcomes due to socioeconomic differences. Hypothesis Level 1 trauma centers will be successful in mitigating the disparity in complication rates and length of stay associated with racial and socioeconomic differences among trauma patients experiencing an open tibia fracture. Patients and methods The National Trauma Databank was reviewed from 2008 to 2015, identifying 81,855 encounters with an open tibia fracture, and 33,047 at a Level I trauma center. Regression models determined effects of race and insurance status on outcomes by trauma center while controlling for confounders. Results Black race [OR 1.36, 95% CI, 1.17-1.58; p < 0.05] and "other" race [OR 1.28, 95% CI, 1.07-1.52; p < 0.05] were associated with higher odds of injury-specific complications. Patients without private insurance and of non-White or Black race in comparison to White patients had a significantly longer length of stay [coefficient 1.66, 95% CI, 1.37-1.94; p < 0.001]. These differences persisted in patients treated at an American College of Surgeons (ACS) Level I trauma center. Discussion Treatment at an ACS Level I trauma center did not reduce the independent effects of race and insurance status on outcomes after open tibia fracture, emphasizing the need to recognize this disparity and improve care for at-risk populations.
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Affiliation(s)
- Lily R. Mundy
- Department of Orthopaedic Surgery, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA
- Division of Plastic Surgery, Department of Surgery, Duke University, Durham, NC, USA
| | - Ronnie L. Shammas
- Division of Plastic Surgery, Department of Surgery, Duke University, Durham, NC, USA
| | - Tracy Truong
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Nicolas Zingas
- Department of Orthopaedic Surgery, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA
| | - Sarah B. Peskoe
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Scott T. Hollenbeck
- Division of Plastic Surgery, Department of Surgery, Duke University, Durham, NC, USA
| | - Mark J. Gage
- Department of Orthopaedic Surgery, Duke University Health System, Durham, NC, USA
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Sergesketter AR, Mundy LR, Geng Y, Shammas RL, Langdell HC, Wang SM, Njoroge M, Stukes B, Hollenbeck ST. Mapping Patient Encounters in Breast Cancer Care: An Analysis of 8800 Clinical Encounters Among Patients Undergoing Mastectomy. Ann Plast Surg 2023; 90:S433-S439. [PMID: 36913551 DOI: 10.1097/sap.0000000000003448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
BACKGROUND Transitions toward value-based systems require a comprehensive definition of the complexity and duration of provider effort required for a given diagnosis. This study modeled the numbers of clinical encounters involved in various treatment pathways among breast cancer patients undergoing mastectomy. METHODS Clinical encounters with medical oncologists, radiation oncologists, breast surgeons, or plastic surgeons ≤4 years after diagnosis among all patients undergoing mastectomy from 2017 to 2018 were reviewed. Relative encounter volumes were modeled each 90-day period after diagnosis. RESULTS A total of 8807 breast cancer-related encounters from 221 patients were analyzed, with mean (SD) encounter volume 39.9 (27.2) encounters per patient. Most encounters occurred in the first year after diagnosis (70.0%), with years 2, 3, and 4 representing 15.8%, 9.1%, and 3.5% of encounters, respectively. Overall stage was associated with encounter volume, with higher encounter volume with increasing stage (stages 0: 27.4 vs I: 28.5 vs II: 48.4 vs III: 61.1 vs IV: 80.8 mean encounters). Body mass index (odds ratio [OR], 0.22), adjuvant radiation (OR, 6.8), and receipt of breast reconstruction (OR, 3.5) were also associated with higher encounter volume (all P 's < 0.01). Duration of encounter volume varied by treatment phases, with medical oncology and plastic surgery sustaining high clinical encounter volume 3 years after diagnosis. CONCLUSIONS Encounter utilization in breast cancer care persists 3 years after index diagnosis and is influenced by overall stage and treatment characteristics, including receipt of breast reconstruction. These results may inform the design of episode durations within value-based models and institutional resource allocation for breast cancer care.
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Affiliation(s)
- Amanda R Sergesketter
- From the Division of Plastic, Oral, and Maxillofacial Surgery, Duke University, Durham, NC
| | - Lily R Mundy
- Department of Surgery, Johns Hopkins University, Baltimore, MD
| | | | - Ronnie L Shammas
- From the Division of Plastic, Oral, and Maxillofacial Surgery, Duke University, Durham, NC
| | - Hannah C Langdell
- From the Division of Plastic, Oral, and Maxillofacial Surgery, Duke University, Durham, NC
| | | | | | | | - Scott T Hollenbeck
- From the Division of Plastic, Oral, and Maxillofacial Surgery, Duke University, Durham, NC
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Mundy LR, Zingas NH, McKibben N, Healey K, O'Hara NN, O'Toole RV, Pensy RA. Financial Toxicity Is Common in Patients After Tibia Fracture. J Orthop Trauma 2023; 37:e147-e152. [PMID: 36730601 DOI: 10.1097/bot.0000000000002520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To evaluate the presence of financial distress and identify risk factors for financial toxicity in patients after tibial shaft fracture. DESIGN A cross-sectional analysis. SETTING Level I trauma center. PATIENTS All patients within 4 years after tibial shaft fracture (open, closed, or fracture that required flap reconstruction). INTERVENTION Injury-related financial distress. MAIN OUTCOME MEASUREMENTS Financial distress related to the injury, as reported by the patient in a binary question. Financial toxicity using the LIMB-Q, scored from 0 to 100, with higher scores indicating more financial toxicity. RESULTS Data were collected from 142 patients after tibial shaft fracture [44% closed (n = 62), 41% open (n = 58), and 15% flap (n = 22)]. The mean age was 44 years (SD 17), 61% were men, and the mean time from injury was 15 months. Financial distress was reported by 64% of patients (95% confidence interval, 56% to 72%). Financial toxicity did not differ by fracture severity ( P = 0.12). Medical complications were associated with a 14-point increase in financial toxicity ( P = 0.04). Age older than 65 years (-15 points, P = 0.03) and incomes of $70,000 or more ($70,000-$99,999, -15 points, P = 0.02; >$100,000, -19 points, P < 0.01) protected against financial toxicity. CONCLUSION We observed financial distress levels more than twice the proportion observed after cancer. Medical complications, lower incomes, and younger age were associated with increased financial toxicity. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Lily R Mundy
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
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Mundy LR, Stukes B, Njoroge M, Fish LJ, Sergesketter AR, Wang SM, Worthy V, Fayanju OM, Greenup RA, Hollenbeck ST. Community collaboration to improve access and outcomes in breast cancer reconstruction: protocol for a mixed-methods qualitative research study. BMJ Open 2022; 12:e064121. [PMID: 36344000 PMCID: PMC9644344 DOI: 10.1136/bmjopen-2022-064121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Breast reconstruction plays an important role for many in restoring form and function of the breast after mastectomy. However, rates of breast reconstruction in the USA vary significantly by race, ethnicity and socioeconomic status. The lower rates of breast reconstruction in non-white women and in women of lower socioeconomic status may reflect a complex interplay between patient and physician factors and access to care. It remains unknown what community-specific barriers may be impacting receipt of breast reconstruction. METHODS AND ANALYSIS This is a mixed-methods study combining qualitative patient interview data with quantitative practice patterns to develop an actionable plan to address disparities in breast reconstruction in the local community. The primary aims are to (1) capture barriers to breast reconstruction for patients in the local community, (2) quantitatively evaluate practice patterns at the host institution and (3) identify issues and prioritise interventions for change using community-based engagement. ETHICS AND DISSEMINATION Ethics approval was obtained at the investigators' institution. Results from both the quantitative and qualitative portions of the study will be circulated via peer-review publication. These findings will also serve as pilot data for extramural funding to implement and evaluate these proposed solutions.
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Affiliation(s)
- Lily R Mundy
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Bryanna Stukes
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Moreen Njoroge
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Laura Jane Fish
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
- Duke Cancer Institute, Duke University, Durham, North Carolina, USA
| | - Amanda R Sergesketter
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Sabrina M Wang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Valarie Worthy
- Duke Cancer Institute, Duke University, Durham, North Carolina, USA
- Triangle Chapter, Sisters Network, Raleigh-Durham, North Carolina, USA
| | | | - Rachel A Greenup
- Department of Surgery, Yale University, New Haven, Connecticut, USA
| | - Scott T Hollenbeck
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
- Duke Cancer Institute, Duke University, Durham, North Carolina, USA
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Shammas RL, Sergesketter AR, Taskindoust M, Glener AD, Cason RW, Hollins A, Atia AN, Mundy LR, Hollenbeck ST. An Assessment of Patient Satisfaction and Decisional Regret in Patients Undergoing Staged Free-Flap Breast Reconstruction. Ann Plast Surg 2021; 86:S538-S544. [PMID: 34100812 DOI: 10.1097/sap.0000000000002699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the setting of radiation therapy or significant medical comorbidities, free-flap breast reconstruction may be intentionally delayed or staged with tissue expander placement ("delayed-immediate" approach). The effect of a staged approach on patient satisfaction and decisional regret remains unclear. METHODS All patients undergoing free-flap breast reconstruction (n = 334) between 2014 and 2019 were identified. Complication rates, patient satisfaction using the BREAST-Q, and decisional regret using the Decision Regret Scale were compared between patients undergoing immediate, delayed, and staged approaches. RESULTS Overall, 100 patients completed the BREAST-Q and Decision Regret Scale. BREAST-Q scores for psychosocial well-being (P = 0.19), sexual well-being (P = 0.26), satisfaction with breast (P = 0.28), physical well-being (chest, P = 0.49), and physical well-being (abdomen, P = 0.42) did not significantly vary between patients undergoing delayed, staged, or immediate reconstruction. Overall, patients experienced low regret after reconstruction (mean score, 11.5 ± 17.1), and there was no significant difference in regret scores by reconstruction timing (P = 0.09). Compared with normative BREAST-Q data, unlike immediate and delayed approaches, staged reconstruction was associated with lower sexual well-being (P = 0.006). Furthermore, a significantly higher infection rate was seen among staged patients (immediate 0%, delayed 5%, staged 20%, P = 0.01). CONCLUSIONS Staged free-flap breast reconstruction confers similar long-term satisfaction and decisional regret as immediate and delayed reconstruction but may be associated with worsened sexual well-being, when compared with normative data, and an increased risk of surgical site infection. When counseling patients regarding the timing of reconstruction, it is important to weigh these risks in the context of equivalent long-term satisfaction and decisional regret between immediate, delayed, and staged approaches.
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Affiliation(s)
- Ronnie L Shammas
- From the Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC
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Mundy LR, Truong T, Shammas RL, Cunningham D, Hollenbeck ST, Pomann GM, Gage MJ. Amputation Rates in More Than 175,000 Open Tibia Fractures in the United States. Orthopedics 2021; 44:48-53. [PMID: 33284985 DOI: 10.3928/01477447-20201202-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 11/06/2019] [Indexed: 02/03/2023]
Abstract
Open tibia fractures are often associated with considerable soft tissue injuries. Management of open tibia fractures can be challenging, and some patients require amputation. The patient and treatment factors have not been described on a population level in the United States. A retrospective analysis was completed using the 2000 to 2011 Nationwide Inpatient Sample. Amputation rates during the index hospitalization after open tibia fracture were computed based on injury, patient, and hospital characteristics in patients 18 years or older. The overall amputation rate in open tibia fractures during the index hospitalization was 2.2% (n=3769). Patients with midshaft tibia fractures comprised the largest portion of patients undergoing amputation (46.8% of total amputations) compared with distal tibia (34.0%) and proximal tibia (19.3%) fractures. Patients with no neurovascular injury comprised the largest portion of patients undergoing amputation (85.9%), followed by isolated arterial injury (11.1%), combined neurovascular injury (1.9%), and isolated nerve injury (1.1%). Amputation rates were significantly increased for midshaft tibia fractures with neurovascular injury (odds ratio, 12.39; 95% CI, 5.52-27.83) and distal tibia fractures with neurovascular injury (odds ratio, 5.45; 95% CI, 1.73-17.19) compared with tibia fractures with no neurovascular injury while controlling for confounders. On the basis of a review of the Nationwide In-patient Sample during the past decade, the authors have shown that the early amputation rate in open tibia fractures for all-comers is 2.2%. Rates of amputation varied based on fracture site, associated neurovascular injury, medical comorbidities, and hospital location. [Orthopedics. 2021;44(1):48-53.].
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Mundy LR, Klassen A, Sergesketter AR, Grier AJ, Carty MJ, Hollenbeck ST, Pusic AL, Gage MJ. Content Validity of the LIMB-Q: A Patient-Reported Outcome Instrument for Lower Extremity Trauma Patients. J Reconstr Microsurg 2020; 36:625-633. [PMID: 32615610 DOI: 10.1055/s-0040-1713669] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Limb-threatening lower extremity traumatic injuries can be devastating events with a multifaceted impact on patients. Therefore, evaluating patient-reported outcomes (PROs) in addition to traditional surgical outcomes is important. However, currently available instruments are limited as they were not developed specific to lower extremity trauma patients and lack content validity. The LIMB-Q is being developed as a novel PRO instrument to meet this need, with the goal to measure all relevant concepts and issues impacting amputation and limb-salvage patients after limb-threatening lower extremity trauma. METHODS This is a qualitative interview-based study evaluating content validity for the LIMB-Q. Patients aged 18 years and older who underwent amputation, reconstruction, or amputation after failed reconstruction were recruited using purposeful sampling to maximize variability of participant experiences. Expert opinion was solicited from a variety of clinical providers and qualitative researchers internationally. Preliminary items and scales were modified, added, or removed based on participant and expert feedback after each round of participant interviews and expert opinion. RESULTS Twelve patients and 43 experts provided feedback in a total of three rounds, with changes to the preliminary instrument made between each round. One scale was dropped after round one, one scale was added after round two, and only minor changes were needed after round three. Modifications, additions and removal of items, instructions, and response options were made after each round using feedback gathered. CONCLUSION The LIMB-Q was refined and modified to reflect feedback from patients and experts in the field. Content validity for the LIMB-Q was established. Following a large-scale field test, the LIMB-Q will be ready for use in research and clinical care.
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Affiliation(s)
- Lily R Mundy
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Duke University, Durham, North Carolina
| | - Anne Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Amanda R Sergesketter
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Duke University, Durham, North Carolina
| | - Andrew Jordan Grier
- Department of Orthopaedic Surgery, Section of Orthopaedic Trauma, Duke University, Durham, North Carolina
| | - Matthew J Carty
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Scott T Hollenbeck
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Duke University, Durham, North Carolina
| | - Andrea L Pusic
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Patient Reported Outcomes, Value & Experience Center, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mark J Gage
- Department of Orthopaedic Surgery, Section of Orthopaedic Trauma, Duke University, Durham, North Carolina
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Mundy LR, Klassen A, Grier J, Carty MJ, Pusic AL, Hollenbeck ST, Gage MJ. Development of a Patient-Reported Outcome Instrument for Patients With Severe Lower Extremity Trauma (LIMB-Q): Protocol for a Multiphase Mixed Methods Study. JMIR Res Protoc 2019; 8:e14397. [PMID: 31625944 PMCID: PMC6913330 DOI: 10.2196/14397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/09/2019] [Accepted: 08/18/2019] [Indexed: 12/28/2022] Open
Abstract
Background A current limitation in the care of patients with severe lower extremity traumatic injuries is the lack of a rigorously developed patient-reported outcome (PRO) instrument specific to lower extremity trauma patients. Objective This mixed methods protocol aims to describe phases I and II of the development of a PRO instrument for lower extremity trauma patients, following international PRO development guidelines. Methods The phase I study follows an interpretive description approach. Development of the PRO instrument begins with identifying the concepts that are important to patients, after which a preliminary conceptual framework is devised from a systematic literature review and used to generate an interview guide. Patients aged 18 years or above with limb-threatening lower extremity traumatic injuries resulting in reconstruction, amputation, or amputation after failed reconstruction will be recruited. The subjects will participate in semistructured, in-depth qualitative interviews to identify all important concepts of interest. The qualitative interview data will be coded with top-level domains, themes, and subthemes. The codes will then be utilized to refine the conceptual framework and generate preliminary items and a set of scales. The preliminary scales will be further refined via a process of conducting cognitive debriefing interviews with lower extremity trauma patients and soliciting expert opinions. Phase III will include a large-scale field test, using Rasch measurement theory to analyze the psychometric properties of the instrument; shortening and finalizing the scales; and determining the reliability, validity, and responsiveness of the instrument. Results Phases I and II of this study have been funded. Phase I of this study has been completed, and phase II began in January 2019 and is expected to be completed in November 2019. Phase III will begin following the completion of phase II. Conclusions This protocol describes the initial phases of development of a novel PRO instrument for use in lower extremity trauma patients. International Registered Report Identifier (IRRID) DERR1-10.2196/14397
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Affiliation(s)
- Lily R Mundy
- Division of Plastic and Reconstructive Surgery, Duke University, Durham, NC, United States
| | - Anne Klassen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Jordan Grier
- Section of Orthopaedic Trauma, Department of Orthopaedic Surgery, Duke University, Durham, NC, United States
| | - Matthew J Carty
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, MA, United States
| | - Andrea L Pusic
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, MA, United States.,Patient Reported Outcomes, Value & Experience Center, Brigham and Women's Hospital, Boston, MA, United States
| | - Scott T Hollenbeck
- Division of Plastic and Reconstructive Surgery, Duke University, Durham, NC, United States
| | - Mark J Gage
- Section of Orthopaedic Trauma, Department of Orthopaedic Surgery, Duke University, Durham, NC, United States
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Phillips BT, Boehm KS, Cho MJ, Drinane JJ, Egro FM, Frojo G, Goldman JJ, Mundy LR, Teven CM, Gosain AK. Spotlight in Plastic Surgery. Plast Reconstr Surg 2019. [DOI: 10.1097/prs.0000000000005183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ziolkowski NI, Mundy LR, Pusic A, Fish JS, Klassen A. 14 SCAR-Q: An Update on Field-testing a Patient-reported Outcome Instrument for Burn, Surgical, and Traumatic Scars. J Burn Care Res 2018. [DOI: 10.1093/jbcr/iry006.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- N I Ziolkowski
- University of Toronto, Toronto, ON, Canada; Duke, Durham, NC; Memorial Sloan Kettering Cancer Center, New York City, NY; The Hospital for Sick Children, Toronto, ON, Canada; McMaster University, Hamilton, ON, Canada
| | - L R Mundy
- University of Toronto, Toronto, ON, Canada; Duke, Durham, NC; Memorial Sloan Kettering Cancer Center, New York City, NY; The Hospital for Sick Children, Toronto, ON, Canada; McMaster University, Hamilton, ON, Canada
| | - A Pusic
- University of Toronto, Toronto, ON, Canada; Duke, Durham, NC; Memorial Sloan Kettering Cancer Center, New York City, NY; The Hospital for Sick Children, Toronto, ON, Canada; McMaster University, Hamilton, ON, Canada
| | - J S Fish
- University of Toronto, Toronto, ON, Canada; Duke, Durham, NC; Memorial Sloan Kettering Cancer Center, New York City, NY; The Hospital for Sick Children, Toronto, ON, Canada; McMaster University, Hamilton, ON, Canada
| | - A Klassen
- University of Toronto, Toronto, ON, Canada; Duke, Durham, NC; Memorial Sloan Kettering Cancer Center, New York City, NY; The Hospital for Sick Children, Toronto, ON, Canada; McMaster University, Hamilton, ON, Canada
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Shammas RL, Cho EH, Glener AD, Poveromo LP, Mundy LR, Greenup RA, Blackwell KL, Hollenbeck ST. Association Between Targeted HER-2 Therapy and Breast Reconstruction Outcomes: A Propensity Score-Matched Analysis. J Am Coll Surg 2017; 225:731-739.e1. [DOI: 10.1016/j.jamcollsurg.2017.08.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 08/22/2017] [Accepted: 08/22/2017] [Indexed: 10/18/2022]
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Mundy LR, Homa K, Klassen AF, Pusic AL, Kerrigan CL. Reply: Breast Cancer and Reconstruction: Normative Data for Interpreting the BREAST-Q. Plast Reconstr Surg 2017; 141:181e-182e. [PMID: 28938342 DOI: 10.1097/prs.0000000000003971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Lily R Mundy
- Division of Plastic and Reconstructive Surgery, Duke University, Durham, N.C
| | - Karen Homa
- Dartmouth Hitchcock Medical Center, Lebanon, N.H
| | | | - Andrea L Pusic
- Plastic and Reconstructive Service, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Carolyn L Kerrigan
- Division of Plastic Surgery, Dartmouth Hitchcock Medical Center, Lebanon, N.H
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Abstract
BACKGROUND The BREAST-Q is a rigorously developed, well-validated, patient-reported outcome instrument with a module designed for evaluating breast augmentation outcomes. However, there are no published normative BREAST-Q scores, limiting interpretation. METHODS Normative data were generated for the BREAST-Q Augmentation module by means of the Army of Women, an online community of women (with and without breast cancer) engaged in breast-cancer related research. Members were recruited by means of e-mail; women aged 18 years or older without a history of breast cancer or breast surgery were invited to participate. Descriptive statistics and a linear multivariate regression were performed. A separate analysis compared normative scores to findings from previously published BREAST-Q augmentation studies. RESULTS The preoperative BREAST-Q Augmentation module was completed by 1211 women. Mean age was 54 ± 24 years, the mean body mass index was 27 ± 6 kg/m, and 39 percent (n = 467) had a bra cup size of D or greater. Mean scores were as follows: Satisfaction with Breasts, 54 ± 19; Psychosocial Well-being, 66 ± 20; Sexual Well-being, 49 ± 20; and Physical Well-being, 86 ± 15. Women with a body mass index of 30 kg/m or greater and bra cup size of D or greater had lower scores. In comparison with Army of Women scores, published BREAST-Q augmentation scores were lower before and higher after surgery for all scales except Physical Well-being. CONCLUSIONS The Army of Women normative data represent breast-related satisfaction and well-being in women not actively seeking breast augmentation. These data may be used as normative comparison values for those seeking and undergoing surgery as we did, demonstrating the value of breast augmentation in this patient population.
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Affiliation(s)
- Lily R. Mundy
- Division of Plastic and Reconstructive Surgery, Duke University, Durham, NC
| | - Karen Homa
- Dartmouth Hitchcock Medical Center, Lebanon, NH
| | | | - Andrea L. Pusic
- Plastic and Reconstructive Service, Memorial Sloan-Kettering Cancer Center, New York, NY
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Mundy LR, Gage MJ, Yoon RS, Liporace FA. Comparing the speed of irrigation between pulsatile lavage versus gravity irrigation: an Ex-vivo experimental investigation. Patient Saf Surg 2017; 11:7. [PMID: 28360942 PMCID: PMC5368899 DOI: 10.1186/s13037-017-0124-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/25/2017] [Indexed: 05/29/2023] Open
Abstract
Background The need for reoperation or wound infection treatments between pulsatile and gravity irrigation are statistically equivalent, however, it is unclear which method maximizes operative efficiency and expeditious irrigation. In this study we set out to determine the differences in irrigation rate between these various treatment methods. Methods This was an ex-vivo experimental laboratory study not involving human subjects. Irrigation rates were tested based on the time in seconds required to empty a three-liter bag of normal saline hanging at either 6 or 9 ft. Three forms of irrigation were tested: gravity irrigation (GI6, GI9), low-pressure pulsatile irrigation (LP6, LP9) and high-pressure pulsatile irrigation. One-way ANOVA and Student’s t-test were used to compare rates based on height and form of irrigation. Results Significant differences in irrigation rates were noted at 6 ft between all three forms of irrigation with gravity irrigation the fastest followed by high-pressure and low-pressure pulsatile irrigation (GI6, mean 142 s ± 3.2; HP6, mean 189 s ± 10.2; LP6, mean 323 s ± 22.5; p < 0.001). This difference was also found at 9 ft (GI9, mean 114 s ± 1.5; HP9, mean 186 s ± 10.5; LP9, mean 347 s ± 3.5; p < 0.001). Gravity irrigation was significantly faster (p < 0.001) at an increased height, whereas the high and low-pressure irrigation rates were unaffected by height. List price comparison found pulsatile irrigation to cost approximately 3.3 times more than gravity lavage. Conclusions Gravity irrigation provided the most rapid rate of irrigation tested, regardless of the height. With existing literature demonstrating equivalent clinical outcomes between methods, gravity lavage offers a faster and potentially more cost-effective form of irrigation.
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Affiliation(s)
- Lily R Mundy
- Division of Plastic and Reconstructive Surgery, Duke University, Durham, NC USA
| | - Mark J Gage
- Section of Orthopaedic Trauma, Department of Orthopaedic Surgery, Duke Univsersity, Durham, NC USA
| | - Richard S Yoon
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, 355 Grand Ave, Jersey City, NJ 07302 USA
| | - Frank A Liporace
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, 355 Grand Ave, Jersey City, NJ 07302 USA
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Mundy LR, Miller HC, Klassen AF, Cano SJ, Pusic AL. Patient-Reported Outcome Instruments for Surgical and Traumatic Scars: A Systematic Review of their Development, Content, and Psychometric Validation. Aesthetic Plast Surg 2016; 40:792-800. [PMID: 27357634 PMCID: PMC5505642 DOI: 10.1007/s00266-016-0642-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 04/15/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patient-reported outcomes (PROs) are of growing importance in research and clinical care and may be used as primary outcomes or as compliments to traditional surgical outcomes. In assessing the impact of surgical and traumatic scars, PROs are often the most meaningful. To assess outcomes from the patient perspective, rigorously developed and validated PRO instruments are essential. METHODS The authors conducted a systematic literature review to identify PRO instruments developed and/or validated for patients with surgical and/or non-burn traumatic scars. Identified instruments were assessed for content, development process, and validation under recommended guidelines for PRO instrument development. RESULTS The systematic review identified 6534 articles. After review, we identified four PRO instruments meeting inclusion criteria: patient and observer scar assessment scale (POSAS), bock quality of life questionnaire for patients with keloid and hypertrophic scarring (Bock), patient scar assessment questionnaire (PSAQ), and patient-reported impact of scars measure (PRISM). Common concepts measured were symptoms and psychosocial well-being. Only PSAQ had a dedicated appearance domain. Qualitative data were used to inform content for the PSAQ and PRISM, and a modern psychometric approach (Rasch Measurement Theory) was used to develop PRISM and to test POSAS. Overall, PRISM demonstrated the most rigorous design and validation process, however, was limited by the lack of a dedicated appearance domain. CONCLUSIONS PRO instruments to evaluate outcomes in scars exist but vary in terms of concepts measured and psychometric soundness. This review discusses the strengths and weaknesses of existing instruments, highlighting the need for future scar-focused PRO instrument development. 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 Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Lily R Mundy
- College of Physicians and Surgeons, Columbia University, 630 West 168th Street, New York, NY, USA
| | - H Catherine Miller
- School of Medicine, University of Washington, 4333 Brooklyn Avenue Northeast, Seattle, WA, USA
| | - Anne F Klassen
- Departments of Pediatrics and Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, Canada
| | - Stefan J Cano
- Clinical Neurology Research Group, Peninsula Schools of Medicine and Dentistry, Plymouth University, Drake Circus, Plymouth, Devon, UK
| | - Andrea L Pusic
- Plastic and Reconstructive Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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Cohen WA, Mundy LR, Ballard TNS, Klassen A, Cano SJ, Browne J, Pusic AL. The BREAST-Q in surgical research: A review of the literature 2009-2015. J Plast Reconstr Aesthet Surg 2015; 69:149-62. [PMID: 26740288 DOI: 10.1016/j.bjps.2015.11.013] [Citation(s) in RCA: 242] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 09/06/2015] [Accepted: 11/15/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Health outcomes research has gained considerable traction over the past decade as the medical community attempts to move beyond traditional outcome measures such as morbidity and mortality. Since its inception in 2009, the BREAST-Q has provided meaningful and reliable information regarding health-related quality of life (HRQOL) and patient satisfaction for use in both clinical practice and research. In this study, we review how researchers have used the BREAST-Q and how it has enhanced our understanding and practice of plastic and reconstructive breast surgery. METHODS An electronic literature review was performed to identify publications that used the BREAST-Q to assess patient outcomes. Studies developing and/or validating the BREAST-Q or an alternate patient-reported outcome measure (PROM), review papers, conference abstracts, discussions, comments and/or responses to previously published papers, studies that modified a version of BREAST-Q, and studies not published in English were excluded. RESULTS Our literature review yielded 214 unique articles, 49 of which met our inclusion criteria. Important trends and highlights were further examined. DISCUSSION The BREAST-Q has provided important insights into breast surgery highlighted by literature concerning autologous reconstruction, implant type, fat grafting, and patient education. The BREAST-Q has increased the use of PROMs in breast surgery and provided numerous important insights in its brief existence. The increased interest in PROMs as well as the underutilized potential of the BREAST-Q should permit its continued use and ability to foster innovations and improve quality of care.
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Affiliation(s)
- Wess A Cohen
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY, USA.
| | - Lily R Mundy
- College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Tiffany N S Ballard
- Section of Plastic and Reconstructive Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | | | | | - John Browne
- Department of Epidemiology and Public Health, University College Cork, Western Gateway Building, Western Road, Cork, Ireland
| | - Andrea L Pusic
- Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
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Mundy LR. Treatment of alcoholism in a general hospital. J Med Soc N J 1979; 76:577-9. [PMID: 295375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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