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Donato D, Veith J, Holoyda K, Magno-Padron D, Simpson A, King B, Agarwal J. Associations of discharge destination and length of stay in lower extremity free flap reconstruction. J Plast Surg Hand Surg 2023; 57:279-284. [PMID: 35848882 DOI: 10.1080/2000656x.2022.2070175] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Indexed: 10/17/2022]
Abstract
Patients with lower extremity defects requiring free flap reconstruction often have difficult postoperative courses with prolonged length of stay and need for transfer to a post-acute care facility. The primary aim of this study was to determine associations of preoperative and perioperative variables with length of stay and discharge destination in patients undergoing lower extremity free flap reconstruction. The secondary aim was to determine associations of various complications with their discharge destination. The 2011- 2017 NSQIP database was queried for CPT codes for free flap procedures and ICD-9/ICD-10 codes for lower extremities. Univariate and multivariate analyses were used to determine associations of preoperative and perioperative variables with length of stay and discharge destination in patients undergoing lower extremity free flap reconstruction and associations of complications with their discharge destination. A total of 420 patients were identified who underwent lower extremity reconstruction in 2011-2017. Of 79.8% were discharged home and 21.2% were discharged to destinations other than home. On multivariate analysis, female gender, age > 55, ASA class > 2 and dependent functional status were found to have independent associations with discharge to post-acute care facilities. ASA classification greater than 2, active smoking, and discharge to a post-acute care facility all were independently associated with prolonged length of stay. Increased length of stay and discharge to post-acute care facility are closely associated. Understanding variables that influence length of stay and need for discharge to post-acute care facilities can help identify patients that may be triaged through appropriate interventions and expectation management.
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Affiliation(s)
- Daniel Donato
- Department of Surgery, Division of Plastic Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Jacob Veith
- Department of Surgery, Division of Plastic Surgery, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Kathleen Holoyda
- Department of Surgery, Division of Plastic Surgery, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - David Magno-Padron
- Department of Surgery, Division of Plastic Surgery, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Andrew Simpson
- Department of Surgery, Division of Plastic Surgery, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Brody King
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jayant Agarwal
- Department of Surgery, Division of Plastic Surgery, School of Medicine, University of Utah, Salt Lake City, UT, USA
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Rodosli Pires G, Hosein R, Agarwal J, Moss W, Kwok AC, Casucci T, McFarland M, Magno-Padron D. Complication and Failure Rates of Human, Porcine, and Bovine Acellular Dermal Matrix in Prepectoral Breast Reconstruction: A Scoping Review. Plast Reconstr Surg Glob Open 2022. [PMCID: PMC9592505 DOI: 10.1097/01.gox.0000898816.65112.bc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Luo J, Collier W, Magno-Padron D, Tieman J, Pires G, Moss W, Rosales M, Kim J, Agarwal JP, Kwok AC. Characteristics of Nonelderly Adult Health Care Persistent Super Utilizers in Utah. Popul Health Manag 2022; 25:472-479. [PMID: 35353618 DOI: 10.1089/pop.2021.0275] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In the United States, the top 1% and top 5% of health care spenders account for 23% and 50% of total health care spending, respectively. These high spenders have been coined the term super utilizers (SU). The aim of this study was to identify the characteristics associated with these patients to aid in developing public health interventions aimed at transitioning patients out of the SU category and thus ultimately helping to control health care costs. The authors utilized the Utah All-Payer Claims Database and Utah Population Database from 2013 to 2015 to identify demographics, comorbid conditions, health care utilization, and cost characteristics of persistent super utilizers (PSU) (≥3 hospitalizations per year for 3 years) of health care compared with persistent nonsuper utilizers (PNSU) (<3 hospitalizations per year for 3 years). Multivariable logistic regression was utilized to identify the characteristics associated with PSU versus PNSU. Higher outpatient/Emergency Department/noninpatient (eg, visits with imaging and Centers for Medicare & Medicaid Services preventive visits) health care utilization and spending, and prevalence of comorbid disease and psychosocial conditions were associated with PSU. In multivariable analysis, factors such as heart disease, chronic kidney disease (CKD), diabetes, alcohol abuse, and depression were statistically significantly associated with higher odds of PSU, with the most noteworthy being CKD (odds ratio [OR] 6.85, 95% confidence interval [95% CI] 5.84-8.02; P < 0.001), alcohol abuse (OR 5.90, 95% CI 4.49-7.69; P < 0.001), and heart diseases (OR 4.41, 95% CI 3.74-5.18; P < 0.001). The annual health care cost of a PSU is about 11.5 times greater than a PNSU ($54,776 vs. $4801; P < 0.001).
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Affiliation(s)
- Jessica Luo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Willem Collier
- Division of Biostatistics, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - David Magno-Padron
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Joshua Tieman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Giovanna Pires
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Whitney Moss
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Megan Rosales
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jaewhan Kim
- Department of Physical Therapy and Athletic Training, and CTSI Health Economics Core, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jayant P Agarwal
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Alvin C Kwok
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Simpson AM, Donato DP, Veith J, Magno-Padron D, Agarwal JP. Hand and Wrist Injuries Among Collegiate Athletes: The Role of Sex and Competition on Injury Rates and Severity. Orthop J Sports Med 2020; 8:2325967120964622. [PMID: 33403205 PMCID: PMC7745597 DOI: 10.1177/2325967120964622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/08/2020] [Indexed: 11/26/2022] Open
Abstract
Background: There is a high incidence of hand and wrist injuries in athletes participating in collegiate sports, but there is little information published characterizing them. Purpose: To characterize hand and wrist injuries in collegiate athletes using a large national database. Study Design: Descriptive epidemiology study. Methods: This retrospective cross-sectional analysis was designed using data from the National Collegiate Athletic Association (NCAA) Injury Surveillance Program database to identify hand and wrist injuries (exclusive of any radial or ulnar fractures) in male and female collegiate athletes participating in NCAA Division I, II, and III sports from 2004 to 2015. Descriptive analyses were performed on stratified data to examine the associations between these injuries and sport, event type, and sex. Results: Men’s ice hockey (8.25 per 10,000 athlete-exposures [AEs]) and women's ice hockey (8.21 per 10,000 AEs) had the highest rate of hand and wrist injuries in all exposures. In every sport except women’s gymnastics (P = .107), injuries were more commonly sustained during competition rather than during practice. Ligamentous injury to the phalynx was the most commonly sustained injury overall (1.416 per 10,000 AEs), and a metacarpal fracture was the most commonly sustained hand or wrist fracture (0.507 per 10,000 AEs). Injuries sustained during men’s wrestling (14.08 days) and women’s gymnastics (10.39 days) incurred the most time lost from sport. Surgery for hand and wrist injuries was most commonly required for men’s football (0.413 per 10,000 AEs) and women’s field hockey (0.404 per 10,000 AEs). Conclusion: Hand and wrist injuries were common among collegiate athletes. Male athletes experienced injuries with more frequency and severity. Injuries occurred more commonly during competition. While the majority of injuries were minor and did not require surgery, certain sports conferred a much higher risk of significant injuries requiring a surgical intervention.
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Affiliation(s)
- Andrew M. Simpson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - Daniel P. Donato
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Jacob Veith
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
- Jacob Veith, MD, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, 30 North 1900 East, #3B400, Salt Lake City, UT 84132, USA ()
| | - David Magno-Padron
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Jayant P. Agarwal
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
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Wright T, Donato D, Veith J, Magno-Padron D, Agarwal J. Thirty-Day Outcomes following Upper Extremity Flap Reconstruction. J Hand Microsurg 2020; 13:101-108. [PMID: 33867769 PMCID: PMC8041497 DOI: 10.1055/s-0040-1715557] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction
Flap reconstructions of upper extremity defects are challenging procedures. It is important to understand the surgical outcomes of upper extremity flap reconstruction, as well as associations between preoperative/perioperative variables and complications.
Materials and Methods
The National Surgical Quality Improvement Program (NSQIP) database was queried for patients from 2005 to 2016 who underwent flap reconstruction of an upper extremity defect. Patient and perioperative variables were collected for identified patients and assessed for associations with rates of any complication and major complications.
Results
On multivariate analysis, American Society of Anesthesiologists (ASA) classification >2, bleeding disorder, preoperative steroid use, free flap reconstruction, wound classification other than clean, and nonplastic surgeon specialty were independently associated with any complications. Bleeding disorder, ASA classification >2, male gender, wound classification other than clean, and preoperative anemia were independently associated with major complications. Free flap reconstruction was associated with increased length of stay, operative time, any complications, transfusions, and unplanned reoperations.
Conclusion
There is an association between complications in patients undergoing upper extremity free flap reconstruction and ASA classification >2, preoperative anemia, preoperative steroid use, bleeding disorders, and contaminated wounds. Male patients may require more thorough counseling in activity restriction following reconstruction. Free flaps for upper extremity reconstruction will require increased planning to reduce the chance of complications.
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Affiliation(s)
- Thomas Wright
- Division of Plastic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Daniel Donato
- Division of Plastic Surgery, Department of Surgery, University of Texas Medical Branch, Texas, United States
| | - Jacob Veith
- Division of Plastic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - David Magno-Padron
- Division of Plastic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Jayant Agarwal
- Division of Plastic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States
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