Outcome Of Reconstructive Surgery Research Articles

Outcomes of Reconstructive Surgery for Cleft Palate Patients: A survey on patients Admitted to Imam Khomeini and Apadana Hospitals during 2004-2010

Outcomes of Reconstructive Surgery for Cleft Palate Patients: A survey on patients Admitted to Imam Khomeini and Apadana Hospitals during 2004-2010

A Review of the Use of Medicare Claims Data in Plastic Surgery Outcomes Research.

Summary:With a growing national emphasis in data transparency and reporting of public health data, it is essential for researchers to know more about Medicare claims data, the largest and most reliable source of health-care utilization and expenditure for individuals older than 65 years in the United States. This article provides an overview of Medicare claims data for plastic surgery outcomes research. We highlight essential information on various files included in Medicare claims data, strengths and limitations of the data, and ways to expand the use of existing data for research purposes. As of now, Medicare data are limited in providing adequate information regarding severity of diagnosed conditions, health status of individuals, and health outcomes after certain procedures. However, the data contain all health-care utilization and expenditures for services that are covered by Medicare Parts A, B, and D (inpatient, outpatient, ambulatory-based and physician-based services, and prescription drugs). Additionally, Medicare claims data can be used for longitudinal analysis of variations in utilization and cost of health-care services at the patient level and provider level. Linking Medicare claims data with other national databases and utilizing the ICD-10 coding system would further expand the use of these datasets in health services research.

Outcomes of Reconstructive Surgery for Defects of the Articular Ends of Bones Using Home Joint Implants

Long-term outcomes of reconstructive operations for substitution of post-resection defects of the articular ends of tubular bones that form the hip, knee and shoulder joints using home endoprosthesis were studied. The study included 344 patients who were treated at CITO department of bone pathology from 2004 to 2014. Substitution of the defect was performed in 236 and 108 cases for the knee, hip joints, respectively. Indications for surgical intervention were: bone tumors; previously performed arthroplasty failure; defects of the articular ends after failed traumatologic and orthopaedic operations; severe forms of knee arthroses. Functional results (MSTS scale), survival of constructions, inflammatory complications were analyzed and comparative evaluation with imported analogues was performed. General functional outcomes and rate of complications correspond to the data on application of new oncologic and modular endoprostheses presented in foreign literature.

Outcomes of Reconstructive Surgery for Defects of the Articular Ends of Bones Using Home Joint Implants

Long-term outcomes of reconstructive operations for substitution of post-resection defects of the articular ends of tubular bones that form the hip, knee and shoulder joints using home endoprosthesis were studied. The study included 344 patients who were treated at CITO department of bone pathology from 2004 to 2014. Substitution of the defect was performed in 236 and 108 cases for the knee, hip joints, respectively. Indications for surgical intervention were: bone tumors; previously performed arthroplasty failure; defects of the articular ends after failed traumatologic and orthopaedic operations; severe forms of knee arthroses. Functional results (MSTS scale), survival of constructions, inflammatory complications were analyzed and comparative evaluation with imported analogues was performed. General functional outcomes and rate of complications correspond to the data on application of new oncologic and modular endoprostheses presented in foreign literature.

The value of perioperative antibiotics on the success of oral free flap reconstructions.

The subject of the presented study was to monitor and compare problems and outcomes of reconstructive surgery with microvascular free flaps in the head and neck region between groups of patients treated with perioperative antibiotics and a group of patients without antibiotics. Patients requiring oral reconstructive surgery following cancer resections with microvascular free flaps were prospectively evaluated (2007-2012). Antibiotic therapy was started 30 min before the operation and administered for 10 days. Three hundred and fifty patients were included (208 male, 59.4%; 142 female, 40.6%; mean age 59.8 ± 13.2 years). 330 patients received perioperative antibiotics. Twenty patients (5.7%) who received no antibiotics for specific reasons served as the control group. Wound infections developed in 33 of 122 patients (27%) who received benzylpenicillin, 17 of 88 patients (19.3%) who received amoxicillin combined with sulbactam and 25 of 120 patients (20.8%) who received cefuroxime. Ten patients (50%) who did not receive antibiotics developed wound infections. Receiving no antibiotics or penicillin showed no benefit (P = 0.11). Those receiving cefuroxime showed significantly lower incidence of wound infections (P = 0.034; risk decreased by the factor 2.88). The use of amoxicillin combined with sulbactam showed the lowest rate of wound infections (P = 0.018; risk decreased by the factor 3.46). The use of amoxicillin combined with sulbactam appears to be the most appropriate prophylactic antibiotic followed by cefuroxime in oral microsurgical free flap reconstructions. These data may serve as a guide until a controlled multicenter prospective trial is performed comparing newer antibiotics against current standards.

The impact of advancing age on postoperative outcomes in plastic surgery

Age has been shown to be an independent predictor of complications in general surgery patients. In contrast, the effect of age on outcomes after plastic surgery has yet to be confirmed or refuted. The objective of the current investigation was to evaluate a possible association between age and postoperative outcomes after plastic surgery. The 2005–2012 NSQIP database was retrospectively reviewed for all patients undergoing plastic surgery. Patients ≥60 years with procedures under the category of plastic surgery in NSQIP were selected for analysis. The primary outcome of interest was 30-day overall complication rates. Multivariate regression models were constructed to control for potential perioperative confounders. Of the 2,320,920 patients captured in the NSQIP database, 36,819 patients underwent plastic surgery and met inclusion criteria. The incidence of unadjusted overall complications increased with age with an overall complication rate of 9.0% in patients <60 years, 11.6% in patients 60–69 years, 13.2% in patients 70–79 years, and 15.9% in patients 80 or more years (p < 0.001). After adjusting for potential confounders, age was not independently associated with increased overall complications rates in patients 60–69 years (OR = 1.026; 95% CI = 0.927–1.135; p = 0.619) and 70–79 years (OR = 0.933; 95% CI = 0.797–0.919; p = 0.393), although patients 80 years and older experienced more medical complications (OR = 1.626; 95% CI = 1.218–2.172; p = 0.001). Age is not independently associated with overall worse outcomes in patients undergoing plastic surgery. Medical complications and mortality were more likely in extremes of age (>80 years). Age alone should not be included as a decisional factor in patients <80 years old considering plastic surgery.

Rodger H. Brown, MD.

Dr. Rodger Brown is an assistant professor in the Division of Plastic Surgery in the Michael E. DeBakey Department of Surgery at Baylor College of Medicine, Houston, Texas. He completed his medical degree and integrated plastic surgery residency training at Baylor College of Medicine. Dr. Brown maintains a very diverse practice in both cosmetic and reconstructive surgery, with the majority of his practice focusing on breast reduction, breast reconstruction, Mohs reconstruction, body contouring, thoracic and abdominal wall reconstruction, and facial and lower extremity trauma. His research interests focus on improving clinical outcomes in plastic surgery. I want to thank Dr. Brown for serving as guest editor for this issue of Seminars in Plastic Surgery on techniques in breast reduction and mastopexy. We also appreciate the efforts made by each outstanding author for sharing with us their knowledge and expertise.

Eigen-disfigurement model for simulating plausible facial disfigurement after reconstructive surgery.

BackgroundPatients with facial cancers can experience disfigurement as they may undergo considerable appearance changes from their illness and its treatment. Individuals with difficulties adjusting to facial cancer are concerned about how others perceive and evaluate their appearance. Therefore, it is important to understand how humans perceive disfigured faces. We describe a new strategy that allows simulation of surgically plausible facial disfigurement on a novel face for elucidating the human perception on facial disfigurement.MethodLongitudinal 3D facial images of patients (N = 17) with facial disfigurement due to cancer treatment were replicated using a facial mannequin model, by applying Thin-Plate Spline (TPS) warping and linear interpolation on the facial mannequin model in polar coordinates. Principal Component Analysis (PCA) was used to capture longitudinal structural and textural variations found within each patient with facial disfigurement arising from the treatment. We treated such variations as disfigurement. Each disfigurement was smoothly stitched on a healthy face by seeking a Poisson solution to guided interpolation using the gradient of the learned disfigurement as the guidance field vector. The modeling technique was quantitatively evaluated. In addition, panel ratings of experienced medical professionals on the plausibility of simulation were used to evaluate the proposed disfigurement model.ResultsThe algorithm reproduced the given face effectively using a facial mannequin model with less than 4.4 mm maximum error for the validation fiducial points that were not used for the processing. Panel ratings of experienced medical professionals on the plausibility of simulation showed that the disfigurement model (especially for peripheral disfigurement) yielded predictions comparable to the real disfigurements.ConclusionsThe modeling technique of this study is able to capture facial disfigurements and its simulation represents plausible outcomes of reconstructive surgery for facial cancers. Thus, our technique can be used to study human perception on facial disfigurement.Electronic supplementary materialThe online version of this article (doi:10.1186/s12880-015-0050-7) contains supplementary material, which is available to authorized users.

Patient-reported outcome measures in reconstructive breast surgery: is there a role for generic measures?

Patient-reported outcomes provide an invaluable tool in the assessment of outcomes in plastic surgery. Traditionally, patient-reported outcomes have consisted of either generic or ad hoc measures; however, more recently, there has been interest in formally constructed and validated questionnaires that are specifically designed for a particular patient population. The purpose of this systematic review was to determine whether generic measures still have a role in the evaluation of breast reconstruction outcomes, given the recent popularity and push for use of specific measures. A systematic review was performed to identify all articles using patient-reported outcomes in the assessment of postmastectomy breast reconstruction. Frequency of use was tabulated and the most frequently used tools were assessed for success of use, using criteria described previously by the Medical Outcomes Trust. To date, the most frequently used measures are still generic measures. The 36-Item Short-Form Health Survey was the most frequently used and most successfully applied showing evidence of responsiveness in multiple settings. Other measures such as the Hospital Anxiety and Depression Scale, the Hopwood Body Image Scale, and the Rosenberg Self-Esteem Scale were able to show responsiveness in certain settings but lacked evidence as universal tools for the assessment of outcomes in reconstructive breast surgery. Despite the recent advent of measures designed specifically to assess patient-reported outcomes in the breast reconstruction population, there still appears to be a role for the use of generic instruments. Many of these tools would benefit from undergoing formal validation in the breast reconstruction population.

The impact of perioperative hypothermia on plastic surgery outcomes: a multivariate logistic regression of 1062 cases.

Perioperative hypothermia has been associated with increased rates of infection, prolonged recovery time, and coagulopathy. The authors assessed the impact of hypothermia on patient outcomes after plastic surgery and analyzed the impact of prewarming on postoperative outcomes. The medical charts of 1062 patients who underwent complex plastic surgery typically lasting at least 1 hour were reviewed. Hypothermia was defined as a temperature at or below 36°C. Postoperative complication data were collected for outcomes including infection, delayed wound healing, seroma, hematoma, dehiscence, deep venous thrombosis, and overall wound problems. Odds ratios (ORs) were estimated from 3 multivariate logistic regression models of hypothermia and one model of body contouring procedures that included prewarming as a parameter. Perioperative hypothermia was not a significant predictor of wound problems (OR = 0.83; P = .28). In the stratified regression model, hypothermia did not significantly impact wound problems. The regression model measuring the interaction between hypothermia and operating time did not show a significantly increased risk of wound problems. Prewarming did not significantly affect perioperative hypothermia (P = .510), and in the model of body contouring procedures with prewarming as a categorical variable, massive weight loss was the most significant predictor of wound complications (OR = 2.57; P = .003). Prewarming did not significantly affect outcomes (OR = 1.49; P = .212). Based on univariate and multivariate models in our study, mild perioperative hypothermia appears to be independent of wound complications. LEVEL OF EVIDENCE 4: Risk.

Commentary on: The Impact of Perioperative Hypothermia on Plastic Surgery Outcomes: A Multivariate Logistic Regression of 1062 Cases

Constantine et al1 chose the interesting approach of studying not only the important subject of perioperative hypothermia but also the impact of perioperative hypothermia on outcomes by using a large 4-year database from an academic medical center. However, the retrospective nature of their study led to severe limitations with regard to the conclusions that can be drawn because cases cannot be compared when a well-defined protocol is missing. For example, the authors mention the inclusion of “intraoperative temperature” in the database and subsequent analysis, as well as the exclusion of all cases for which this information was not present. Unfortunately, we do not know whether this means core temperature as measured using an esophageal or a tympanic membrane probe2 or skin or rectal temperature, which cannot be considered to be core temperature.3 Analyzing the charts of 1801 procedures is hard work, for which the authors must be congratulated. Unfortunately, we do not know what the inclusion criteria were for this number of “complex plastic …

The outcome of reconstructive surgery for dental implant

The outcome of reconstructive surgery for dental implant

The utility of outcome studies in plastic surgery.

Summary:Outcome studies help provide the evidence-based science rationalizing treatment end results that factor the experience of patients and the impact on society. They improve the recognition of the shortcoming in clinical practice and provide the foundation for the development of gold standard care. With such evidence, health care practitioners can develop evidence-based justification for treatments and offer patients with superior informed consent for their treatment options. Furthermore, health care and insurance agencies can recognize improved cost-benefit options in the purpose of disease prevention and alleviation of its impact on the patient and society. Health care outcomes are ultimately measured by the treatment of disease, the reduction of symptoms, the normalization of laboratory results and physical measures, saving a life, and patient satisfaction. In this review, we outline the tools available to measure outcomes in plastic surgery and subsequently allow the objective measurements of plastic surgical conditions. Six major outcome categories are discussed: (1) functional measures; (2) preference-based measures and utility outcome scores; (3) patient satisfaction; (4) health outcomes and time; (5) other tools: patient-reported outcome measurement information system, BREAST-Q, and Tracking Operations and Outcomes for Plastic Surgeons; and (6) cost-effectiveness analysis. We use breast hypertrophy requiring breast reduction as an example throughout this review as a representative plastic surgical condition with multiple treatments available.

Three-dimensional nipple-areola tattooing: a new technique with superior results.

Traditional coloring techniques for nipple-areola tattooing ignore the artistic principles of light and shadow to create depth on a two-dimensional surface. The method presented in this article is essentially the inverse of traditional technique and results in a more realistic and three-dimensional reconstruction that can appear better than surgical methods. The application of three-dimensional techniques or "realism" in tattoo artistry has significant potential to improve the aesthetic outcomes of reconstructive surgery.

Patient-Reported Outcomes in Cosmetic Oculofacial Plastic Surgery: A Systematic Review

Introduction: This work reviews the current state of patient-reported outcomes research in periocular cosmetic plastic surgery. Materials and Methods: A systematic review of the English-language medical literature from January 1946 through March 2013 was conducted for patient-reported outcomes measures used in periocular cosmetic plastic surgery patient populations. These measures were assessed for adherence to minimum standards recommended by the International Society for Quality of Life Research. Results: Thirteen outcome measures were identified. Upper-lid blepharoplasty was the only procedure for which an instrument, the Blepharoplasty Outcomes Evaluation, had been formally developed in the target patient group (periocular cosmetic surgery), and that met or exceeded minimum standards of reporting. Nine formally developed instruments were identified in the following applications: general facial cosmetic surgery (instruments that may be applied to periocular surgery, which are not restricted to any single facial intervention or anatomic region), chemodenervation, filler, and skin treatment. Of these, 5 instruments met minimum standards. Conclusions: Few well-developed, patient-reported outcomes measures targeted at periocular cosmetic patients exist at this time.

Cementless Total Hip Arthroplasty in Patients with Crowe Type-4 Developmental Dysplasia

Developmental dysplasia of the hip is one of the most common causes of secondary osteoarthritis. The purpose of our study was to review clinical and radiological outcomes of reconstruction surgery using cementless total hip arthroplasty in patients with Crowe type-IV dysplastic hips. This study included eighty-seven primary total hip arthroplasties performed between January 2005 and January 2010 at our clinic in 74 patients who had Crowe type-IV developmental dysplasia of the hip. Cementless total hip arthroplasty was applied in all hips. At the clinical status analysis, any limping, the Harris hip score, surgical approach, the use of bone grafts, the presence of femoral osteotomy, any component migration, union status of the osteotomy site (if present), and any osteolysis or heterotopic ossification were noted. Mean follow-up time was 4.8 years. Mean Harris hip score was improved from 41.8 points preoperatively to 86.2 points postoperatively (p<0.001). At the final clinical examination, none of the patients had severe limping. Restoration of the anatomical hip centre was achieved in all hips. Pseudoarthrosis of the femoral osteotomy site was seen in two hips (3.6%). Twelve hips (13.8%) underwent revision surgery. Neurological complications were seen in two hips (2.3%). Heterotopic ossification was detected in one hip. Cementless total hip arthroplasty with restoration of the anatomic hip centre resulted in satisfactory clinical outcomes in patients with secondary coxarthrosis due to Crowe type IV developmental dysplasia of the hip joint.

Tradução para a língua portuguesa, adaptação cultural e validação do Breast Evaluation Questionnaire

BACKGROUND: Measurable data on plastic surgery outcomes are scarce. In recent years, questionnaires to measure quality of life have been used globally. In Brazil, there are no questionnaires validated and adapted in the Brazilian population that specifically assess quality of life after breast surgery. The aim of this study was to translate the Breast Evaluation Questionnaire (BEQ 55) into Portuguese, and culturally adapt and validate the translation for use in Brazil. METHODS: Two translations, two revisions by a multidisciplinary group, and two back translations of the questionnaire were performed. Cultural adaptation was performed by applying the questionnaire to groups of 20 patients from the plastic surgery outpatient clinic. The questionnaire included relevant modifications for better understanding of the questions. To test the questionnaire's reproducibility and validity, 20 patients were interviewed on two separate occasions. On the first occasion, they were interviewed by different interviewers, and on the second occasion (after 7 days and after 14 days), by only one. In addition, the Short-Form 36 was applied during the first interview. RESULTS: During cultural adaptation, questions were modified to facilitate the patients' understanding. A new group was tested to confirm that items were understood. Internal consistency of the questionnaire ranged between 0.931 and 0.936. The interobserver reproducibility coefficient was 0.962, and the intraobserver reproducibility coefficient was 0.919. Only the domains of the SF-36 regarding functional capacity, general health status, and emotional aspects correlated with the total score of the BEQ 55. CONCLUSIONS: The BEQ 55 questionnaire was successfully translated and adapted. The Brazilian version was called Questionario de Avaliacao das Mamas (BEQ-Brasil) and was demonstrated to be valid and reproducible.

The impact of surgical duration on plastic surgery outcomes

Historically, prolonged operative time has been associated with increased risk for morbidity and mortality. However, there is a paucity of clear data regarding the effect of longer operative times on outcomes in the field of plastic surgery. We endeavored to investigate the impact of operative time on postoperative morbidity and mortality in plastic surgery. Utilizing a multi-institutional surgical outcomes database spanning from 2006 to 2010, we identified 15,289 plastic surgery procedures. Operative time was tracked in 30-min increments. Multivariate logistic regression was utilized to investigate the relationship between operative time and primary outcomes of interest (medical complications, surgical complications, overall complications, and mortality). Subgroup analysis explored the relationship between operative time and outcomes in a homogenous high-risk cohort. When progressing from the shortest surgical duration cohort to the longest, we see an incremental increase in overall complications (6.22 to 24.86 %), surgical complications (2.73 to 13.08 %), and medical complications (3.68 to 15.89 %). Furthermore, for every 30-min increase in operative time, there was a corresponding increased risk for 30-day overall complications (odds ratio (OR) 1.13, 95 % confidence interval (CI) 1.08–1.18), medical complications (OR 1.14, 95 % CI 1.06–1.23), and surgical complications (OR 1.14, 95 % CI 1.09–1.20). There was no significant association with 30-day mortality. Findings were substantiated through subgroup analysis. Drawing from data on over 15,000 plastic surgery procedures, we determined that increased operative time was associated with a higher risk of medical, surgical, and overall complications. As outcome measures take a more prominent role in the care of plastic surgery patients, these findings will advance patient education and practice management. Level of Evidence: Level III, pronostic/risk study

Resident Involvement and Plastic Surgery Outcomes

Intraoperative experience is an essential component of surgical training. The impact of resident involvement in plastic surgery has not previously been studied on a large scale. The authors retrospectively reviewed the American College of Surgeons National Surgical Quality Improvement Program database from 2006 to 2010 for all reconstructive plastic surgery cases. Resident involvement was tracked as an individual variable to compare outcomes. A total of 10,356 cases were identified, with 43 percent noted as having resident involvement. The average total relative value units, a proxy for surgical complexity, and operative time were higher for procedures with residents present. When balanced by baseline characteristics using propensity score stratification into quintiles, no differences in graft, prosthesis, or flap failure or mortality were observed. Furthermore, there were no differences in overall complications or wound infection with resident involvement for a majority of the quintiles. Multivariable logistic regression analysis revealed that resident involvement was a significant predictor of overall morbidity, but not associated with increased odds of wound infection, graft, prosthesis or flap failure, or overall mortality. Residency has the dual mission of training future physicians and also providing critical support for academic medical centers. Using a large-scale, multicenter database, the authors were able to confirm that well-matched cohorts with-and without-resident presence had similar complication profiles. Moreover, even when residents were involved in comparably more complex cases with longer operative times, infection, graft and flap failure, and mortality remained similar.

A Qualitative Analysis of Identity and Goals in Patients With Deformities

Economically and socially vulnerable patients with deformities are likely to live a marginalized life, reducing their quality of life and societal participation. An evidence-based approach is needed for these patients who may not be able to advocate for themselves. The objective of this study is to identify important aspects of the perceived identity of adult patients with deformities. This retrospective qualitative analysis is of applicant responses to an intake questionnaire for Fresh Start Surgical Gifts, a charitable reconstructive surgery organization serving children and adults with deformities. Five open-ended questions were analyzed and grouped into 2 broad categories: Identity and Goals. Keywords were identified by an online survey website and subjective judgment of the investigators. Keywords were then combined into broader themes. Seventy respondents with a mean age of 24.79 (median 23) between 1992 and 2011 were analyzed. Social and professional issues were the most frequently occurring themes among Identity and Goals questions. The current identity of patients with deformities centers on social aspects of their lives, rather than a career or profession, yet they do hold both professional and social aspirations. This research will guide the development of an objective tool to measure patient-reported impact and outcomes of reconstructive plastic surgery.