Plastic Surgery Procedures Research Articles

Gingival Depigmentation : a Review

A beautiful smile surely enhances the individual’s self-confidence. The harmony of smile is attributable to the shape, color, and position of the teeth in conjunction with the gingival tissue. Gingival pigmentation occurs in all races of man, varies from one race to another & caused by a variety of external and endogenous sources. Excessive deposition of melanocytic pigmentation has a significant impact on aesthetics and also produces psychological distress. A periodontal plastic surgery procedure called gingival depigmentation eliminates or reduces hyperpigmentation. Although there are numerous depigmentation procedures available to treat this problem, but there is a lack of research to aid clinicians in selecting the best effective approach. As a result, the goal of this review is to assess the existing depigmentation therapies. Cryosurgery, followed by lasers, has been reported by many studies to be superior procedures, with better aesthetic results and a low recurrence rates. However, additional randomized controlled long term studies are needed to better understand the efficiency and effectiveness of present approaches.

Health Literacy in Oculofacial Plastic Surgery: A Literature Review.

Patient satisfaction following oculofacial cosmetic procedures depends on preoperative expectations, which may be influenced by online material. Patients with poor health literacy are particularly vulnerable to misinformation and low-quality resources. However, few studies have evaluated the quality of online information on common oculofacial plastic surgeries and procedures. This study aimed to review the literature on the readability and quality of online material related to oculofacial plastic surgery. We conducted a systematic search of the PubMed/MEDLINE database and included 10 studies in our review. Among the readability scores reported in these studies, the lowest was 10, representing a tenth-grade reading level. Furthermore, the online materials were often rated as "poor" quality based on multiple grading scales. Our systematic review of the literature demonstrates that online materials covering common oculofacial plastic surgery procedures are consistently of poor quality and exceed the recommended readability level. Therefore, considering these online materials that influence patient expectations could enable oculofacial plastic surgeons to better tailor their preoperative counseling.

Evaluation of pathogen distribution and antimicrobial resistance in breast plastic surgery infection.

The demand for mammaplasty has increased in recent years, and infection remains one of the common and serious post-operative complications. In this study, we analyzed the pathogen distribution and antibiotic susceptibility of breast plastic surgery infections, and compared the differences in pathogenic species between surgical procedures. The number of each species was counted in the microbial samples of breast plastic surgery infections in Plastic Surgery Hospital of Chinese Academy of Medical Sciences from January 2011 to December 2021. The in vitro antibiotic sensitivity testing data were analyzed using WHONET 5.6 software. The surgical techniques, the period of infection, and other details were gathered in accordance with the clinical data. There were a total of 42 cases included, and 43 different types of pathogenic bacteria, mostly gram-positive bacteria, were found. CoNS (13/43) and Staphylococcus aureus (22/43) made up the majority. The most prevalent of the five Gram-negative bacteria was Pseudomonas aeruginosa. Results of drug sensitivity tests indicate that S. aureus is highly sensitive to vancomycin, cotrimoxazole, and linezolid, whereas CoNS is highly sensitive to vancomycin, linezolid, and chloramphenicol. Both of these bacteria show high resistance to erythromycin and penicillin. Breast augmentation, breast reconstruction, and breast reduction surgery were the most frequently associated breast surgery procedures in this study with infections, with the highest number of infections occurring following breast augmentation with fat grafting, breast reduction surgery, and breast reconstruction with autologous tissue. Various breast plastic surgery procedures have different common pathogens of infection, but the most prevalent are CoNS and S. aureus. Additionally, the majority of the infections in this study were in the early stages. Gram-positive bacteria were the predominant cause of breast plastic surgery infections, and the types of infection strains, the period of infection onset, and the antibiotic susceptibility of prevalent strains varied between breast plastic procedures.

Plastic Surgery and Artificial Intelligence: How ChatGPT Improved Operation Note Accuracy, Time, and Education

ObjectivesTo evaluate the feasibility and effectiveness of employing a large language model (LLM), particularly the chat generative pretrained transformer (ChatGPT), as a supporting and educational tool for plastic surgeons. Patients and MethodsThe study involved generating operative notes for plastic surgery procedures using ChatGPT-4 and comparing them with handwritten or computer-written notes for the same procedures. All operations were performed in a single institution from February 1, 2023, to April 20, 2023, by 4 surgeons. Data were compared using the Likert scale that included the following: procedure type; seniority of operating surgeon and operative note creator; type of note; time of surgeon generated note; time of artificial intelligence (AI)-generated note; adherence of AI note to current guidelines; surgeon satisfaction about AI-generated note; patient demographic characteristics; and patient satisfaction about AI-generated note. ResultsChatGPT-generated operative notes (n=30) took considerably less time to create than human-generated notes (5.1 seconds vs 7.10 minutes; P<.05), with 100% of the ChatGPT notes adhering to the current guidelines. Surgeons and patients expressed high satisfaction with the process of generating operative notes by the AI with (n=13) surgeons being very satisfied, (n=12) surgeons being satisfied, (n=4) surgeons being neutral, and only (n=1) surgeon was dissatisfied with the generated operative note. From a patient point of view, (n=13) patients were very satisfied, (n=13) patients were satisfied, (n=3) patients were neutral, and only (n=1) patient was dissatisfied. The mean time for surgeons to create a human note was 7.10 minutes (standard error of mean of 0.334 minutes). By contrast, the ChatGPT platform generated notes in 5.1 seconds (standard error of mean of 0.12 seconds), with an average of 2.1 edits needed per note. In addition, another AI tool enhanced the operative notes with realistic image creations to illustrate surgical incisions. ConclusionLLM-generated notes are significantly faster to create, adhere to guidelines, and receive high user satisfaction from surgeons and patient perception. AI-generated hyper-realistic images further enhanced the operative notes. Although not able to replace human input, these findings show AI’s potential in the medical field and opportunities for future advancement.

A rare outcome of liposuction complicated by the development of peritonitis following perforation of the small intestine: a case report

There are a growing number of demands for liposuction each year and it is one of the most performed procedures in plastic surgery for aesthetic purposes. Bowel perforation and peritonitis are rare, but life-threatening complications following liposuction. However, there is a lack of awareness of these ill-fated outcomes which are underestimated and under-reported in the literature. We present the case of a 63-year-old male admitted to emergency department (ED) with the symptoms of abdominal pain and distension with anorexia and nausea. The patient stated that he had not been feeling well since the liposuction procedure which he received 6 days prior. During the physical examination, there was mild abdominal distension with tenderness and some guarding in all 4 quadrants. A computed tomography (CT) scan showed pneumoperitoneum. The patient underwent an exploratory laparotomy where multiple small bowel perforations were repaired and a part of the small bowel was resected. The patient eventually recovered well and was discharged on post-op day 12. Bowel perforation which can lead to peritonitis following liposuction is rare, but the risk increases in patients with a previous history of abdominal surgery such as hernia repair, as in this patient. Increased awareness of possible life-threatening complications and close follow-up in patients with risk factors are essential to prevent undesirable outcomes and promptly treat the patient.

PECS 1 block as analgesic adjuncts in breast augmentation surgery

The analgesic benefits of using pectoral nerve (PECS) block as regional analgesia in breast cancer surgery have been widely published. However, the use of PECS block in aesthetic breast surgery remains underreported. Breast augmentation is one of the most popular plastic surgery procedures. Pain and discomfort are common after breast augmentation surgery. We report a case series using ultrasound-guided PECS 1 block as part of multimodal analgesia, which further enhanced the recovery experience in patients undergoing primary augmentation mammaplasty using silicone implants in a day-surgery setting.

Superior Pedicle Breast Reduction: Multivariate Analysis of Complication Risk Factors and Building a Predictive Score in 1306 Patients.

Breast reduction surgery for hypertrophy is one of the most commonly performed procedures in plastic surgery. This surgery exposes patients to complications that are well-documented in the literature. The objective of this study is to identify risk factors to establish an estimate of the risk of developing complications. The authors propose the first predictive score of postoperative complications, including continuous preoperative variables such as body mass index (BMI) and suprasternal notch-to-nipple distance (SSN:N). An analytic observational retrospective cohort study was conducted including 1306 patients who underwent superior pedicle reduction mammaplasty at the Rennes University Hospital (France) between January 1, 2011, and December 31, 2016. The primary endpoint was to study the association between known preoperative risk factors and occurrence of any complications using multivariable logistic regression to identify independent risk factors. A secondary endpoint was to establish a score to estimate a probability of occurrence of complications. A total of 1306 patients were analyzed. Multivariable logistic regression showed three independent risk factors: active smoking [OR, 6.10 (95% CI: 4.23, 8.78); P < 0.0001], BMI [OR, 1.16 (95% CI: 1.11, 1.22); P < 0.0001], and SSN:N [OR, 1.14 (95% CI: 1.08, 1.21); P < 0.0001]. The Rennes Plastic Surgery Score estimating the occurrence of postoperative complications was determined, integrating regression coefficients of each risk factor. Active smoking, BMI, and SSN:N distance are independent preoperative risk factors for the occurrence of breast reduction complications. The Rennes Plastic Surgery Score including the continuous values of BMI and SSN:N allows us to provide our patients with a reliable estimation of the risk of occurrence of these complications. Risk, III.

Ethnic Rhinoplasty: A Middle East-Centered Patient Satisfaction Survey Using the FACE-Q Questionnaire.

Background Rhinoplasty is a common and complex plastic surgery procedure. The evaluation of surgical success in rhinoplasty is primarily based on patient satisfaction. The purpose of the study is to assess the characteristics of patients who underwent rhinoplasty and their satisfaction using the FACE-Q questionnaire. Methodology This was a retrospective, cross-sectional study of patients who underwent primary rhinoplasty, septorhinoplasty, or a revision rhinoplasty from 2010 to 2020 at a single center. Patients were asked to complete the FACE-Q nose score pre and postoperatively. Patients also provided information on their sociodemographic characteristics, smoking status, alcohol consumption, number of rhinoplasty procedures, cause of revision, and respiratory symptoms before rhinoplasty. Results This study included 183 patients who underwent rhinoplasty between 2010 and 2020. The mean (SD) age of patients at surgery was 25.92 (8.69) years. There were 156 female respondents (85.2%) and 27 male respondents (14.8%). FACE-Q nose satisfaction scores increased significantly after surgery with a mean of 67.21 ± 22.3 (p = 0.000). The most common reason for revision surgery was tip dissatisfaction. Conclusions The findings of this study show that ethnic rhinoplasty, although a complex procedure, can lead to aesthetically pleasing outcomes in a complex population such as the Middle Eastern population.

Excess Opioid Medication and Variation in Prescribing Patterns Following Common Breast Plastic Surgeries.

Purpose: Excess opioid prescribing has societal impacts including addiction, dependence, and misuse. This study aims to investigate prescribing patterns and self-reported patient experiences with opioid use, pain control, and disposal of unused medication following common breast surgeries. Methods: A total of 46 patients undergoing 5 breast procedures were identified during a predefined 14-week period. All procedures were carried out at a single tertiary care hospital by 9 plastic surgeons. Provincial narcotic monitoring program provided linked prescription information for identified patients. All patients were invited to participate in a telephone interview regarding postoperative opioid use. Results: A total of 41.6% of patients received and filled an opioid prescription following a breast procedure. Hydromorphone was the most commonly prescribed narcotic. The average number of opioid tablets dispensed following breast procedures was 31.9. Four percent of breast patients required an opioid refill. A total of 75% of breast patients used at least 1 over-the-counter analgesic, most commonly acetaminophen alone. Average self-reported pain score and total pain period were not significantly different between those using opioids and those not. A total of 6.7% and 23.1% of patients report returning excess narcotics to a pharmacy, while the majority report still having or self-disposing of excess tablets. Conclusions: Opioids are prescribed in excess for the breast procedures we analyzed. The majority of unused opioids were noted to still be at home or disposed of inappropriately. This suggests a role for reviewing opioid-prescribing patterns for common plastic surgery procedures to reduce the burden of the ongoing opioid epidemic.

Effect of the COVID-19 Pandemic on Global Interest in Plastic Surgery

Due to the SARS-CoV-2 (COVID-19) pandemic, many elective surgeries were canceled, including most aesthetic plastic surgery procedures. Although studies have shown COVID-19's effect on plastic surgery in the United States, no study to date has examined the international interest in plastic surgery procedures after the start of the COVID-19 pandemic. Thus, we sought to find this effect using the Google Trends tool. The most common cosmetic procedures and top countries with the highest plastic surgery volume were selected from the International Society of Plastic Surgeons report and used as the search terms for Google Trends. Weekly search data from each procedure and country were collected from March 18, 2018 to March 13, 2022, split into 2 periods according to the start of the US COVID-19 lockdown, and compared. Among the countries, the United States had the most plastic surgery interest after the COVID-19 pandemic, with India and Mexico closely following. On the other hand, Russia and Japan had the fewest changes in procedure interest. Regarding specific procedures, interest in breast augmentation, forehead lift, injectable filler, laser hair removal, liposuction, microdermabrasion, and rhytidectomy increased in all countries after the COVID-19 pandemic. After COVID-19, there has been increasing interest in almost all plastic surgery procedures globally, especially nonsurgical procedures and facial plastic surgery, with the greatest increases in the United States, India, and Mexico. These results can help inform plastic surgeons which procedures to focus on and which devices or technologies to invest in that are specific to their country.

Changing Aesthetic Surgery Interest in Men: An 18-Year Analysis.

Historically, men have been shamed if they cared seemingly too much about their appearance and especially, if they pursued aesthetic surgery. However, due to the changing landscape of the culture, this stigma has seemed to decrease. Men have diverse and quickly changing interests in particular procedures that have not been readily explored in the currently available reports. To examine this, we analyzed interest in specific plastic surgery procedures in men over the last two decades using the Google Trends tool. The most common cosmetic procedures were chosen from the American Society of Plastic Surgeons website and served as the search terms for the Google Trends tool from 2004 to 2021. All 19 procedures were examined for overall trends and for changes in the last decade through comparing the data in bisected time periods. Interest in all plastic surgery procedures in men increased since 2004 except for breast reduction. Most notably, jawline filler, Botox, microneedling, lip filler, chemical peel, CoolSculpting, and butt lift had the largest trend increases. In the last decade, all procedures showed a significant increase in interest. While surgical volume data are valuable, our study shows that Google Trends is a beneficial tool to predict quickly changing and specific trends, especially as the patient population of plastic surgery grows with increased diversity and generational changes. Our study shows that there is an increase in male-centered plastic surgery procedures, especially nonsurgical facial procedures. Male interest in plastic surgery will continue to increase with time. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Updates on Enhanced Recovery after Surgery protocols for plastic surgery of the breast and future directions

Introduction Perioperative pain control is an important component of any plastic surgery practice. Due to the incorporation of Enhanced Recovery after Surgery (ERAS) protocols, reported pain level, opioid consumption, and hospital length of stay numbers have decreased significantly. This article provides an up-to-date review of current ERAS protocols in use, reviews individual aspects of ERAS protocols, and discusses future directions for the continual improvement of ERAS protocols and control of postoperative pain. ERAS components ERAS protocols have proven to be excellent methods of decreasing patient pain, opioid consumption, and postanesthesia care unit (PACU) and/or inpatient length of stay. ERAS protocols have three phases: preoperative education and pre-habilitation, intraoperative anesthetic blocks, and a postoperative multimodal analgesia regimen. Intraoperative blocks consist of local anesthetic field blocks and a variety of regional blocks, with lidocaine or lidocaine cocktails. Various studies throughout the surgical literature have demonstrated the efficacy of these aspects and their relevance to the overall goal of decreasing patient pain, both in plastic surgery and other surgical fields. In addition to the individual ERAS phases, ERAS protocols have shown promise in both the inpatient and outpatient sectors of plastic surgery of the breast. Conclusion ERAS protocols have repeatedly been shown to provide improved patient pain control, decreased hospital or PACU length of stay, decreased opioid use, and cost savings. Although protocols have most commonly been utilized in inpatient plastic surgery procedures of the breast, emerging evidence points towards similar efficacy when used in outpatient procedures. Furthermore, this review demonstrates the efficacy of local anesthetic blocks in controlling patient pain.

Risk of Complications in Combined Plastic Surgery Procedures Using the Tracking Operations and Outcomes for Plastic Surgeons Database.

Combining multiple surgical procedures into one operative session is widespread in the field of plastic surgery; however, the implications of this practice are not fully understood. This study compared 30-day complication rates associated with combined plastic surgery procedures compared to index procedures. This retrospective cohort analysis utilized the Tracking Operations and Outcomes for Plastic Surgeons database from 2016-2020 to identify the three most frequent combinations with augmentation mammaplasty, reduction mammaplasty, trunk liposuction, mastopexy, and abdominoplasty. The 30-day overall complication rate was 5.0% (1,400 of 26,771 patients), with a higher complication rate for combined procedures compared to index (7.6% vs 4.2%, aOR 1.91 (95% CI 1.61-2.27), p<0.001). There were no significant differences in complication rates for abdominoplasty or mastopexy combinations compared to index. Complication rates for reduction mammaplasty combinations compared to index were not statistically different after controlling for demographics (aOR 1.02 (95% CI 0.61, 1.64) p=0.93). Higher rates of minor and major complications were observed for combinations of trunk liposuction (aOR 4.84, (95% CI 3.31, 7.21), p<0.001) and augmentation mammaplasty (aOR 1.60, (95% CI 1.13, 2.22), p=0.007) compared to index. TOPS data suggests that combinations with trunk liposuction or augmentation mammaplasty present with increased risk of complications compared to index, controlling for demographics. Abdominoplasty and mastopexy may be combined with other plastic surgery procedures without increased risk to patients. The complication risk of reduction mammaplasty combinations is mediated by other variables, suggesting the need for shared surgical decision making when recommending these combinations to patients.

Thematic and Demographic Analysis of Crowdsourcing Practices for Plastic Surgery.

In this study, we investigate the characterization of medical crowdsourcing on GoFundMe for plastic surgery procedures, with overall funds raised being the primary end point. Certain demographic factors such as sex and race mentioned in campaign narratives are associated with the effectiveness of medical crowdfunding campaigns. Search terms were used to aggregate fundraising campaigns for plastic surgery medical procedures on GoFundMe. These studies were then stratified by demographics based on campaign text or author consensus, and were further subdivided into categories based on procedure type. Men were found to have higher median shares than women-raising an average of $609 more than female counterparts ( P < 0.05). Fundraising for themes such as lack of insurance, travel costs, lifesaving treatment, and end-of-life expenses were more successful than the theme of psychosocial effects of disease or social impairment. In addition, those that included a smiling picture of the recipient and those created by a friend/relative raised more funds. Although no significant difference was found in fundraising between demographics based on race, a majority (72.8%) of campaigners were White. Across ~2000 plastic surgery campaigns, a total of $10,186,687 were raised from these data. We identified both modifiable and nonmodifiable factors that influence success. These successful campaigns can serve as a learning opportunity for many who have been marginalized by the medical and pharmaceutical industry, and they demonstrate a promising area for demographic studies.

PLASTIC SURGERY AFTER BARIATRIC SURGERY: REVIEW OF THE LITERATURE

Plastic surgery is increasingly common for individuals who have undergone bariatric surgery and suffer from excess skin and tissue laxity. A literature review of studies from the past decade found that over 50% of bariatric surgery patients experienced excess skin in the arms and 75.5% experienced it in the abdomen. Plastic surgery can improve the quality of life for these patients by improving appearance and self-esteem. However, potential risks and complications such as infections, bleeding, and poor wound healing should be taken into account before the procedure. The most common plastic surgery procedures include abdominoplasty, breast surgery, brachioplasty, thigh lift, and face and neck lift.

Institutional Experience With Surgical and Injectable Procedures at a Department Resident Aesthetic Plastic Surgery Clinic

Abstract Goals/Purpose Over the past several decades, the number of aesthetic procedures in plastic surgery has risen drastically in the United States. To meet this public demand, it is important to ensure plastic surgery residents are well-equipped to incorporate aesthetics into their future practice. Given the elective nature of aesthetic surgery, many patients opt to personally select their surgeon from qualified private practitioners. Patients’ tendency to avoid academic institutions, coupled with relatively high postoperative expectations, has historically led to limited hands-on experience for residents. Recent literature has documented graduating plastic surgery residents have felt deficient in performing aesthetic procedures, particularly those of the face. In a recent survey, 30% of department chairs/division chiefs acknowledged difficulties with and inadequacies of aesthetic surgery training at their institutions and recommending the need for more effective training models. The objective was to review the volume and outcomes of our resident aesthetic clinic. Methods/Technique The Resident Aesthetic Surgery Clinic at the Hansjörg Wyss Department of Plastic Surgery at NYU Langone Health sees patients 5 days per week and provides a total of 6 months of training experience for residents. Patients presenting to the clinic are first evaluated by senior residents, who perform the entire consultation. Patients are staffed with the attending present that day who provides feedback, oversight, and supervision and helps the residents refine their clinical skills of indicating a patient for surgery, pre-operative planning, and post-surgical follow-up visits. Dedicated clinic front office staff streamline the process by assisting with surgical quotes, preoperative clearance, and operating room scheduling. The resident aesthetic clinic does not engage in any formal advertising, but rather relies on word-of-mouth and direct referrals for patient recruitment. Patients are billed on a fee-for-service basis and insurance is not accepted. The revenue generated is used to offset operational costs of the clinic and operating rooms, as well as contribute to the salary of staff supporting the clinic. The remaining operational costs of the clinic are subsidized by the department. We conducted a retrospective review of all surgical and injectable procedures completed by the NYU Resident Aesthetic Surgery Clinic in 2021. Patients were excluded from the study if outcome information was missing. Participating residents were surveyed before and after their rotation in the clinic to assess their confidence performing aesthetic procedures which was rated on a scale of 1 to 5. Procedures were defined similar to how procedures are recorded for resident case logs for the Accreditation Council for Graduate Medical Education (ACGME).1 Bilateral procedures (e.g., bilateral breast augmentation) were counted as two separate procedures (left and right). Blepharoplasty was not only separated by laterality, but also by upper and lower lids. In contrast, an operation was defined as a single trip to the operating room or office visit in which the patient received at least one procedure. Complications were categorized as either minor, moderate, or major. Minor complications were treated with non-operative management. Moderate complications required a small intervention such as seroma aspiration, while major complications necessitated return to the operating room. Complication and revision rates were calculated by summing the number of complications and revisions, respectively, and dividing by the total number of procedures. Data analyzed using IBM SPSS software and the ggplot2 package in R. A chi-squared test assessed for significant deviation in frequencies of procedures across yearly quarters. Mann-Whitney tests evaluated significance between pre- and post-rotation confidence ratings among residents. A p-value of less than 0.05 was considered statistically significant. Complication and revision rates were calculated with respect to the total number of procedures. The complication rate, revision rate, and surgeon fees were compared to data from other institutions available in the literature. Surgeon fees were also compared to national averages according to the 2020 ASPS Plastic Surgery Statistics Report and 2021 Aesthetic Plastic Surgery National Databank Statistics. Results/Complications In 2021, 144/379 consultations led to an operation (38.0% conversion rate), resulting in 420 distinct surgical procedures. The majority (53.3%) of procedures involved the head and neck. Complication and revision rates were 5.5% and 1.0%, respectively, with surgeon fees consistently below national average. Residents reported being significantly more confident performing face lifts, rhinoplasties, and aesthetic surgery in general following their clinic rotation. Analyzing our injectable experience, 223/233 consultations led to an injection (95.7% conversion rate) for 142 patients. Neurotoxin was most commonly injected into the upper face, while fillers were most commonly injected into the midface. Only 2 complications from fillers (0.9% complication rate) and one touch-up (0.4% touch-up rate) occurred. Procedural fees were substantially less than national averages and comparable to other academic settings. Conclusion These data represent the largest annual reported study of plastic surgery resident aesthetic surgical and injectable procedures and outcomes, demonstrating the high volume and productivity of the NYU Resident Aesthetic Surgery Clinic. These results further support resident aesthetic clinics as a robust training modality.

A Temporal Analysis of the Cost of Aesthetic Surgical Procedures Over the Past Decade in Relation to Consumer Price Indices and the Stock Market

Abstract Goals/Purpose As inflation continues to rise, virtually all consumer markets are affected. However, the effect of these increases on aesthetic surgical procedures are not well defined. An important relational understanding of these effects can help aesthetic practices offer fair market prices to benefit both patients and practices alike. The purpose of this study was to quantify temporal changes in pricing for the most common aesthetic surgeries and to make comparisons to various indices of inflation and the stock market. Methods/Technique Annual surgical fees for 18 aesthetic plastic surgery procedures were collected from 2007 to 2020 using the ASAPs and ASPS yearly plastic surgery statistic reports. In addition, annual consumer price indices (CPI) for all items, physicians’ services, and hospital services were collected from the U.S Bureau of Labor Statistics. Finally yearly Dow Jones Industrial (DJI) Averages were collected during the same time frame. Correlation statistics, generalized additive models, and parametric tests were performed to understand the relationships of these surgical costs to other indices. Results/Complications A total of 322 annual measurements were collected for analysis. The cumulative percent change from 2007 to 2020 was highest for rhytidectomy, blepharoplasty, and otoplasty 38.1%, 33.4%, and 30.4%, respectively. Liposuction had the lowest overall cumulative percent change at -10.0%. Kendall correlation test revealed that out of all surgeries, male gynecomastia had the strongest correlation with time, Tau= 0.74, p=0.001. Breast augmentation, blepharoplasty, and abdominoplasty also correlated with time. When comparing the temporal change in prices to the various indices through nonparametric general additive modeling, breast augmentation, blepharoplasty, facelift, and liposuction costs changed at a statistically different rate than the overall CPI of all items, p=0.035, 0.018, 0.012, and &amp;lt;0.001, respectively. In contrast, rates of price changes in rhinoplasty, buttock lift, and breast lift surgery have not differed significantly from that of the CPI. The DJI has grown at rates far greater than the price of any aesthetic surgery procedure and models have been statistically different. Conclusion While over the past decade aesthetic surgery costs have changed, certain procedure costs such as the rhytidectomy have greatly increased, while others have modestly increased, and liposuction has even decreased. Interestingly, the cost for the majority of the most performed aesthetic procedures are not greatly impacted by inflation. This suggests that other forces such as supply and demand may have a greater impact on price changes over the years. Many surgical procedures however were found to have similar rates of price change as the CPI, suggesting that these surgeries and their costs are more vulnerable to inflationary adjustments. Furthermore the price changes of aesthetic surgeries seem to be independent of how the stock market fluctuates and therefore possibly independent of other markets as a whole. This study has several limitations, with the data source as its greatest. The ASPS and ASAPs statistic reports are based on surveys from national members and computational adjustments, which have inherent biases and can vary significantly in any given year. Furthermore the various modeling and statistical analyses performed herein were based on several assumptions and estimates. An understanding of the price trends in aesthetic surgery over time and in relation to consumer price indices and the DJI can help plastic surgery practices and patients better appreciate the economics surrounding aesthetic surgeries.

Evaluating the Development Status of Fluorescence-Guided Surgery (FGS) in Pediatric Surgery Using the Idea, Development, Exploration, Assessment, and Long-Term Study (IDEAL) Framework.

Fluorescence-guided surgery (FGS) is used in many pediatric subspecialties but there are currently no standard guidelines or outcome data. We aimed to assess the current status of FGS in pediatrics using the Idea, Development, Exploration, Assessment, and Long-term study (IDEAL) framework. Clinical papers on FGS in children published from January 2000 to December 2022 were systematically reviewed. The stage of research development was measured considering seven fields of application: biliary tree imaging, vascular perfusion for gastrointestinal procedures, lymphatic flow imaging, tumor resection, urogenital surgery, plastic surgery, and miscellaneous procedures. Fifty-nine articles were selected. For each field of application, the overall IDEAL stage was determined to be 2a for biliary tree imaging (10 publications, 102 cases), 1 for vascular perfusion for gastrointestinal procedures (8 publications, 28 cases), 1 for lymphatic flow imaging (12 publications, 33 cases), 2a for tumor resection (20 publications, 238 cases), 2a for urogenital surgery (9 publications, 197 cases), and 1-2a for plastic surgery (4 publications, 26 cases). One report did not belong to any categories. FGS in children is still in an early phase of adoption and development. We recommend using the IDEAL framework as a guide and suggest developing multicenter studies to define the standard guidelines, effectiveness, and outcomes.

MP48-07 NATIONAL TRENDS OF COMMON FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY PROCEDURES: 2016-2019

You have accessJournal of UrologyCME1 Apr 2023MP48-07 NATIONAL TRENDS OF COMMON FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY PROCEDURES: 2016-2019 Connie Wang, Daniel Schoenfeld, Joseph Marte, and Gregory Joice Connie WangConnie Wang More articles by this author , Daniel SchoenfeldDaniel Schoenfeld More articles by this author , Joseph MarteJoseph Marte More articles by this author , and Gregory JoiceGregory Joice More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003294.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To evaluate national trends in settings and charges of common female pelvic medicine and reconstructive surgery (FPMRS) procedures. METHODS: Common FPMRS procedures were identified by Current Procedural Terminology and International Classification of Diseases (10th Revision) Procedure Coding System codes and classified into 3 categories: 1) stress urinary incontinence procedures (SUI-p) 2) pelvic organ prolapse procedures (POP-p) and 3) overactive bladder procedures (OAB-p). Data from inpatient (IP) and outpatient (OP) encounters for included procedures between 2016-2019 were extracted from the Nationwide Inpatient Sample and Nationwide Ambulatory Surgery Sample from the Healthcare Cost and Utilization Project. Stratified cluster sampling was used to create weighted, national estimates. Student t-tests and multivariable linear regression was performed to compare procedural factors. RESULTS: A total of 893,450 weighted procedures were analyzed, of which 9.3% were performed IP and 90.7% were performed OP. Over the study period, there was a 4.3% increase in total number of procedures, and the proportion performed OP increased from 88.1% to 92.5%. Between 2016-2019, there was a 10.6% and 10.5% increase in SUI-p and POP-p performed OP, respectively. Over the study period, proportion of SUI-p performed OP increased from 96.4% to 99.7%, and proportion of POP-p performed OP increased from 76.5% to 82.8%. 99.9% of OAB-p were performed OP. Charges for SUI-p performed IP were $16,705 higher than those performed OP (p=0.007) and charges for POP-p performed IP were $21,864 higher than those performed OP (p<0.0001). Predictors of SUI-p and POP-p being performed OP included private insurance, fewer co-morbidities, and receiving care at a rural facility or at a center in the Midwest or South. Additionally, SUI-p were more likely to be performed OP for patients < 52 years of age. POP-p were more likely to be performed IP than SUI-p (OR 20.8; 95% CI 20.2 - 21.5), while OAB-p were less likely to be performed IP than SUI-p (OR 0.01; 95% CI 0.01 – 0.02). CONCLUSIONS: An increasing majority of SUI and OAB procedures performed nationwide are performed in OP settings. These procedures performed OP carry less charge than those performed IP and are more likely for younger, healthier patients with private insurance. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e657 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Connie Wang More articles by this author Daniel Schoenfeld More articles by this author Joseph Marte More articles by this author Gregory Joice More articles by this author Expand All Advertisement PDF downloadLoading ...

Maximum Dose of Plain Epinephrine in Plastic Surgery: Room to Explore.

Epinephrine mixed with local anesthetics such as lidocaine or bupivacaine is routinely used in plastic surgery to increase the maximum safe dosage of local anesthesia and reduce blood loss through vasoconstriction. The pharmacokinetics of these epinephrine-local anesthetic combinations has been well studied, leading to well-established guidelines for maximum local anesthetic doses.1 However, local anesthetics have an associated toxicity risk and prevent impulse transmission/stimulation of motor nerves, which is particularly relevant in peripheral nerve surgery. As an alternative, plain epinephrine may be used to decrease blood loss and minimize blood within the surgical site. For this reason, it is commonly used in a wide range of plastic surgery procedures, including peripheral nerve surgery, body contouring procedures, cosmetic procedures performed under local anesthesia, and pediatric craniofacial surgery. In this Viewpoint, we examine the existing literature on the maximum dose of subcutaneous plain epinephrine and advocate for further research to guide the establishment of a maximum epinephrine dose. Within the literature, there have been reports of excessive epinephrine use causing systematic changes to patients’ physiology. These include increases in heart rate, cardiac index, and decreases in both mean arterial pressure and systemic vascular resistance index,2,3 which may be significant for patients with high-risk cardiovascular conditions. For this reason, plastic surgeons may act conservatively regarding maximum epinephrine dosing despite potential benefits with increased dosing. Additionally, studies of the vasoconstrictive effect of different epinephrine concentrations are almost exclusively conducted using epinephrine combined with local anesthetics.4 Kinsella et al have also identified this gap in the literature and studied the use of local epinephrine infiltration without local anesthetic in 102 palatoplasties, concluding that doses up to 10 μg/kg every 30 minutes did not lead to any cases of unstable tachycardia or hypertension.3 Similarly, Swan et al demonstrated no significant difference in heart rate, systolic blood pressure, or diastolic blood pressure in their high volume palatoplasty center when using 8 μm/kg of epinephrine mixed with 2 mg/kg of levobupivacaine.5 A recent review of the literature demonstrated that concentrations of epinephrine between 1:50,000 and 1:400,000 provide superior vasoconstrictive effects compared with dilute epinephrine concentrations.1 Given the frequency of use and potential benefit of plain epinephrine in a variety of surgical procedures, the lack of literature in this area warrants further investigation. The first step in addressing this gap is to establish a reference range by conducting a comprehensive review of clinical series in which epinephrine was used without hemodynamic complications. Next, small and large animal models should be used to establish preliminary dosing guidelines before human trials. Although basic science and clinical trials of this caliber would be logistically challenging and have significant associated costs, the authors believe that this gap in knowledge is worth highlighting for plastic surgeons, researchers, and trainees. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.