Should Proximal Fixation Be at C2 or C3-C4? An Application of the Operative Value Index for Elective Posterior Cervical Decompression and Fusion.

Introduction: There is clinical equipoise regarding the ideal upper instrumented vertebrae (UIV) for elective posterior cervical decompression and fusion (PCDF). Instrumentation may be performed at the axial C2 level, or at the subaxial C3/C4 vertebrae. To our knowledge, a true "value" (outcomes per dollar spent) comparison axial versus subaxial UIV for PCDF has never been performed.

Introducing the operative value index for glioma surgery: an integration of quality-adjusted life years with time-driven activity-based costing.

Background: Although many studies have examined outcomes after glioma surgery, few have explored the factors driving variation in the cost-effectiveness of surgical care. In this study, we integrate granular time-driven activity-based costing (TDABC) methodology with quality-adjusted life years (QALYs) to measure the true "value" (outcomes achieved per dollar spent) of glioma surgery.

Methods: 176 glioma surgeries performed at a single institution were reviewed.

Challenging Diagnosis in a Pediatric Eyelid Mass: Resection of a Subcutaneous Pyogenic Granuloma Versus Sarcoma.

Introduction: Pediatric eyelid masses pose a diagnostic challenge, with overlapping presentations between infectious, inflammatory, and neoplastic etiologies. Subcutaneous pyogenic granulomas (SPG), a rare variant, can mimic malignant tumors such as soft tissue sarcomas, leading to potential delays in appropriate management. This case report details the surgical resection of a rapidly growing pediatric eyelid subcutaneous mass, ultimately diagnosed as a subcutaneous pyogenic granuloma with histologic variation.

Does body mass index influence intraoperative costs and operative times for open transforaminal lumbar interbody fusion? A time-driven activity-based costing analysis.

Background: The increasing prevalence of obesity has raised concerns about its impact on surgical outcomes and healthcare costs. This study evaluates the influence of Body Mass Index (BMI) on intraoperative costs and operative times during open Transforaminal Lumbar Interbody Fusion (TLIF) procedures using a Time-Driven Activity-Based Costing (TDABC) approach.

Methods: A retrospective analysis was conducted on 279 patients who underwent TLIF between 2019 and 2022.

Are Mildly Disabled Patients Appropriate for Spine Bundles? An Application of the Operative Value Index.

Background: Many studies have evaluated the effect of preoperative disability status on functional outcomes following spine surgery. However, no research has compared the "value" (outcomes per dollar spent) of surgery for patients with different levels of diagnosis-specific disability.

Methods: We retrospectively reviewed 429 patients who underwent neurosurgical anterior cervical discectomy and fusion.

Drivers Of Intraoperative Costs for Transsphenoidal Endoscopic Surgery for Sellar Lesions: A Time-Driven Activity-Based Cost Analysis.

Introduction: Neurosurgeons lack precise insights into the true costs of transsphenoidal endoscopic surgery for sellar and suprasellar lesions (TESS), including pituitary adenomas, craniopharyngiomas, and apoplexy. To address this critical knowledge gap, we employ time-driven activity-based costing (TDABC) for TESS.

Methods: We analyzed 221 TESS procedures performed between 2017 and 2022 at a large academic medical center.

Evaluating Large Language Models for Automated CPT Code Prediction in Endovascular Neurosurgery.

Large language models (LLMs) have been utilized to automate tasks like writing discharge summaries and operative reports in neurosurgery. The present study evaluates their ability to identify current procedural terminology (CPT) codes from operative reports. Three LLMs (ChatGPT 4.

Unplanned 180-day Readmissions and Health Care Utilization after Immediate Breast Reconstruction for Breast Cancer.

Background:  To assess the burden of postdischarge health care utilization given by readmissions beyond 30 days following immediate breast reconstruction (IBR) nationwide.

Methods:  Women with breast cancer who underwent mastectomy and concurrent IBR (autologous and implant-based) were identified within the 2010 to 2019 Nationwide Readmission Database. Cox proportional hazards and generalized linear regression controlling for patient- and hospital-level confounders were used to determine factors associated with 180-day unplanned readmissions and incremental hospital costs, respectively.

The Use of Tranexamic Acid in Breast Reduction and Abdominoplasty: A Review of a Multicenter Federated Electronic Health Record Database.

Background: Tranexamic acid (TXA), a fibrinolysis inhibitor, is widely used in various surgical fields to minimize blood loss. However, its efficacy and safety in plastic surgery, especially in reduction mammaplasty and abdominoplasty, remain underexplored. This study investigates the utility of intravenous (IV) TXA in these procedures, focusing on reducing postoperative complications and evaluating its safety in the context of venous thromboembolism (VTE).

Evaluating the Efficacy of Large Language Models in CPT Coding for Craniofacial Surgery: A Comparative Analysis.

Background: The advent of Large Language Models (LLMs) like ChatGPT has introduced significant advancements in various surgical disciplines. These developments have led to an increased interest in the utilization of LLMs for Current Procedural Terminology (CPT) coding in surgery. With CPT coding being a complex and time-consuming process, often exacerbated by the scarcity of professional coders, there is a pressing need for innovative solutions to enhance coding efficiency and accuracy.

Technical considerations in robotic aberrant right subclavian artery resection for dysphagia lusoria.

Dysphagia lusoria occurs due to compression of the esophagus as an aberrant right subclavian artery (ARSA) crosses the mediastinum. Surgical management includes open, hybrid, and endovascular techniques, with no consensus gold standard. There are few reports of robotic-assisted ARSA resection.

Streamlining Iliac Bone Harvest for Maxillary Reconstruction With Novel Use of Arthrex Osteochondral Autograft Transfer System.

This study introduces a novel application of the Osteochondral Autograft Transfer System (OATS) for autologous bone grafting during alveolar cleft repair. Approximately 75% of patients with cleft lip and palate have an alveolar cleft, which often necessitates secondary bone grafting from common donor sites such as the iliac crest. Traditional harvesting techniques, although effective, can be labor-intensive and increase the risk of donor site injury.

Increased Incidence of Suspected Smoke Inhalation During the Coronavirus Disease 2019 Pandemic: A National Database Study.

The COVID-19 pandemic has forced many Americans to adapt their daily routines. In 2020, there was a significant increase in house fires according to the National Fire Prevention Association (NFPA). The objective of this study was to characterize the changes in suspected smoke inhalations (SSIs) during the first year of the pandemic in the National Emergency Medical Services Information System (NEMSIS).

Incidence and Epidemiology of Traumatic Tympanic Membrane Rupture: A National Trauma Data Bank Analysis.

The incidence of traumatic tympanic membrane rupture (TTMR) has increased over recent decades. The association of certain external injury causes and bone fracture patterns with TTMR is anecdotal. It has been suggested that a diagnosis of TTMR may be missed during the acute trauma admission.

Inspiring Women in Engineering and Medicine: The Impact of a One-Day STEM Experience on High School Females' Attitude Toward Male-Dominant Professions.

Objective: Inspiring Women in Orthopedics and Engineering (IWEM) is a program founded by UConn Health orthopedic surgeon Dr. Katherine Coyner (KC) focused on boosting diversity and introducing young women to the traditionally male-dominant fields of orthopedics and engineering. Over the course of one day, we assessed change in interest in (1) STEM, (2) medical school, (3) orthopedic surgery, and (4) confidence in performing basic surgical skills.

Primary Pancreatic Signet Ring Cell Carcinoma: A Case Report and Review of the Literature.

Primary pancreatic signet ring cell carcinoma (PPSRCC) is a rare (<1%) poorly reported histopathological variant of pancreatic cancer with ill-defined treatment guidelines. Herein, we describe a case of nonmetastatic PPSRCC in a 45-year-old female. A 45-year-old female presented with 3 weeks of abdominal pain radiating to her back.