Patient expectations and patient-reported outcomes in surgery: a systematic review.

Background: Recent events in health care reform have brought national attention to integrating patient experiences and expectations into quality metrics. Few studies have comprehensively evaluated the effect of patient expectations on patient-reported outcomes (PROs) after surgery. The purpose of this study is to systematically review the available literature describing the relationship between patient expectations and postoperative PROs.

A systematic review of outcomes of revision amputation treatment for fingertip amputations.

Purpose: The purpose of this study was to conduct a systematic review of outcomes of fingertip revision amputation for fingertip amputation injuries in the English-language literature to provide best evidence of functional outcomes.

Methods: A MEDLINE literature search was performed to identify studies that met the following criteria: (1) reported primary data; (2) included at least five cases of primary revision amputation treatment following digit amputation injury; (3) reported finger or thumb amputation at or distal to the distal interphalangeal (DIP) joint or interphalangeal (IP) joint, respectively; (4) presented at least one of the following outcomes: static two-point discrimination (2PD), cold intolerance, arc of motion (AOM) of metacarpophalangeal (MCP) joints, proximal interphalangeal joints (PIP), DIP joints, or return-to-work time.

Results: Thirty-eight studies met the inclusion criteria.

Gaps in exposure to essential competencies in hand surgery fellowship training: a national survey of program directors.

Background: Graduate medical education has moved towards competency-based training. The aim of this study was to assess hand surgery program directors' opinions of exposure gaps in core competencies rated as essential for hand surgery training.

Methods: We surveyed the 74 ACGME hand surgery fellowship program directors.

Economic analysis of revision amputation and replantation treatment of finger amputation injuries.

Background: The purpose of this study was to perform a cost-utility analysis to compare revision amputation and replantation treatment of finger amputation injuries across a spectrum of injury scenarios.

Methods: The study was conducted from the societal perspective. Decision tree models were created for the reference case (two-finger amputation injury) and seven additional injury scenarios for comparison.

Use of autologous and microsurgical breast reconstruction by U.S. plastic surgeons.

Background: Concern exists that plastic surgeons are performing fewer autologous and microsurgical breast reconstructions, despite superior long-term outcomes. The authors describe the proportion of U.S.

Program director opinions of core competencies in hand surgery training: analysis of differences between plastic and orthopedic surgery accredited programs.

Background: The authors' aim was to conduct a national survey of hand surgery fellowship program directors to determine differences of opinions of essential components of hand surgery training between program directors from plastic and orthopedic surgery programs.

Methods: The authors performed a Web-based survey of 74 program directors from all Accreditation Council for Graduate Medical Education-accredited hand surgery fellowship programs to determine components that are essential for hand surgery training. The survey included assessment of nine general areas of practice, 97 knowledge topics, and 172 procedures.

The influence of procedure delay on resource use: a national study of patients with open tibial fracture.

Background: The purpose of this study was to (1) understand national variation in delay of emergency procedures in patients with open tibial fracture at the hospital level and (2) compare length of stay and cost in patients cared for at the best- and worst-performing hospitals for delay.

Methods: The authors retrospectively analyzed the 2003 to 2009 Nationwide Inpatient Sample. Adult patients with open tibial fracture were included.

A national survey of program director opinions of core competencies and structure of hand surgery fellowship training.

Purpose: We assessed hand surgery program directors' opinions of essential components of hand surgery training and potential changes in the structure of hand surgery programs.

Methods: We recruited all 74 program directors of Accreditation Council of Graduate Medical Education-accredited hand surgery fellowship programs to participate. We designed a web-based survey to assess program directors' support for changes in the structure of training programs and to assess opinions of components that are essential for graduates to be proficient.

Relationship between timing of emergency procedures and limb amputation in patients with open tibia fracture in the United States, 2003 to 2009.

Background: The authors aimed to characterize patterns in the timing of initial emergency procedures for patients with open tibia fracture and examine the relationship between initial procedure timing and in-hospital amputation.

Methods: Data were analyzed from the Nationwide Inpatient Sample, 2003 to 2009. Adult patients were included if they had a primary diagnosis code of open tibia fracture.

A guide to interpreting a study of patient-reported outcomes.

Outcomes measured from the patient perspective are particularly important in plastic surgery, where many of the treatments are aimed at improving physical function, psychosocial function, and quality of life. Understanding the measurement of patient-reported outcomes is critical to determine the value of the interventions performed, to better inform clinical decision-making, and to guide policy debates. It is critical that physicians understand their patients' individual values when making treatment and policy recommendations based on evidence.

Replantation of finger avulsion injuries: a systematic review of survival and functional outcomes.

Purpose: Recent studies presenting functional outcomes after replantation of finger avulsion injuries have challenged the historical practice of performing revision amputation for all complete finger avulsion injuries. The aim of this study is to conduct a systematic review of the English literature of replantation of finger avulsion injuries to provide best evidence of survival rates and functional outcomes.

Methods: A Medline literature search yielded 1,398 studies, using key words "traumatic amputation" or "replantation", with limitation to humans and finger injuries.

Decision analysis in plastic surgery: a primer.

Decision analysis modeling can help plastic surgeons systematically evaluate competing strategies in complex clinical decisions. The aim of this article is to introduce the decision analysis technique and discuss its essential components in an effort to apply the best available evidence for modeling treatment decisions. The following components of the decision analysis technique are discussed in detail: (1) the clinical question is designed, (2) a model is created to incorporate possible treatment strategies and relevant outcomes, (3) probabilities and outcome values are assigned to the model, (4) the model is analyzed and the best strategy is identified, and (5) sensitivity analysis is performed to test the robustness of the model.

Validity and responsiveness of the Jebsen-Taylor Hand Function Test.

Purpose: The aim of this study was to demonstrate the validity and responsiveness of the Jebsen-Taylor Hand Function Test (JTT) in measuring hand function in patients undergoing hand surgery, compared with the Michigan Hand Outcomes Questionnaire (MHQ).

Methods: A prospective cohort of patients with rheumatoid arthritis (n = 37), osteoarthritis (n= 10), carpal tunnel syndrome (n = 18), and distal radius fracture (n = 46) were evaluated preoperatively and at 9 to 12 months of follow-up. We administered the JTT and MHQ.

The outcomes of outcome studies in plastic surgery: a systematic review of 17 years of plastic surgery research.

Background: The authors assessed the state of outcomes studies in plastic surgery since the initiation of the modern outcomes movement in 1988 and propose future research directions.

Methods: A systematic review of health outcomes research in plastic surgery was conducted. Studies were extracted from the journals Plastic and Reconstructive Surgery and Annals of Plastic Surgery from 1988 to 2004, yielding 3520 articles, 1670 of which did not meet the inclusion criteria; thus, 1850 articles were reviewed.

Outcomes research in hand surgery: where have we been and where should we go?

Purpose: The outcomes movement began in response to a national emphasis to control cost and to limit geographic variation in medical services. The impact of the outcomes movement on hand surgery research is unknown. We conducted a systematic review of hand surgery studies to assess the past and current states of outcomes research in this specialty.