Bayesian Reanalysis of Statistically Nonsignificant Outcomes in Plastic Surgery Clinical Trials.

Background: Statistically nonsignificant randomized clinical trial (RCT) results are challenging to interpret, as they are unable to prove the absence of a difference between treatment groups. Bayesian analysis offers an alternative statistical framework capable of providing a comprehensive understanding of nonsignificant results.

Methods: This cross-sectional study conducted a post hoc Bayesian analysis of statistically nonsignificant outcomes from RCTs published in from 2013 to 2022.

Access and Cost Trends for Same-Day Plastic Surgery among Propensity-Matched Patients by Site-of-Service.

Background: Same-day surgery is common in plastic surgery. Sites-of-service are associated with cost differences. Freestanding (F-ASCs) and hospital-owned ambulatory surgery centers (HO-ASCs) are less costly than hospital outpatient departments (HOPDs), though access disparities are reported.

Employer-Sponsored Medicare Advantage Plans and the 2018 Therapy Cap Repeal: Reduced Overall Spending Does Not Constrain Out-of-Pocket Costs.

Background: Policy impacting traditional Medicare beneficiaries may have unintended effects for privately insured patients. After the repeal of a longstanding $1500 outpatient therapy cap in 2018, we aimed to evaluate if this policy change was associated with differences in use of cost of postoperative therapy after common hand surgeries, including carpal tunnel release, trigger finger release, ganglion cyst excision, De Quervain tenosynovitis release, carpometacarpal arthroplasty, and distal radius fracture open reduction/internal fixation or percutaneous pinning.

Methods: The Medicare Supplement and Coordination of Benefits files from Marketscan were used.

2020 CMS prior authorization for hospital outpatient departments: Associated surgical volume impact.

Background: Prior authorization is common for privately administered Medicare Advantage plans but is rarely used for surgical care when considering publicly administered plans. A 2020 Centers for Medicare and Medicaid services (CMS) policy, CMS-1717-FC, requires prior authorization for Medicare Fee-for-Service beneficiaries undergoing select procedures (blepharoplasty, abdominoplasty, botulinum toxin injection, rhinoplasty, and vein ablation) in hospital outpatient departments. The impact of this policy on surgical volume at hospital outpatient departments and shifts in care to ambulatory surgery centers is unknown.

Impact of Regional Surgeon Competition on Use, Cost, and Outcomes of Breast Reconstruction in the United States.

Background: Breast reconstruction following mastectomy is underused in the United States. Evidence suggests that more competitive hospital markets offer increased access to procedural care across specialties. This study aims to determine the impact of regional plastic surgeon competition on use, outcomes, and cost of breast reconstruction following mastectomy for breast cancer.

Postoperative hand therapy and the 2018 Medicare therapy cap repeal: Appraising cost and use changes.

Background: Therapy use is common following carpal tunnel release (CTR), trigger finger release, ganglion cyst excision, De Quervain tenosynovitis release, carpometacarpal arthroplasty, and distal radius fracture, open reduction internal fixation or percutaneous pinning (DRF). Policy that improves coverage influences the cost and use of health care services.

Purpose: This study aims to evaluate changes to the cost and use of postoperative hand therapy by race and procedure following the repeal of a longstanding annual Medicare outpatient therapy cap.

P-Value Reporting and Reliability in Plastic and Reconstructive Surgery: A Primer for Readers and Investigators.

The p-value is ubiquitous in research. However, misuse and misinterpretation are common. This special topics article aims to demystify the p-value for researchers, students, physicians, and experienced investigators alike.

The effect of Medicaid expansion on rates of carpal tunnel release: an interrupted time series analysis.

Background: Medicaid expansion through the Affordable Care Act (ACA) has been associated with greater access and utilization of surgical services in underserved populations. However, its impact on use of hand surgical care is less understood. The purpose of this study was to evaluate the association between New York State adoption of the ACA and carpal tunnel release (CTR) procedural volume in Medicaid beneficiaries.

Reported Prices for High-Volume Hand Surgery in the Era of Price Transparency: Implications for Future Policy Iterations.

Background: In 2021, the United States enacted a law requiring hospitals to report prices for health care services. Across several health care services, poor compliance and wide variation in pricing was found. This study was performed to investigate variation in reporting and listed prices by hospital features for high-volume hand procedures, including carpal tunnel release, trigger finger release, de Quervain tenosynovitis release, and carpometacarpal arthroplasty.

Medicare Eligibility and Racial and Ethnic Disparities in Operative Fixation for Distal Radius Fracture.

Importance: Medicare provides near-universal health insurance to US residents aged 65 years or older. How eligibility for Medicare coverage affects racial and ethnic disparities in operative management after orthopedic trauma is poorly understood.

Objective: To assess the association of Medicare eligibility with racial and ethnic disparities in open reduction and internal fixation (ORIF) after distal radius fracture (DRF).

The Role of Methylene Blue Spray to Keep Parathyroid Gland and Recurrent Laryngeal Nerve Safe During Thyroidectomy.

The main postoperative complications of thyroidectomy are hypoparathyroidism and recurrent laryngeal nerve (RLN) palsy. Methylene blue, which is a drug and dye, is safe and easy to get, and we can use it to avoid complications during thyroidectomy. Objectives: We aim to assess that we can spray Methylene blue to allow the identification of important structures intraoperative which are the parathyroid gland and recurrent laryngeal nerve.

Quasi-Experimental Design for Health Policy Research: A Methodology Overview.

Health policy impacts all aspects of the authors' field. Research on this topic informs future policy direction and serves as an impactful means to advocate for their patients. The present work aims to promote policy research in plastic surgery.

The impact of immunonutrition on pancreaticoduodenectomy outcomes.

Background: Malnutrition is a significant risk factor for decreased survival in cancer patients undergoing a pancreaticoduodenectomy (PD). Our study aims to investigate the impact of immunonutrition on length of stay (LOS), infection rates, postoperative pancreatic fistula (POPF), and delayed gastric emptying (DGE).

Study Design: This study retrospectively reviewed 344 patients who underwent PD between 2007 and 2018.

Pancreatic neuroendocrine tumors: Surgical outcomes and survival analysis.

Background: Pancreatic neuroendocrine tumors are rare, with rising incidence and limited clinicopathological studies.

Methods: Adult patients with pNET at a single tertiary care center were retrospectively evaluated.

Results: In total, 87 patients with histologically confirmed pNET who underwent resection were evaluated.

Non-Hispanic Blacks undergoing distal pancreatectomy have higher risk-adjusted rates of morbidity and are more likely to be high-cost outliers.

Background: Few studies evaluate racial disparities in costs and clinical outcomes for patients undergoing distal pancreatectomy (DP).

Methods: We queried the Healthcare Cost and Utilization Project State Inpatient Databases to identify patients undergoing DP. Multivariable regression (MVR) was used to evaluate the association between race and postoperative outcomes.

Association of obesity with postoperative outcomes after proctectomy.

Background: Prior efforts evaluating obesity as a risk factor for postoperative complications following proctectomy have been limited by sample size and uniform outcome classification.

Methods: The ACS NSQIP was queried for patients with non-metastatic rectal adenocarcinoma who underwent elective proctectomy. After stratification by BMI classification, multivariable modeling was used to identify the effect of BMI class on adjusted risk of 30-day outcomes controlling for patient, procedure, and tumor factors.

Recurrent pseudoaneurysm after carotid endarterectomy.

Pseudoaneurysms and patch infections are known complications of carotid endarterectomy with patch angioplasty. Although they are rare occurrences, they carry high morbidity and almost uniformly require surgical intervention. Infectious pathogens are often gram-positive bacteria, most commonly species, whereas gram-negative infections are less frequently observed.

4-Hydroxynonenal dependent alteration of TRPV1-mediated coronary microvascular signaling.

We demonstrated previously that TRPV1-dependent regulation of coronary blood flow (CBF) is disrupted in diabetes. Further, we have shown that endothelial TRPV1 is differentially regulated, ultimately leading to the inactivation of TRPV1, when exposed to a prolonged pathophysiological oxidative environment. This environment has been shown to increase lipid peroxidation byproducts including 4-Hydroxynonenal (4-HNE).

Differential regulation of TRPV1 channels by H2O2: implications for diabetic microvascular dysfunction.

We demonstrated previously that TRPV1-dependent coupling of coronary blood flow (CBF) to metabolism is disrupted in diabetes. A critical amount of H2O2 contributes to CBF regulation; however, excessive H2O2 impairs responses. We sought to determine the extent to which differential regulation of TRPV1 by H2O2 modulates CBF and vascular reactivity in diabetes.