Search

Introduction: There is an absence of literature regarding the risks of catastrophic medical outcomes (CMOs) such as stroke, cardiac arrest, and pulmonary embolism in microvascular free tissue transfer. This study aims to determine the CMO and mortality rates, as well as risk factors, associated with microvascular reconstruction of the head and neck, extremity, and breast., Methods: This study uses data from the American College of Surgeons National Surgical Quality Improvement Program. Cases of microvascular free tissue transfer from 2012 to 2021 were analyzed to assess the 30-day rates of CMOs, including death, as well as associated risk factors., Results: Of the 22,839 included patients, 785 (3.44%) experienced 1043 CMOs, including 99 (0.43%) deaths. Pulmonary complications of prolonged respiratory failure and pulmonary embolism were the most common. Independent risk factors included age, male sex, underweight status, longer operation times, American Society of Anesthesiologists (ASA) class of III or above, wound classification other than clean, and underlying conditions such as diabetes, hypertension, chronic obstructive pulmonary disorder, dyspnea, metastatic cancer, and ventilator dependence. CMOs were associated with an average 10-day delay in hospital discharge. Multivariate regression analysis revealed that head and neck reconstructions were associated with increased risk of CMO (OR 4.96; p < 0.0001)., Conclusion: This is the largest study to examine CMOs following microvascular free tissue transfer. Compared to previous literature spanning the period between 2006 and 2011, we observed a decreased rate of CMOs but a slight increase in 30-day mortality. Our data provide updated and comprehensive criteria for risk stratification and patient counseling. The modifiable risk factors reported in our study should be considered in elective, non-urgent cases of microvascular reconstruction., Competing Interests: Conflict of interest None., (Copyright © 2024. Published by Elsevier Ltd.)

Introduction: Capsular contracture is a common complication after 2-stage breast reconstruction. The relationships between native breast size, the rate of tissue expander expansion, and capsule formation have not been elucidated. This study aims to evaluate how these factors contribute to capsular contracture and establish cutoff values for increased risk., Methods: A data set consisting of 229 patients who underwent 2-stage breast reconstruction between 2012 and 2021 was included in the study. The rate of expansion is estimated as the final expanded volume subtracted by the initial filling volume of the tissue expander over time elapsed. The native breast size was estimated using various preoperative breast measurements and the weight of mastectomy specimen (grams). Further stratified analysis evaluated patients separately based on postoperative radiation status., Results: Greater nipple-inframammary fold distance and faster tissue expander enlargement rate conferred decreased odds of developing capsular contracture ( P < 0.05). On stratified analysis, faster tissue expansion rate was not significant in the nonradiated cohort but remained a significant negative predictor in the radiation group (odds ratio, 0.996; P < 0.05). Cut-point analysis showed an expansion rate of <240 mL/mo and a nipple-inframammary fold value of <10.5 cm as conferring a greater risk of capsular contracture., Conclusion: Smaller inframammary fold distance may be associated with a higher risk of capsular contracture. Slower expansion rates correlate with increased odds of contracture in patients undergoing adjuvant radiation. Breast geometry should be considered when risk stratifying various reconstruction approaches (implant vs autologous). In addition, longer delays between implant exchange and initial tissue expansion should be avoided if clinically feasible., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Smoking as a risk factor for postoperative complications is more relevant in elective plastic surgery than in urgent general surgery. From 2005 to 2014, the U.S. smoking rate decreased from 20.9 percent to 16.8 percent. This study compares smoking prevalence in plastic and general surgery patients, and postoperative complications when smoking is isolated as an independent risk factor., Methods: The American College of Surgeons National Surgical Quality Improvement Program database was used to examine smoking and 30-day postoperative complications for plastic and general surgery procedures. Patients were propensity score matched for demographics and comorbidities., Results: The authors examined 294,903 patients from 2005 to 2014. The smoking rates in general surgery mirrored national trends (R = -0.85), whereas those in plastic surgery were significantly lower (p < 0.01). General surgery smokers were more comorbid and experienced more superficial surgical-site infections, pulmonary embolism, and myocardial infarction (p < 0.02) than general surgery nonsmokers. Plastic surgery smokers were not significantly different than plastic surgery nonsmokers. The general surgery cohort was more comorbid than the plastic surgery cohort. All smokers had increased dehiscence, deep surgical-site infection, and reoperation (p ≤ 0.01). Plastic surgery patients suffered more wound complications and bleeding than general surgery patients (p < 0.01)., Conclusions: This is the first propensity score-matched, large-scale database analysis isolating smoking as a risk factor for postoperative complications. Smoking may have different risk factor profiles for postoperative complications in plastic surgical versus general surgical patient populations, emphasizing the need for caution when generalizing general surgical evidence for use in the plastic surgical population., Clinical Question/level of Evidence: Risk, II.

Background Communication, particularly transmission of information between the surgical and nursing teams, has been identified as one of the most crucial determinants of patient outcomes. Nonetheless, transfer of information among and between the physician and nursing teams in the immediate postoperative period is often informal, verbal, and inconsistent. Methods An iterative process of multidisciplinary information gathering was undertaken to create a novel postoperative communication system (the "Pop-form"). Once developed, nurses were surveyed on multiple measures regarding the perceived likelihood that it would improve their ability to provide directed patient care. Data were quantified using a Likert scale (0-10), and statistically analyzed. Results The Pop-form records and transfers operative details, specific anatomic monitoring parameters, and senior physician contact information. Sixty-eight nurses completed surveys. The perceived usefulness of different components of the Pop-form system was as follows: 8.9 for the description of the procedure; 9.3 for the operative diagram; 9.4 for the monitoring details and parameters; and 9.4 for the direct contact information for the appropriate surgical team member. All respondents were in favor of widespread adoption of the Pop-form. Conclusion This uniform, visual communication system requires less than 1 minute to compose, yet formalizes and standardizes inter-team communication, and therefore shows promise for improving outcomes following microvascular free tissue transfer. We believe that this simple, innovative communication tool has the potential to be more broadly applied to many other health care settings., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Background: Partial hypopharyngeal defects are most commonly reconstructed with the pectoralis major myocutaneous flap (PMMF) or free fasciocutaneous (FFC) flap. The purpose of this study is to determine the ideal method for reconstruction of partial hypopharyngeal defects by reviewing our institutional experience and the literature., Methods: A retrospective review of partial hypopharyngeal reconstructions since 2009 was performed. A National Library of Medicine search of studies on partial hypopharyngeal reconstruction since 1988 was performed. Data on complications, diet, and speech were extracted and pooled., Results: A total of 18 patients were studied-9 had PMMF reconstruction and 9 had FFC reconstruction. Operative time (8.75 vs. 13.0 hours, p = 0.0003) was shorter in the PMMF group. Pharyngocutaneous fistula developed in one PMMF patient (11.1%) and two FFC patients (22.2%). Late strictures occurred in three PMMF patients. Six patients in each group (66.7%) progressed to a regular diet. Three patients in each group produced tracheoesophageal speech after TEP. Literature review identified 36 relevant studies, with 301 patients reconstructed with PMMF and 605 patients with FFC. Pooled-data analysis revealed that PMMF had higher reported rates of fistula (24.7 vs. 8.9%, p < 0.0001) and requirement for second surgery (11.3 vs. 5.5%, p = 0.04). There was no difference in stricture rates or progression to regular diet. Fewer PMMF patients produced tracheoesophageal speech (17.5 vs. 52.1%, p < 0.0001)., Conclusions: PMMF and FFC flaps are valid approaches to reconstructing partial hypopharyngeal defects, though rates in the literature of fistula, need for revisional surgery, and tracheoesophageal speech after laryngectomy are more favorable after free flap reconstruction., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

The safety of performing operations in surgery centers that require overnight stays has not been established. To determine whether this practice is safe we performed a retrospective chart review of all cases performed at Paces over a 12-year period. There were 12,072 total cases and 11,147 general anesthesia (GA) or monitored anesthesia care (MAC) cases. Four thousand eight hundred ten patients stayed overnight. The hospital admission rate for patients undergoing either GA or MAC was 0.12% and for local anesthesia it was 0%. Overnight stay patients had a rate of 0.15%, while same day discharge patients had a rate of 0.08%. Excluding local anesthesia cases, the rate increased to 0.10%. For the GA and MAC patients, there was no statistical difference in hospitalization rates between the same day and the overnight stay groups. All patients had good outcomes after hospitalization. Performing operations that require an overnight stay in a surgery center can be a safe practice.