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While the novel Coronavirus 2019 disease’s (COVID-19) impact on the practice of orthopaedics has been readily apparent, the effects of COVID-19 on the orthopaedic literature has not been studied. The objective of this paper is to analyze the COVID-19 pandemic’s impact on peer-reviewed articles published in the orthopaedic surgery literature. Using the Journal Citation Reports, twenty orthopaedic surgery journals with the highest impact factor in 2019 were selected and articles within those journals were sorted by mention of COVID-19. The Altmetric Attention Score (AAS) and citation count were collected and compared for COVID-19 versus non-COVID-19 related articles using the Mann-Whitney U test. Furthermore, within COVID-19 related articles, AAS and citation count were compared using Kruskal-Wallis test between sub specialty of orthopaedics, type of article, study type, and quarter of publication. The average AAS of COVID-19 articles was significantly higher than non-COVID articles (15 vs. 6, p=0.019). Within COVID-19 articles, those pertaining to spine and trauma had a significantly lower AAS than those pertaining to orthopaedics as a whole (20 & 6 vs 51, p Orthopaedic articles related to COVID-19 demonstrated a greater influence, dissemination, and impact than articles not related to COVID-19 as demonstrated by AAS and citations accrued.

As online media acquires increased utilization as a means of disseminating scientific research, Altmetric analyses are useful to identify socially impactful publications and their characteristics. Accordingly, the objective of this investigation was to determine the most mentioned articles online regarding craniofacial surgery and compare these articles with their most cited counterparts. Using the Web of Science database, 7097 craniofacial surgery publications were identified. Altmetric Attention Score (AAS) and average citations per year (ACpY) were extracted, and articles were ranked by their social and scientific impact. Descriptive, comparative, and correlational analyses were performed to examine characteristics including AAS, ACpY, country of origin, journal, open access (OA) status, publication year, study design, and topic. The average AAS of the 50 most mentioned articles was 83.68 (SD±107.40), and the average citation count of the 50 most cited articles was 76.38 (SD±35.15). OA status was significantly more prevalent among the most mentioned articles (24.0%) relative to all articles (10.72%) and the most cited articles (4.0%). The most mentioned and the most cited articles primarily originated from the United States (64.0% and 38.0%, respectively), discussed topics related to the medical and surgical management of patients (48.0% and 58.0%, respectively), and were systematic reviews (16.0% and 28.0%, respectively). However, there was significantly more geographic diversity in the latter cohort. In summary, this comparative examination reveals important differences between the most mentioned and most cited articles, highlighting the distinct utility of AAS and citation count when evaluating research impact.

Social media have altered the mechanisms by which published research is disseminated and accessed. The objective of this study was to measure the effect of promotion on research article dissemination, influence, and impact in Plastic and Reconstructive Surgery .All articles published in Plastic and Reconstructive Surgery from January 1, 2016, to December 31, 2018, were obtained and reviewed to determine inclusion/exclusion and for the Altmetric Attention Score, citations, relative citation rate, and 16 unique promotional tags (e.g., journal club, editor's pick, press release, patient safety, and so on) as indexed on the Plastic and Reconstructive Surgery website. The analysis included 1502 articles. Statistical analysis was completed using descriptive statistics, Pearson correlations, and t tests where appropriate with a predetermined level of significance of p ≤ 0.05.A total of 637 articles (42.4 percent) had a promotional tag, whereas 252 (16.8 percent) had multiple tags. Articles with promotional tags had a higher Altmetric Attention Score (30.35 versus 8.22; p0.001), more citations (11.96 versus 8.47; p0.001), and a higher relative citation rate (2.97 versus 2.06; p0.001) compared to articles without a tag. Articles with multiple tags had a higher Altmetric Attention Score (50.17 versus 17.39; p0.001), more citations (15.78 versus 9.47; p0.001), and a higher relative citation rate (3.67 versus 2.51; p0.001) compared to articles with only one tag. As the number of tags increased for an article, Altmetric Attention Score ( p0.001), citation count ( p0.001), and relative citation rate ( p0.001) likewise increased.This analysis strongly suggests that promotion of research articles is associated with significantly wider dissemination, broader visibility, and more subsequent citations in the literature.

The coronavirus disease-19 (COVID-19) pandemic dramatically changed the delivery of breast cancer care. The objective of this study was to quantify the effect of the pandemic on breast cancer screening, treatment, and reconstruction at a single institution in New York City.A retrospective chart review was conducted to determine the number of mammograms, lumpectomies, mastectomies, and breast reconstruction operations performed between January 1, 2019 and June 30, 2021. Outcomes analyzed included changes in mammography, oncologic surgery, and breast reconstruction surgery volume before, during and after the start of the pandemic.Mammography volume declined by 11% in March-May of 2020. Oncologic breast surgeries and reconstructive surgeries similarly declined by 6.8% and 11%, respectively, in 2020 compared with 2019, reaching their lowest levels in April 2020. The volume of all procedures increased during the summer of 2020. Mammography volumes in June and July 2020 were found to be at pre-COVID levels, and in October-December 2020 were 15% higher than in 2019. Oncologic breast surgeries saw a similar rebound in May 2020, with 24.6% more cases performed compared with May 2019. Breast reconstruction volumes increased, though changes in the types of reconstruction were noted. Oncoplastic closures were more common during the pandemic, while two-stage implant reconstruction and immediate autologous reconstruction decreased by 27% and 43%, respectively. All procedures are on track to increase in volume in 2021 compared to that in 2020.The COVID-19 pandemic reduced the volume of breast cancer surveillance, surgical treatment, and reconstruction procedures. While it is reassuring that volumes have rebounded in 2021, efforts must be made to emphasize screening and treatment procedures in the face of subsequent surges, such as that recently attributable to the Delta and Omicron variants.

Introduction This study aims to define the impact that the novel Coronavirus Disease 2019 (COVID-19) pandemic has had on the volume of common plastic and reconstructive procedures. Methods TrinetX is a national, federated database that was utilitzed in surveying plastic and reconstructive procedural volumes among 53 Healthcare organizations (HCO) between March 2018 and May 2021. This timeframe was divided into pre-pandemic (March 2018 to February 2020) and pandemic periods (March 2020 to May 2021). Each period was then sub-divided into the four seasons of the year and mean monthly procedural volume per HCO was compared. A student's t-tests comparing pre-pandemic and pandemic seasonal mean procedural volumes were used for statistical analysis. Results A total of 366,032 patient encounters among 53 HCO were included. The average seasonal volume per HCO of all procedures decreased from 872.11 procedures during pre-pandemic seasons to 827.36 during pandemic seasons. Spring 2020 volumes declined for most procedures as 15 of 24 (63%) assessed procedure categories experienced statistically significant decreases. Spring 2021 experienced rebounds with 15 of 24 (63%) assessed procedures showing statistically significant increases. Conclusion During the pandemic period, the average procedural volume per HCO of 14 procedure categories was significantly less than the pre-pandemic average procedural volume. As a whole, there was a inverse relationship between new United States COVID-19 cases and plastic and reconstructive surgery procedure volumes.

OBJECTIVE Rankings of residency programs are highly influential and utilized by residency applicants. Existing ranking resources often use opaque criteria that may include bias or do not accurately represent the academic achievement of current faculty. This study aims to create an updated general surgery residency ranking list based on the academic achievements of their respective surgery department faculty members. DESIGN One hundred and six general surgery residency programs were selected from the American Medical Association Residency & Fellowship Programs Database. The names of faculty members affiliated with the departments of surgery were manually obtained. Lifetime and five-year h-indexes, a sum of grant awards from the National Institute of Health and Veterans Affairs, and a tally of journal editorial board positions were collected for the faculty. Metrics were compared among surgical departments, and the corresponding residency programs were ranked accordingly. SETTING The study evaluated university-based general surgery residency programs in the United States from 2017 to 2019 via assessing their respective institutions’ departments of surgery. PARTICIPANTS A total of 7568 faculty members were evaluated. Faculty were required to be full-time, clinical surgeons to meet inclusion criteria. RESULTS Based on a composite of all measured criteria, the top overall surgery department was at the University of Michigan. Massachusetts General Hospital had the highest lifetime and five-year h-indexes. Brigham and Women's Hospital had the most National Institute of Health funding, and the University of Pittsburgh Medical Center had the most Veterans Affairs funding. Washington University in St. Louis/Barnes Jewish Hospital had the most editorial board positions in their department. CONCLUSIONS The academic success of departments of surgery was evaluated to develop a ranking list of general surgery residency programs. Through utilizing standardized methods and several measures of academic achievement, this comprehensive general surgery residency classification system will allow residency applicants to make more informed decisions.

Clinicians and medical researchers increasingly turn to nonformal online platforms to promote research. Altmetric Attention Score (AAS) is a quantitative measurement of online influence of research in real time. The objective of this study is to determine if AAS correlates with traditional bibliometrics in the orthopaedic literature.From the 15 orthopaedic journals with the highest impact factor, the 10 most cited articles from each journal were reviewed for 2014 -2017. For each article, AAS was collected using the Altmetric Bookmarklet application and citation count from SCOPUS. Journal impact factor was recorded using Journal Citation Reports. Statistical analysis included Pearson's and Spearman's correlation coefficients.A total of 600 articles were analyzed. A significant positive correlation was found between citation count and AAS for 2014 (r = 0.3188, p0.0001), and no correlation for 2015 (r = 0.1504, P = 0.0653), 2016 (r = 0.0087, P = 0.9157), and 2017 (r = 0.0061, P = 0.9408). There was no significant correlation between impact factor and AAS in 2014 (r = 0.4312, P = 0.1085), 2015 (r = 0.3850, P = 0.1565), 2016 (r = 0.1460, P = 0.6035) and 2017 (r = 0.0451 P = 0.8732).AAS and traditional bibliometrics are currently not strongly correlated in orthopaedic literature. Citations take years to accumulate and AAS represents immediate influence of an article. An amalgamation of traditional bibliometrics and AAS may prove useful in determining the short- and long-term impact and influence of publications in orthopaedics.

Introduction The COVID-19 pandemic has impacted multiple aspects of medicine, including research focus and medical literature. Specifically, the dermatology literature has reflected the challenges faced by dermatologists throughout the pandemic.1 Given the widespread interest in understanding the pandemic and its effects on the field of dermatology, we conducted an analysis of the dermatology literature to characterize the literature’s impact, content, trends, and the publication process. We anticipated that there would be more interest in dermatology publications pertaining to COVID-19. Methods Journal Citation Reports was used to select the 15 dermatology journals with the highest impact factor in 2019, and all articles published in these journals in 2020 were evaluated.2 Altmetric Attention Score (AAS) was recorded for each article. For COVID-19 related articles, we also assessed whether AAS and citations varied by the type of article (editorial, original article, or guideline) and sub-specialty of dermatology to which the article pertained. Results Analysis revealed journals prioritized publishing articles related to COVID-19, as the mean time from submission to publication was shorter (43 days) than what has previously been observed. COVID-19 related articles in the dermatology literature received more widespread attention as measured by the average AAS (33 vs. 4 p

Compressive neuropathies of the forearm are common and involve structures innervated by the median, ulnar, and radial nerves. A thorough patient history, occupational history, and physical examination can aid diagnosis. Electromyography, X-ray, and Magnetic Resonance Imaging may prove useful in select syndromes. Generally, first line therapy of all compressive neuropathies consists of activity modification, rest, splinting, and non-steroidal anti-inflammatory drugs. Many patients experience improvement with conservative measures. For those lacking adequate response, steroid injections may improve symptoms. Surgical release is the last line therapy and has varied outcomes depending on the compression. Carpal Tunnel syndrome (CTS) is the most common, followed by ulnar tunnel syndrome. Open and endoscopic CTS release appear to have similar outcomes. Endoscopic release appears to incur decreased cost baring a low rate of complications, although this is debated in the literature. Additional syndromes of median nerve compression include pronator syndrome (PS), anterior interosseous syndrome, and ligament of Struthers syndrome. Ulnar nerve compressive neuropathies include cubital tunnel syndrome and Guyon’s canal. Radial nerve compressive neuropathies include radial tunnel syndrome and Wartenberg’s syndrome. The goal of this review is to provide all clinicians with guidance on diagnosis and treatment of commonly encountered compressive neuropathies of the forearm.

Background: The novel coronavirus disease (COVID-19) has had a significant impact on orthopedic surgery practice, but there has been little investigation of the effects of COVID-19 on the orthopedic surgery literature. Additionally, because orthopedic research plays a vital role in physician education, changes to the characteristics and content of published literature can have lasting impacts on future teaching and learning. This paper represents the first known analysis of the COVID-19 pandemic's impact on peer-reviewed articles published in orthopedic surgery journals. Methods: The 20 orthopedic journals with the highest impact factors in 2019, according to the Journal Citation Reports, were included in this study. Using PubMed and COVID-19 related keywords as well as manual screening, a final count of 199 articles were assessed for this study and subsequently sorted by country of origin, orthopedic subspecialty, article type, and general theme. Kruskal Wallis and Pearson's Chi-squared tests were used to analyze continuous and categorical variables, respectively. Results: Fourteen journals published articles relating to COVID-19, representing 26 countries with the United States (37%) and United Kingdom (13%) publishing the greatest proportion of all COVID-19 articles. Sixty percent of publications discussed COVID-19's impact on the overall field of orthopedic surgery, with the remainder focusing on specific subspecialties. Forty-seven percent of publications were original research articles while 46% were editorials or commentaries. The median time to publication for all COVID-19 related articles was 24.5 days, compared to the 129 days reported for orthopedic journals prior to the COVID-19 pandemic (p

As a biologic product derived from human tissue, acellular dermal matrices did not require premarket approval for their initial use as a soft-tissue support product. Since their first use in breast surgery, acellular dermal matrices have allowed for numerous advances in breast reconstruction. They quickly gained popularity in breast surgery and are used frequently in various applications. During an investigation into potential factors leading to breast implant-associated anaplastic large-cell lymphoma, the U.S. Food and Drug Administration made an official statement that acellular dermal matrices were not approved for use in breast reconstruction and that using them in breast surgery was considered off-label. This special topic article details the history of acellular dermal matrices in breast surgery and describes the ongoing evolution of the relationship between the U.S. Food and Drug Administration and acellular dermal matrices.

Despite the increased use of nipple-sparing mastectomies, there are limited data examining long-term cancer recurrence rates in these patients. The objective of this study was to analyze breast cancer recurrence in patients who underwent therapeutic nipple-sparing mastectomy with a median of 10 years of follow-up.All patients undergoing nipple-sparing mastectomy at a single institution were retrospectively reviewed temporally to obtain a median of 10 years of follow-up. Patient demographic factors, mastectomy specimen pathologic findings, and oncologic outcomes were analyzed. Univariate analysis was performed to identify independent risk factors for locoregional recurrence.One hundred twenty-six therapeutic nipple-sparing mastectomies were performed on 120 patients. The most frequently observed tumor histology included invasive ductal carcinoma (48.4 percent) and ductal carcinoma in situ (38.1 percent). Mean tumor size was 1.62 cm. Multifocal or multicentric disease and lymphovascular invasion were present in 31.0 percent and 10.3 percent of nipple-sparing mastectomy specimens, respectively. Sentinel lymph node biopsy was performed in 84.9 percent of nipple-sparing mastectomies, and 17.8 percent were positive. The rate of positive frozen subareolar biopsy was 7.3 percent ( n = 82) and that of permanent subareolar pathology was 9.5 percent ( n = 126). The most frequently observed pathologic tumor stages were stage I (44.6 percent) and stage 0 (33.9 percent). The incidence of recurrent disease was 3.17 percent per mastectomy and 3.33 percent per patient. On univariate analysis, no demographic, operative, or tumor-specific variables were independent risk factors for locoregional recurrence.Overall recurrence rates are low in patients undergoing nipple-sparing mastectomy at a median follow-up of 10-years. Close surveillance should remain a goal for patients and their providers to promptly identify potential recurrence.Risk, III.

Artificial intelligence is rapidly advancing, especially with the advent of ChatGPT technology, and its role in the world of medicine is expanding. Within surgery, AI has the capacity to improve efficiency and results in surgical treatments; however, it similarly has the potential to impose harm onto patients and undermine the role of medical providers. Its benefits may include improvements in surgical outcomes, spanning from enhanced pre-operative diagnostic capabilities to more refined intra-operative techniques, and long term patient experiences, by identifying and reducing complications. Nevertheless apprehensions revolve around laymen use potentially resulting in inappropriate therapeutic interventions, in addition to safety and ethical risks surrounding the use of patient data. Various strategies towards mitigating these harms must be considered, such as patient disclaimers and secondary review policies. While artificial intelligence brings exciting advancements to surgery, its integration must be cautiously monitored.

Background Surgical specialties represent the most competitive residency positions to obtain, and applicants for these spots may apply to increasingly more programs in an attempt to match. We describe trends in residency applications across all surgical specialties from 2017 to 2021 application cycles. Materials and Methods This review of the 2017, 2018, 2019, 2020, and 2021 surgical residency application cycles used the American Association of Medical Colleges’ Electronic Residency Application Service (ERAS) databases. Data from a total of 72,171 applicants to United States surgical residencies during the study’s time period were included. The 2021 ERAS fee schedule was used to calculate the cost of applications. Results The number of applicants across the study interval remains unchanged. Trends suggest more women and underrepresented minorities in medicine are applying to surgical residencies today compared to 5 years ago. The mean number of applications per applicant increased 32.0% from 39.3 in 2017 to 51.8 in 2021, resulting in an increased application fee cost of $329 per applicant. Mean total cost for application fees alone in 2021 were $1211 per applicant. In 2021, the cost of applying to surgical residency for all applicants was over $26 million, a nearly $8 million increase from 2017. Conclusions There has been an increase in the number of applications per applicant in the past 5 residency application cycles. Increased applications create barriers and burdens for applicants, and residency program personnel. These rapid increases are unsustainable and require intervention, although a viable solution has yet to be elucidated.

Background In this study, we reviewed a select sample of ophthalmology literature to determine if there was a correlation between Altimetric and traditional citation-based and impact factor metrics. We hypothesized that Altmetric score would more closely correlate with impact factor and citations in 2016. Methods Journal Citation Reports for the year 2013 was used to find the 15 highest impact factor ophthalmology journals in 2013. Then Elsevier's Scopus was used to identify the 10 most cited articles from each journal for the years 2013 and 2016. Metrics for all identified articles were collected using the Altmetric Bookmarklet, and date of Twitter account creation was noted for journals with such an account. Altmetric scores, impact factor, and citation counts were tabulated for each article. Pearson's correlation coefficient (r) determined correlation of independent variables (number of citations or impact factor) with dependent variable (Altmetric score). For our Twitter analysis, account age was the independent variable and calculated correlation coefficients (r) were the dependent variable. Proportion of variance was determined with a coefficient of determination (R 2). Results This study included 300 articles, evenly split between 2013 and 2016. Within the 2013 cohort, three journals had significant positive correlations between citation count and Altmetric score. For the 2016 cohort, both Altmetric score and citation count (r = 0.583, p Conclusion The findings suggest that correlation between Altmetric score and traditional quality metric scores may be increasing. Altmetric score was correlated with impact factor and number of citations in 2016 but not 2013. At this time, Altmetrics are best used as an adjunct that is complementary but not an alternative to traditional bibliometrics for assessing academic productivity and impact.

BACKGROUND: Autologous fat grafting is a popular technique for volume replacement in the breast and face. The efficacy, safety, and complication rate of this technique at the division of plastic surgery at the University of Alabama at Birmingham will be described in this review. METHODS: An institutional review board–approved retrospective review of patients undergoing fat grafting procedures from January 2015 to July 2018 was performed. Records were reviewed for fat graft recipient site, donor site, amount grafted, and complications. Continuous variables were compared using either a t test or one-way analysis of variance test. Categorical data were compared using χ(2) test. A P value of 0.05 or less was considered statistically significant for all comparisons. RESULTS: A total of 396 patients who underwent fat grafting procedures of the face and body from January 2015 through July 2018 met inclusion criteria. Average amount of fat grafted for all grafts was 124.4 +/− 6.74 grams. Two hundred fifty of the grafts (62.7%) involved the bilateral breasts with an average of 140.6 +/− 93.97 g used, 70 per side. Of the 396 patients, 110 (27.8%) experienced complications. Forty three of the complications (10.9%) were considered to be major, which included hematomas/seromas, fat necrosis, dermatitis/cellulitis, and infection. No statistical differences were seen among recipient site complication rate. Types of minor complications were statistically significant per recipient sites with bilateral breasts more likely to experience asymmetry than the other recipient sites (20% for bilateral breasts vs 16% overall, P < 0.05). Fifty nine of the 110 patients (53.6%) had the complications reported to be resolved. CONCLUSIONS: Fat grafting is a reliable method for volumization of the breasts and face. Minor complications were not infrequent in this case series; however, no life-threatening complications were observed. Continued work needs to be done to use fat grafting beyond traditional measures.

The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on the practice of medicine worldwide, particularly in anesthesiology. As the clinical realm has rapidly adjusted to the realities of the pandemic, anesthesiology literature has also changed significantly to reflect this. The purpose of this study was to characterize the effects the COVID-19 pandemic has had on anesthesiology literature. Specifically, it was hypothesized that the COVID-19-related literature in the anesthesiology community would gain more interest than non-COVID-19-related articles. A total of 15 anesthesiology-related journals with the highest impact factor in 2019, according to the Journal Citation Reports (JCR)

Background Although controversial, the use of acellular dermal matrices (ADMs) for abdominal wall reconstruction (AWR) is increasing. There are now many different ADMs available, but there is a lack of studies directly comparing ADMs in terms of outcomes. Materials and methods A retrospective chart review was performed to compare perioperative wound complications (up to 120 d postoperatively) between patients who underwent AWR with the human noncrosslinked ADMs Alloderm or Cortiva from January 2012 to March 2020. Surgical technique uniformly consisted of open component separation, onlay implantation of ADM, and progressive tension suture fixation of ADM. Results After exclusions, 53 patients were in the Alloderm group, and 29 patients were in the Cortiva group. The overall perioperative wound complication rate between Alloderm (51.92%) and Cortiva (72.41%) was not significantly different (P = 0.09921). The average follow-up for Alloderm was 76.69 ± 29.52 d and for Cortiva was 66.93 ± 35.16 d (P = 0.2088). There were no cases that required explantation of ADM. Conclusions Given the similar perioperative wound complication profiles, the more cost-effective ADM may be a consideration for use in AWR. The fact that there were zero instances of ADM explantation also supports the use of ADM in these high-risk cases.