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Article ; Online: Association Between Posterior Tibial Slope and ACL Injury in Pediatric Patients: A Systematic Review and Meta-analysis.

Farid, Alexander R / Pradhan, Pratik / Stearns, Stephen A / Kocher, Mininder S / Fabricant, Peter D

2024 , Page(s) 3635465231199649

Abstract: Background: The posterior tibial slope (PTS) has been proposed to be a radiographic risk factor for anterior cruciate ligament (ACL) injury in adults. However, this has not been well established in pediatric patients.: Purpose: This systematic review ...

Abstract	Background: The posterior tibial slope (PTS) has been proposed to be a radiographic risk factor for anterior cruciate ligament (ACL) injury in adults. However, this has not been well established in pediatric patients. Purpose: This systematic review and meta-analysis was performed to investigate any association between PTS and ACL tears in the pediatric population. Study design: Systematic review and meta-analysis; Level of evidence, 4. Methods: A systematic review was performed to identify studies that examined the relationship between PTS, medial tibial slope (MTS), and lateral tibial slope (LTS) and ACL tears in children and adolescents aged ≤18 years. Full-text observational studies comparing PTS, MTS, and/or LTS values between pediatric (≤18 years of age) patients with and without ACL injury were included in this analysis. Review articles and case series were excluded. The authors calculated the mean difference (MD) via a restricted maximum-likelihood estimator for tau square and a Hartung-Knapp adjustment for random-effects model. Results: A total of 348 articles were identified in the initial database search, yielding 10 for final inclusion and analysis. There was no statistically significant association between PTS (MD, 1.13°; 95% CI, -0.55° to 2.80°; Conclusion: The current study found that unlike what has been shown in adult populations, increased PTS may not be a significant risk factor for ACL tears in pediatric and adolescent patents. LTS was the only measured parameter that neared statistical significance, perhaps suggesting a potential role for this measurement in determining ACL risk if further research is done in this population.
Language	English
Publishing date	2024-01-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	197482-8
ISSN	1552-3365 ; 0363-5465
ISSN (online)	1552-3365
ISSN	0363-5465
DOI	10.1177/03635465231199649
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Article ; Online: Hospital noncompliance with U.S. price transparency regulations.

Miller, Amitai S / Stearns, Stephen A / Berwick, Donald M

Lancet regional health. Americas

2022 Volume 12, Page(s) 100275

Language	English
Publishing date	2022-05-21
Publishing country	England
Document type	Journal Article
ISSN	2667-193X
ISSN (online)	2667-193X
DOI	10.1016/j.lana.2022.100275
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Article ; Online: Rhinoplasty Preferences: Can the Public Detect Prior Surgery on Social Media?

Valentine, Lauren / Weidman, Allan A / Stearns, Stephen A / Dennis, Daniella / Alvarez, Angelica Hernandez / Foppiani, Jose / Lin, Samuel J

Aesthetic plastic surgery

2024

Abstract: Background: The creation of postoperative rhinoplasty results that appear natural and proportional to the face are crucial for patient satisfaction. The purpose of this study was to assess the public's ability to detect a post-rhinoplasty result and ... ...

Abstract	Background: The creation of postoperative rhinoplasty results that appear natural and proportional to the face are crucial for patient satisfaction. The purpose of this study was to assess the public's ability to detect a post-rhinoplasty result and preference of preoperative and postoperative rhinoplasty outcomes. Methods: A survey was distributed using the Amazon Mechanical Turk online platform showing nine preoperative and postoperative rhinoplasty patients. Participants rated aesthetic appearance, identified areas of abnormality, and stated whether they believed the patient had undergone prior rhinoplasty. Results: A total of 456 responses were included. On a scale of 1-5 with 5 being the most aesthetically pleasing, the highest rated nose was a postoperative patient without visible deformities (3.95, SD 1.07) followed by the postoperative patient with a resultant bulbous tip (3.48, SD 0.96). The lowest ranking noses were the prior rhinoplasty with resultant saddle nose deformity (3.02, SD 1.19) and the prior rhinoplasty with nasal trapezoid deformity (2.95, SD 1.04). The public was able to correctly determine if patients had prior rhinoplasty surgery only if there were resultant defects. When respondents believed that the patient had undergone prior rhinoplasty, their average rating was lower than those who believed they had not undergone surgery (3.74/5 vs. 4.15/5, p < 0.0001). Conclusions: The belief that someone had previously undergone rhinoplasty led the public to rate the aesthetic appearance of the nose lower. To provide optimal results following rhinoplasty, surgeons may therefore seek to provide a natural, "un-operated" look. Level of evidence iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . Differences for nasal aesthetic preferences exist and vary based on geographic region The public is unable to discern if a patient previously underwent rhinoplasty if the result does not show a postoperative defect, such as a dorsal hump, over-rotated tip, or mid-vault collapse Oppositely, the public can generally tell if patients have undergone rhinoplasty surgery if a postoperative deformity is present The belief that someone had rhinoplasty surgery negatively impacts the attractiveness ranking of the nose, even without any postoperative defects present.
Language	English
Publishing date	2024-01-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	532791-x
ISSN	1432-5241 ; 0364-216X
ISSN (online)	1432-5241
ISSN	0364-216X
DOI	10.1007/s00266-023-03791-4
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Article ; Online: Patient Comfort with Before and After Photography at Plastic Surgery Offices.

Weidman, Allan A / Valentine, Lauren / Stearns, Stephen A / Alvarez, Angelica Hernandez / Foppiani, Jose / Long, Emily / Lin, Samuel J

Aesthetic plastic surgery

2024

Abstract: Background: Before and after (B&A) photographs are a sensitive part of patients' medical records, and the use of smartphones may pose risks to confidentiality and comfort. The purpose of this study was to assess patient comfort depending on the ... ...

Abstract	Background: Before and after (B&A) photographs are a sensitive part of patients' medical records, and the use of smartphones may pose risks to confidentiality and comfort. The purpose of this study was to assess patient comfort depending on the circumstances under which these photographs being taken. Methods: Amazon's Mechanical Turk crowdsourcing service and REDCap's survey manager were used to recruit survey participants. An anonymous survey was distributed to ascertain demographics and comfort in various B&A scenarios using a five-point Likert scale. T tests and ANOVA testing were used to compare groups. Results: There were 411 respondents with an average age of 36.1 years old. Of them, 46% were female and the majority were White (90%) and non-Hispanic (64%). Nearly one-third had previously undergone plastic surgery, with 80% receiving B&A photography. Surgeons took these photographs 51% of the time with similar rates of smartphone cameras use (47%) versus professional cameras (52%). The public had similar levels of comfort when a nurse or a surgeon took the clinical photographs (p = 0.08). Patients were significantly less comfortable when non-medically trained office staff captured their photographs (p = 0.0041). The public had similar comfort levels with the use of smartphones and professional cameras when dressed but were significantly less comfortable with the use of a smartphone when unclothed (p = < 0.001). Conclusion: To ensure the best patient experience, B&A photography should be taken by a medical professional. If photographs are to be taken when the patient is unclothed, the use of a professional-grade camera may help ease patient discomfort. Level of evidence iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Language	English
Publishing date	2024-03-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	532791-x
ISSN	1432-5241 ; 0364-216X
ISSN (online)	1432-5241
ISSN	0364-216X
DOI	10.1007/s00266-024-03938-x
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Zs.A 1296: Show issues

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Article ; Online: Therapeutic Options for Migraines in the Microsurgical Patient: A Scoping Review.

Stearns, Stephen A / Xun, Helen / Haddad, Anthony / Rinkinen, Jacob / Bustos, Valeria P / Lee, Bernard T

Plastic and reconstructive surgery

2023 Volume 153, Issue 5, Page(s) 988e–1001e

Abstract: Background: There exists an increasing array of treatments proposed to prevent, alleviate, and abort symptoms of a migraine; however, for patients who undergo reconstructive microsurgery, caution must be taken to preserve vascular integrity. This study ... ...

Abstract	Background: There exists an increasing array of treatments proposed to prevent, alleviate, and abort symptoms of a migraine; however, for patients who undergo reconstructive microsurgery, caution must be taken to preserve vascular integrity. This study is the first-to-date scoping review of vascular and bleeding risk of current migraine therapies, with the purpose of identifying potential therapeutic agents for postoperative migraine management appropriate for microsurgical patients. Methods: Currently available migraine therapeutics were compiled from the UpToDate software system and the American Academy of Family Physicians. A PubMed literature review was performed for each therapeutic's effect on bleeding or vascular involvement. Data were compiled into tables of abortive, symptom-controlling and prophylactic, and nonpharmacologic treatments. Expert microsurgeons reviewed the data to provide recommendations for optimized patient care. Results: Triptans and other ergot derivatives demonstrated strong evidence of vasoconstriction and were greatly advised against for immediate postmicrosurgical use. Novel pharmaceutical therapies such as lasmiditan and calcitonin gene-related peptide antagonists have no literature indicating potential for vasoconstriction or hematoma and remain an investigational option for abortive medical treatment. For symptom control, acetaminophen appears the safest option, with clinical judgment and further research needed for use of nonsteroidal antiinflammatory drugs. Alternative treatment techniques may include migraine prophylaxis with botulinum toxin injection or nutraceutical treatment by means of magnesium supplementation or coenzyme Q10 administration, minimizing the need for additional medication in the postoperative setting. Conclusions: Patients undergoing reconstructive microsurgery have a unique medical profile limiting the therapeutic options available to treat migraines. This review provides preliminary evidence to be considered as a guide for prescribing therapeutics for migraine in the postoperative setting.
MeSH term(s)	Humans ; Microsurgery/methods ; Migraine Disorders/prevention & control ; Migraine Disorders/etiology ; Postoperative Complications/prevention & control ; Postoperative Complications/etiology ; Postoperative Complications/therapy ; Plastic Surgery Procedures/methods ; Plastic Surgery Procedures/adverse effects
Language	English
Publishing date	2023-06-20
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	208012-6
ISSN	1529-4242 ; 0032-1052 ; 0096-8501
ISSN (online)	1529-4242
ISSN	0032-1052 ; 0096-8501
DOI	10.1097/PRS.0000000000010861
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Uk I Zs.142: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
Zs.MO 293: Show issues

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Article: Trends in non-operative management of low-energy pelvic fracture: An analysis of the Nationwide Inpatient Sample.

Farid, Alexander R / Stearns, Stephen A / Atarere, Joseph Okiemute / Suneja, Nishant / Weaver, Michael J / Von Keudell, Arvind Gabriel

Journal of orthopaedics

2023 Volume 43, Page(s) 101–108

Abstract: Introduction: Non-operative management is common for low-impact pelvic fractures. In this study, we characterize the epidemiology of those treated nonoperatively following low-energy pelvic fracture, while identifying recent management trends.: ... ...

Abstract	Introduction: Non-operative management is common for low-impact pelvic fractures. In this study, we characterize the epidemiology of those treated nonoperatively following low-energy pelvic fracture, while identifying recent management trends. Methodology: Data from the Nationwide Inpatient Sample (NIS) database from 2011 to 2018 were analyzed. We identified adult patients diagnosed with pelvic fracture based on International Classification of Diseases (ICD) codes, excluding fractures of the acetabulum, femur, polytrauma, and open fractures to isolate cases caused by low-impact mechanisms. Codes indicating operative management were excluded. Demographic information and outcomes (length of stay, in-hospital mortality, hospital discharge status) were collected. Sub-analyses were performed to identify trends. Findings: 123,936 eligible patients were identified. The average age was 68.7 years. 70% were female, showing a decline from 75% to 66% over the study period. Pubic bone involvement was observed in 59% of fractures. The mean Charlson Comorbidity Index (CCI) was 3.83, corresponding to a 10-year survival rate of 58.5%, which remained relatively stable throughout the study period. 62.4% of patients received treatment at urban teaching hospitals. Average length of hospital stay was 6.3 days. Discharge to a skilled nursing facility (SNF) was the most common outcome, ranging from 62.1% to 65.0% during the study period, while 20.0% of patients were discharged home (18.4%-21.1%). Mean in-hospital mortality was 3.28%, showing no significant change, with higher rates among male patients (5.1%) and patients of Asian descent (3.8%). Conclusion: The majority of patients receiving nonoperative treatment for low-energy pelvic fractures were females in their mid-60s with moderate comorbidity. The study reveals a relatively high in-hospital mortality rate of 3.28%, particularly among male patients and those of Asian descent, indicating the need for increased surveillance for further injury in these groups. Most patients were discharged to a SNF, highlighting the necessity for extended rehabilitation in this population. This persistent trend is noteworthy considering the growing emphasis on the cost of inpatient admissions and advancements in outpatient management of orthopedic injuries.
Language	English
Publishing date	2023-07-28
Publishing country	India
Document type	Journal Article
ZDB-ID	2240839-3
ISSN	0972-978X
ISSN	0972-978X
DOI	10.1016/j.jor.2023.07.028
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Geographic Variability of Genital Gender-Affirming Surgery Centers and Costs of Hospitalization.

Kim, Erin J / Stearns, Stephen A / Bustos, Valeria P / Engmann, Toni / Dowlatshahi, Arriyan S / Lee, Bernard T / Cauley, Ryan

Annals of plastic surgery

2023 Volume 92, Issue 1, Page(s) 92–96

Abstract: Purpose: The cost of gender-affirming surgery (GAS) is an important component of healthcare accessibility for transgender patients. However, GAS is often prohibitively expensive, particularly as there are inconsistencies in insurance coverages. ... ...

Abstract	Purpose: The cost of gender-affirming surgery (GAS) is an important component of healthcare accessibility for transgender patients. However, GAS is often prohibitively expensive, particularly as there are inconsistencies in insurance coverages. Variability in hospital costs has been documented for other types of nonplastic surgery procedures; however, this analysis has not been done for GAS. To better understand the financial barriers impairing access to equitable transgender care, this study analyzes the distribution of hospitals that perform genital GAS and the associated costs of inpatient genital GAS. Methods: This is a study of the 2016-2019 National Inpatient Sample database. Transgender patients undergoing genital GAS were identified using International Classification of Diseases, Tenth Revision, diagnosis and procedure codes, and patients undergoing concurrent chest wall GAS were excluded. Descriptive statistics were done on patient sociodemographic variables, hospital characteristics, and hospitalization costs. χ2 test was used to assess for differences between categorical variables and Mood's median test was used to assess for differences between continuous variable medians. Results: A total of 3590 weighted genital GAS encounters were identified. The Western region (50.8%) and Northeast (32.3%) performed the greatest proportion of GAS, compared with the Midwest (9.1%) and the South (8.0%) (P < 0.0001). The most common payment source was private insurance (62.8%), followed by public insurance (27.3%). There were significant differences in the variability of median hospital costs across regions (P < 0.0001). The South and Midwest had the greatest median cost for vaginoplasty ($19,935; interquartile range [IQR], $16,162-$23,561; P = 0.0009), while the West had the greatest median cost for phalloplasty ($26,799; IQR, $19,667-$30,826; P = 0.0152). Across both procedures, the Northeast had the lowest median cost ($11,421; IQR, $9155-$13,165 and $10,055; IQR, $9,013-$10,377, respectively). Conclusions: There is significant regional variability in the number of GAS procedures performed and their associated hospitalization costs. The identified disparities in insurance coverage present an area of possible future improvement to alleviate the financial burden GAS presents to gender-discordant individuals. The variability in cost suggests a need to evaluate variations in care, leading to cost standardization.
MeSH term(s)	Humans ; Sex Reassignment Surgery/methods ; Hospitalization ; Transsexualism/surgery ; Transgender Persons ; Genitalia/surgery
Language	English
Publishing date	2023-12-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	423835-7
ISSN	1536-3708 ; 0148-7043
ISSN (online)	1536-3708
ISSN	0148-7043
DOI	10.1097/SAP.0000000000003729
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Zs.A 1419: Show issues

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Article ; Online: Hand and Wrist Amputation: A Demographic Analysis Using the National Inpatient Sample.

Stearns, Stephen A / Weidman, Allan A / Engmann, Toni F / Valentine, Lauren / Hernandez Alvarez, Angelica / Foppiani, Jose / Lin, Samuel J / Dowlatshahi, Sammy

Hand (New York, N.Y.)

2023 , Page(s) 15589447231167583

Abstract: Background: Traumatic hand and wrist amputations are rare but debilitating injuries. Surgical replantation of the hand provides a unique alternative to revision surgery but requires appropriate access to necessary medical resources. This study aims to ... ...

Abstract	Background: Traumatic hand and wrist amputations are rare but debilitating injuries. Surgical replantation of the hand provides a unique alternative to revision surgery but requires appropriate access to necessary medical resources. This study aims to understand the national practice of replantation of traumatic hand amputation and to determine whether disparities exist in accessing surgical treatment. Methods: International Classification of Diseases, 10th Revision Results: Seventy-two patients were identified. The average patient was 35 years old with a strong male predominance (90%). The racial distribution of the cohort roughly mirrored the demographic proportions of race in the US population. Fifteen (21%) patients underwent replantation. This rate was similar between sexes, races, and income brackets. Hand replantation was primarily performed at large bed size (87%), private not-for-profit (73%), and urban teaching hospitals (94%). The most common insurance status for these patients was private, followed by Medicaid, Medicare, and self-pay. Forty-seven patients underwent revision amputation (65%) with no association between demographic characteristics. The patients remained hospitalized for significantly longer periods ( Conclusion: This study describes the current state of hand amputation management and finds no evidence of sociodemographic factors influencing the surgical care provided.
Language	English
Publishing date	2023-04-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	2277325-3
ISSN	1558-9455 ; 1558-9447
ISSN (online)	1558-9455
ISSN	1558-9447
DOI	10.1177/15589447231167583
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Zs.A 6820: Show issues

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Article ; Online: Impact of financial well-being on gender affirmation surgery access and hospital course.

Kim, Erin J / Stearns, Stephen A / Bustos, Valeria P / Dowlatshahi, Arriyan S / Lee, Bernard T / Cauley, Ryan

Journal of plastic, reconstructive & aesthetic surgery : JPRAS

2023 Volume 85, Page(s) 174–181

Abstract: Background: Although gender affirmation surgery (GAS) can effectively treat gender dysphoria, it remains one of the most expensive components of gender affirming care. This study aims to identify the impact of financial well-being on GAS access and ... ...

Abstract	Background: Although gender affirmation surgery (GAS) can effectively treat gender dysphoria, it remains one of the most expensive components of gender affirming care. This study aims to identify the impact of financial well-being on GAS access and hospital course in the United States. Methods: The National Inpatient Sample database was queried from 2012 to 2019. US transgender patients undergoing GAS were identified. Predictors included patient sociodemographic variables. Outcomes included hospitalization course variables. Regression modeling was used to assess the relationship between predictor and outcome variables. Significance was set at α = 0.05. Results: A total of 5620 weighted GAS encounters were identified (genital surgery 92.3%, chest surgery 16.6%). 1825 (32.5%) patients were in the highest income bracket, compared with 1120 (19.9%) patients in the lowest bracket. Higher income was associated with younger age at the time of GAS. Patients in the highest income quartile were also 3.7 times more likely to be funded by private insurance and self-pay options than those in the lowest income quartile (95% confidence interval [CI]: 3.1-4.4, p < 0.0001). Additionally, patients in the lowest income quartile were 4.2 times more likely to require either home healthcare or transfer to a nursing facility post discharge than those in the highest income quartile (95% CI: 3.1-5.8, p < 0.001). Conclusions: To promote equitable care to transgender patients, efforts to reduce financial barriers to healthcare access are much needed, particularly through broader insurance coverage of GAS procedures. Broadly, our results highlight the impact of socioeconomic variables on healthcare access and outcomes.
MeSH term(s)	Humans ; United States ; Aftercare ; Patient Discharge ; Sex Reassignment Surgery ; Transgender Persons ; Hospitals
Language	English
Publishing date	2023-06-28
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2217750-4
ISSN	1878-0539 ; 1748-6815 ; 0007-1226
ISSN (online)	1878-0539
ISSN	1748-6815 ; 0007-1226
DOI	10.1016/j.bjps.2023.06.059
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Uk I Zs.157: Show issues

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Article ; Online: Utilization of patient-reported outcome measures in plastic surgery clinical trials: A systematic review.

Foppiani, Jose / Alvarez, Angelica Hernandez / Stearns, Stephen A / Taritsa, Iulianna C / Weidman, Allan A / Valentine, Lauren / Escobar-Domingo, Maria J / Foster, Lacey / Schuster, Kirsten A / Ho, Olivia A / Rinker, Brian / Lee, Bernard T / Lin, Samuel J

Journal of plastic, reconstructive & aesthetic surgery : JPRAS

2024 Volume 90, Page(s) 215–223

Abstract: Background: Patient-reported outcomes (PROs) have evolved to validated questionnaires assessing health-related quality of life. This systematic review evaluates the utilization of PROs in United States plastic and reconstructive surgery (PRS) clinical ... ...

Abstract	Background: Patient-reported outcomes (PROs) have evolved to validated questionnaires assessing health-related quality of life. This systematic review evaluates the utilization of PROs in United States plastic and reconstructive surgery (PRS) clinical trials (CTs). Methods: A medical librarian conducted a search strategy for PRS CTs from 2012 to 2022. CTs were identified and assessed for PRO utilization. Summary statistics were performed, and Fisher's exact test was used for subgroup analysis. Results: Of the 3609 studies initially identified, 154 were PRS CTs. Approximately half (80 studies) employed PROs, encompassing 13,190 participants, 95% (12,229) of whom were female. Among the CTs, 37 (48%) were in the field of reconstruction, while 25 (32%) were cosmetic. Pain (35%) and patient satisfaction (24%) were the most common primary outcomes. Validated PROs were the main outcome in 61% of these trials, with the visual analog scale (19%) and BREAST-Q (15%) as the top instruments. Funding was primarily private (34%) or not reported (49%). No significant trend in validated PRO usage was observed over the examined decade. Conclusions: The use of PROs is relevant for healthcare delivery and improvement as they provide insight into the efficacy of treatments from a patient-centered viewpoint. PROs are reported in just over half of PRS CTs, and within those CTs, the use of validated questionnaires is inconsistent. Therefore, emerging CTs should strive to incorporate PRO measures and utilize the existing validated tools to assess novel interventions and ensure that the data reported is objective.
MeSH term(s)	Humans ; Female ; Male ; Quality of Life ; Surgery, Plastic ; Surveys and Questionnaires ; Patient Satisfaction ; Patient Reported Outcome Measures
Language	English
Publishing date	2024-02-02
Publishing country	Netherlands
Document type	Systematic Review ; Journal Article ; Review
ZDB-ID	2217750-4
ISSN	1878-0539 ; 1748-6815 ; 0007-1226
ISSN (online)	1878-0539
ISSN	1748-6815 ; 0007-1226
DOI	10.1016/j.bjps.2024.01.036
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