-
The Journal of Surgical Research Oct 2022The incidence of metabolically unhealthy obesity is rising nationally. In this study, we compare wound and overall complications between metabolically unhealthy obese...
INTRODUCTION
The incidence of metabolically unhealthy obesity is rising nationally. In this study, we compare wound and overall complications between metabolically unhealthy obese and healthy patients undergoing elective plastic surgery and model how operative time influences a complication risk.
METHODS
Patients undergoing elective breast and body plastic surgery procedures in the 2009-2019 National Surgical Quality Improvement Program (NSQIP) dataset were identified. Complications were compared between metabolically unhealthy obese (body mass index [BMI] > 30 with diabetes and/or hypertension) versus metabolically healthy obese patients (BMI > 30 without diabetes or hypertension). Logistic regression was used to model the probability of wound complications across operative times stratified by metabolic status.
RESULTS
Of 139,352 patients, 13.4% (n = 18,663) had metabolically unhealthy obesity and 23.8% (n = 33,135) had metabolically healthy obesity. Compared to metabolically healthy patients, metabolically unhealthy patients had higher incidence of wound complications (6.9% versus 5.6%; P < 0.001) and adverse events (12.4% versus 9.6%; P < 0.001), in addition to higher 30-d readmission, returns to the operating room, and length of stay (all P < 0.001). After adjustment, BMI (Odds ratio [OR] 7.86), hypertension (OR 1.15), and diabetes (OR 1.25) were independent risk factors for wound complications (all P < 0.001). Among metabolically unhealthy patients, the operative time was log-linear with a wound complication risk (OR 1.21; P < 0.001).
CONCLUSIONS
Diabetes and hypertension are additive risk factors with obesity for wound complications in elective plastic surgery. Among patients with metabolically unhealthy obesity, a risk of wound complications increases logarithmically with operative time. This distinction with regard to metabolic state might explain the unclear impact of obesity on surgical outcomes within existing surgical literature.
Topics: Body Mass Index; Humans; Hypertension; Obesity; Obesity, Metabolically Benign; Risk Factors; Surgery, Plastic
PubMed: 35588573
DOI: 10.1016/j.jss.2022.03.017 -
The Journal of Craniofacial SurgeryPlastic surgery has grown rapidly over the past decade, with increasing scientific output. The emergence of coronavirus disease 2019 (COVID-19) has a considerable impact...
BACKGROUND
Plastic surgery has grown rapidly over the past decade, with increasing scientific output. The emergence of coronavirus disease 2019 (COVID-19) has a considerable impact on plastic surgery.
OBJECTIVE
To identify trends in published literature in plastic surgery from 2011 to 2021. To explore the impact of COVID-19 on scientific research output through bibliometric analysis methods.
METHODS
Web of Science was searched by authors on December 23, 2021. Published papers about plastic surgery over the last decade were analyzed. The search output was imported into VOSviewer for science mapping.
RESULTS
The actual number of papers related to plastic surgery during the COVID-19 period was higher than expected one. For scientific outputs in plastic surgery, keywords about surgical practice had a high frequency. "Reconstruction," "effect," "flap," "tissue," "defect," "model" maintained a high level of heat before and after COVID-19. The heat of "risk," "complication," "review," "infection," "cohort," and "meta-analysis" increased after the outbreak of COVID-19. The international collaboration showed an upward trend despite the impact of COVID-19. From the perspective of the volume of plastic surgery publications, some journals had a more positive performance compared to the pre-epidemic period. The proportion of original articles decreased after the spread of COVID-19 from 70.26% to 63.84%.
CONCLUSION
Although the COVID-19 has a profound impact on the healthcare industry, the bibliographic data reveals an increasing scientific output in the field of plastic surgery over time. For plastic surgery, high-frequency terms, research hotspots, popular journals, article types, and international collaboration have changed under the influence of COVID-19.
Topics: Humans; Surgery, Plastic; COVID-19; Plastic Surgery Procedures; Bibliometrics; Publications
PubMed: 36184772
DOI: 10.1097/SCS.0000000000009021 -
Plastic and Reconstructive Surgery.... Oct 2020Artificial intelligence (AI) in healthcare delivery has become an important area of research due to the rapid progression of technology, which has allowed the growth of...
BACKGROUND
Artificial intelligence (AI) in healthcare delivery has become an important area of research due to the rapid progression of technology, which has allowed the growth of many processes historically reliant upon human input. AI has become particularly important in plastic surgery in a variety of settings. This article highlights current applications of AI in plastic surgery and discusses future implications. We further detail ethical issues that may arise in the implementation of AI in plastic surgery.
METHODS
We conducted a systematic literature review of all electronically available publications in the PubMed, Scopus, and Web of Science databases as of February 5, 2020. All returned publications regarding the application of AI in plastic surgery were considered for inclusion.
RESULTS
Of the 89 novel articles returned, 14 satisfied inclusion and exclusion criteria. Articles procured from the references of those of the database search and those pertaining to historical and ethical implications were summarized when relevant.
CONCLUSIONS
Numerous applications of AI exist in plastic surgery. Big data, machine learning, deep learning, natural language processing, and facial recognition are examples of AI-based technology that plastic surgeons may utilize to advance their surgical practice. Like any evolving technology, however, the use of AI in healthcare raises important ethical issues, including patient autonomy and informed consent, confidentiality, and appropriate data use. Such considerations are significant, as high ethical standards are key to appropriate and longstanding implementation of AI.
PubMed: 33173702
DOI: 10.1097/GOX.0000000000003200 -
Einstein (Sao Paulo, Brazil) 2024This work aims to review the existing use of robotics in plastic surgery. (Review)
Review
OBJECTIVE
This work aims to review the existing use of robotics in plastic surgery.
METHODS
A meticulous selection process identified 22 articles relevant to this scoping review.
RESULTS
The literature on the use of robotics in plastic surgery is sparse. Nonetheless, this review highlights emerging benefits in microsurgery, breast reconstruction, and transoral surgery.
CONCLUSION
This scoping review identifies critical articles reporting the emerging use of robotics in plastic surgery. While the scientific medical community has yet to extensively document its use, the available evidence suggests a promising future for robotics in this field.
Topics: Humans; Robotic Surgical Procedures; Plastic Surgery Procedures; Surgery, Plastic; Microsurgery; Mammaplasty
PubMed: 38747887
DOI: 10.31744/einstein_journal/2024RW0710 -
Scientific Reports Nov 2021Predictive factors associated with postoperative mortality have not been extensively studied in plastic and reconstructive surgery. Neutrophil-lymphocyte ratio (NLR), a... (Observational Study)
Observational Study
Predictive factors associated with postoperative mortality have not been extensively studied in plastic and reconstructive surgery. Neutrophil-lymphocyte ratio (NLR), a systemic inflammation index, has been shown to have a predictive value in surgery. We aimed to evaluate association between preoperative NLR and postoperative outcomes in patients undergoing plastic and reconstructive surgery. From January 2011 to July 2019, we identified 7089 consecutive adult patients undergoing plastic and reconstructive surgery. The patients were divided according to median value of preoperative NLR of 1.84. The low NLR group was composed of 3535 patients (49.9%), and 3554 patients (50.1%) were in the high NLR group. The primary outcome was mortality during the first year, and overall mortality and acute kidney injury were also compared. In further analysis, outcomes were compared according to quartile of NLR, and a receiver operating characteristic curve was constructed to estimate the threshold associated with 1-year mortality. This observational study showed that mortality during the first year after plastic and reconstructive surgery was significantly increased in the high NLR group (0.7% vs. 3.5%; hazard ratio, 4.23; 95% confidence interval, 2.69-6.63; p < 0.001), and a graded association was observed between preoperative NLR and 1-year mortality. The estimated threshold of preoperative NLR was 2.5, with an area under curve of 0.788. Preoperative NLR may be associated with 1-year mortality after plastic and reconstructive surgery. Further studies are needed to confirm our findings.
Topics: Acute Kidney Injury; Adult; Biomarkers; Female; Follow-Up Studies; Humans; Lymphocytes; Male; Middle Aged; Neutrophils; Preoperative Care; Prognosis; Plastic Surgery Procedures; Retrospective Studies; Surgery, Plastic; Survival Rate
PubMed: 34728689
DOI: 10.1038/s41598-021-00901-7 -
The Journal of Surgical Research Nov 2020There is a paucity of research comparing journal articles that accrue numerous citations with those that accrue few citations over time. Understanding differences...
BACKGROUND
There is a paucity of research comparing journal articles that accrue numerous citations with those that accrue few citations over time. Understanding differences between journal articles can help direct investigators in designing and conducting their research.
METHODS
Using advanced bibliometric tools, we queried four plastic surgery journals (Journal of Reconstructive Microsurgery, Annals of Plastic Surgery, Plastic and Reconstructive Surgery, and Microsurgery) for primary research articles published between 1998 and 2008 accruing zero or one citations with at least a 10-y lag time. Forty-seven articles were identified as low citation and were compared with an equal number of articles in the same journals that accrued the highest number of citations in the same period as high citation (HC). The data were analyzed using Student t-tests, Wilcoxon rank sum tests, chi-square tests, and Fisher exact tests. The level of significance was established at P < 0.05.
RESULTS
When compared with the HC cohort, the low citation articles were more likely to be nonclinical (P < 0.001), have no plastic surgery authors (P = 0.0026), and focus on the field of microsurgery (P = 0.003). The HC cohort was more likely to have higher sample sizes (P = 0.0339), focus on aesthetic/cosmetic surgery (P = 0.003), have a higher number of other disciplines included on authorship (P < 0.001), references (P = 0.0451), manuscript pages (P < 0.001), and words in the abstract (P < 0.001).
CONCLUSIONS
A small number of articles published in four plastic surgery journals were uncited during a 10-y period. There are qualitative and quantitative differences between highly and lowly cited articles in the plastic surgery literature. Investigators should consider these differences when designing and conducting studies.
Topics: Bibliometrics; Biomedical Research; Publications; Research Design; Surgery, Plastic
PubMed: 32279891
DOI: 10.1016/j.jss.2020.02.009 -
Annals of Plastic Surgery May 2023
Topics: Humans; Surgery, Plastic; Plastic Surgery Procedures; Evidence-Based Medicine
PubMed: 36440909
DOI: 10.1097/SAP.0000000000003329 -
International Journal of Molecular... Feb 2024A hallmark of plastic and reconstructive surgery is restoring form and function. Historically, tissue procured from healthy portions of a patient's body has been used to... (Review)
Review
A hallmark of plastic and reconstructive surgery is restoring form and function. Historically, tissue procured from healthy portions of a patient's body has been used to fill defects, but this is limited by tissue availability. Human-induced pluripotent stem cells (hiPSCs) are stem cells derived from the de-differentiation of mature somatic cells. hiPSCs are of particular interest in plastic surgery as they have the capacity to be re-differentiated into more mature cells, and cultured to grow tissues. This review aims to evaluate the applications of hiPSCs in the plastic surgery context, with a focus on recent advances and limitations. The use of hiPSCs and non-human iPSCs has been researched in the context of skin, nerve, vasculature, skeletal muscle, cartilage, and bone regeneration. hiPSCs offer a future for regenerated autologous skin grafts, flaps comprised of various tissue types, and whole functional units such as the face and limbs. Also, they can be used to model diseases affecting tissues of interest in plastic surgery, such as skin cancers, epidermolysis bullosa, and scleroderma. Tumorigenicity, immunogenicity and pragmatism still pose significant limitations. Further research is required to identify appropriate somatic origin and induction techniques to harness the epigenetic memory of hiPSCs or identify methods to manipulate epigenetic memory.
Topics: Humans; Induced Pluripotent Stem Cells; Surgery, Plastic; Cell Differentiation; Skin; Plastic Surgery Procedures
PubMed: 38339142
DOI: 10.3390/ijms25031863 -
Surgery Aug 2021Coronavirus disease 2019 provided the impetus for unprecedented adoption of telemedicine. This study aimed to understand video visit adoption by plastic surgery...
BACKGROUND
Coronavirus disease 2019 provided the impetus for unprecedented adoption of telemedicine. This study aimed to understand video visit adoption by plastic surgery providers; and patient and surgeon perceptions about its efficacy, value, accessibility, and long-term viability. A secondary aim was to develop the proposed 'Triage Tool for Video Visits in Plastic Surgery' to help determine visit video eligibility.
METHODS
This mixed-methods evaluation assessed provider-level scheduling data from the Division of Plastic and Reconstructive Surgery at Stanford Health Care to quantify telemedicine adoption and semi-structured phone interviews with patients (n = 20) and surgeons (n = 10) to explore stakeholder perspectives on video visits.
RESULTS
During the 13-week period after the local stay-at-home orders due to coronavirus disease 2019, 21.4% of preoperative visits and 45.5% of postoperative visits were performed via video. Video visits were considered acceptable by patients and surgeons in plastic surgery in terms of quality of care but were limited by the inability to perform a physical examination. Interviewed clinicians reported that long-term viability needs to be centered around technology (eg, connection, video quality, etc) and physical examinations. Our findings informed a proposed triage tool to determine the appropriateness of video visits for individual patients that incorporates visit type, anesthesia, case, surgeon's role, and patient characteristics.
CONCLUSION
Video technology has the potential to facilitate and improve preoperative and postoperative patient care in plastic surgery but the following components are needed: patient education on taking high-quality photos; standardized clinical guidelines for conducting video visits; and an algorithm-assisted triage tool to support scheduling.
Topics: Adult; Aged; Aged, 80 and over; COVID-19; Female; Humans; Male; Middle Aged; Patient Satisfaction; Physical Examination; Physician-Patient Relations; Surgeons; Surgery, Plastic; Telemedicine; Young Adult
PubMed: 33941389
DOI: 10.1016/j.surg.2021.03.029 -
International Journal of Impotence... May 2022The reason behind the spread of penis enlargement practices over time is rooted in the virility that the appearance of the genitals can give a man, as well as an altered... (Review)
Review
The reason behind the spread of penis enlargement practices over time is rooted in the virility that the appearance of the genitals can give a man, as well as an altered perception of his own body. The approach should be to modulate the interventions on the real needs of patients, carefully evaluating the history, the psychological picture, and possible surgical advantages. The aim of this study was to shed light on cosmetic surgery of male genitalia through minimally invasive and more radical techniques, with the purpose of laying the foundation for possible indications and recommendations for the future. A non-systematic literature review using the PubMed and Scopus databases was conducted to retrieve papers written in English on cosmetic surgery of the penis published over the past 15 years. Papers discussing cosmetic surgery in patients with concomitant pathologies associated with sexual dysfunction were excluded. The main outcomes recorded were change in penile dimensions in term of length and girth and surgical complications.
Topics: Esthetics; Humans; Male; Penis; Plastic Surgery Procedures; Surgery, Plastic; Urogenital Surgical Procedures
PubMed: 35383340
DOI: 10.1038/s41443-022-00556-6