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1.
Colorectal Dis ; 25(6): 1213-1221, 2023 06.
Article in English | MEDLINE | ID: mdl-36945125

ABSTRACT

AIM: Perianal Paget's disease (PAPD) is a rare disorder with a predisposition to anal and colorectal malignancies and an unclear prognosis. Our previous 25-year series demonstrated a non-aggressive nature. This study aims to describe our updated institutional experience. METHODS: This is a retrospective review of all patients diagnosed with primary PAPD from 1991 to 2021. A prospectively maintained institutional database was searched which included demographics, clinical and pathological manifestations, treatment methods, recurrence, oncological outcome and mortality. RESULTS: Thirty patients were diagnosed with PAPD. Fifteen were women (50%); the average age at diagnosis was 71 ± 10.7 years, and the average lesion size was 3.7 ± 2.6 cm. At diagnosis, 12 (40%) were harbouring invasive anal adenocarcinoma. Eight (27%) developed adenocarcinomas concurrent with PAPD recurrence at a mean interval of 9 ± 4.4 years (range 1.9-14.8). The Kaplan-Meier curve estimated overall survival of 93%, 86%, 82%, 65% and 56% at 1, 3, 5, 10 and 15 years, respectively. Median survival was 16 years. Six (20%) had disease-related mortality. Initially, nine (30%) were treated with abdominoperineal resection (APR), 15 (50%) underwent local resection, three (10%) were treated with radiotherapy, two (7%) received only topical therapy and one (3%) chose observation. Fifteen (50%) experienced recurrence of PAPD, two after undergoing APR. Five (17%) had persistent disease until death. Only 10 (33%) did not experience PAPD recurrence, seven of whom underwent APR. The mean follow-up time was 9.2 ± 6.2 years. CONCLUSIONS: Perianal Paget's disease is an aggressive entity with high rates of synchronous anal adenocarcinoma at diagnosis and development of metachronous adenocarcinoma later in life.


Subject(s)
Adenocarcinoma , Anus Neoplasms , Paget Disease, Extramammary , Humans , Female , Male , Paget Disease, Extramammary/diagnosis , Paget Disease, Extramammary/therapy , Adenocarcinoma/therapy , Adenocarcinoma/pathology , Anus Neoplasms/pathology , Prognosis , Anal Canal/pathology
2.
Ann Surg ; 275(2): 259-270, 2022 02 01.
Article in English | MEDLINE | ID: mdl-33064394

ABSTRACT

OBJECTIVE: To review the racial composition of the study populations that the current USPSTF screening guidelines for lung, breast, and colorectal cancer are based on, and the effects of their application across non-white individuals. SUMMARY OF BACKGROUND DATA: USPSTF guidelines commonly become the basis for establishing standards of care, yet providers are often unaware of the racial composition of the study populations they are based on. METHODS: We accessed the USPSTF screening guidelines for lung, breast, and colorectal cancer via their website, and reviewed all referenced publications for randomized controlled trials (RCTs), focusing on the racial composition of their study populations. We then used PubMed to identify publications addressing the generalizability of such guidelines across non-white individuals. Lastly, we reviewed all guidelines published by non-USPSTF organizations to identify the availability of race-specific recommendations. RESULTS: Most RCTs used as basis for the current USPSTF guidelines either did not report race, or enrolled cohorts that were not representative of the U.S. population. Several studies were identified demonstrating the broad application of such guidelines across non-white individuals can lead to underdiagnosis and higher levels of advanced disease. Nearly all guideline-issuing bodies fail to provide race-specific recommendations, despite often acknowledging increased disease burden among non-whites. CONCLUSION: Concerted efforts to overcome limitations in the generalizability of RCTs are required to provide screening guidelines that are truly applicable to non-white populations. Broader policy changes to improve the pipeline for minority populations into science and medicine are needed to address the ongoing lack of diversity in these fields.


Subject(s)
Breast Neoplasms/diagnosis , Colorectal Neoplasms/diagnosis , Cultural Competency , Early Detection of Cancer/standards , Lung Neoplasms/diagnosis , Racial Groups , Humans , Practice Guidelines as Topic
6.
Surg Endosc ; 35(10): 5441-5449, 2021 10.
Article in English | MEDLINE | ID: mdl-33033914

ABSTRACT

BACKGROUND: Quality improvement (QI) initiatives commonly originate 'top-down' from senior leadership, as staff engagement is often sporadic. We describe our experience with a technology-enabled open innovation contest to encourage participation from multiple stakeholders in a Department of Surgery (DoS) to solicit ideas for QI. We aimed to stimulate engagement and to assist DoS leadership in prioritizing QI initiatives. METHODS: Observational study of a process improvement. The process had five phases: anonymous online submission of ideas by frontline staff; anonymous online crowd-voting to rank ideas on a scale whether the DoS should implement each idea (1 = No, 3 = Maybe, 5 = Yes); ideas with scores ≥ 95th percentile were invited to submit implementation plans; plans were reviewed by a multi-disciplinary panel to select a winning idea; an award ceremony celebrated the completion of the contest. RESULTS: 152 ideas were submitted from 95 staff (n = 850, 11.2%). All Divisions (n = 12) and all staff roles (n = 12) submitted ideas. The greatest number of ideas were submitted by faculty (27.6%), patient service coordinators (18.4%), and residents (17.8%). The most common QI category was access to care (20%). 195 staff (22.9%) cast 3559 votes. The mean score was 3.5 ± 0.5. 10 Ideas were objectively invited to submit implementation plans. One idea was awarded a grand prize of funding, project management, and leadership buy-in. CONCLUSION: A web-enabled open innovation contest was successful in engaging faculty, residents, and other critical role groups in QI. It also enabled the leadership to re-affirm a positive culture of inclusivity, maintain an open-door policy, and also democratically vet and prioritize solutions for quality improvement.


Subject(s)
Hospitals, General , Quality Improvement , Humans , Leadership , Massachusetts
7.
Am J Surg ; 219(4): 557-562, 2020 04.
Article in English | MEDLINE | ID: mdl-32007235

ABSTRACT

BACKGROUND: The "white-flight" phenomenon of the mid-20th century contributed to the perpetuation of residential segregation in American society. In light of recent reports of racial segregation in our healthcare system, could a contemporary "white-flight" phenomenon also exist? METHODS: The New York Statewide Planning and Research Cooperative System was used to identify all Manhattan and Bronx residents of New York city who underwent elective cardiothoracic, colorectal, general, and vascular surgeries from 2010 to 2016. Primary outcome was borough of surgical care in relation to patient's home borough. Multivariable analyses were performed. RESULTS: White patients who reside in the Bronx are significantly more likely than racial minorities to travel into Manhattan for elective surgical care, and these differences persist across different insurance types, including Medicare. CONCLUSIONS: Marked race-based differences in choice of location for elective surgical care exist in New York city. If left unchecked, these differences can contribute to furthering racial segregation within our healthcare system.


Subject(s)
Choice Behavior , Elective Surgical Procedures/statistics & numerical data , Professional Practice Location/statistics & numerical data , Racial Groups/statistics & numerical data , Female , Healthcare Disparities , Humans , Insurance, Health/statistics & numerical data , Male , Medicaid/statistics & numerical data , Medicare/statistics & numerical data , Middle Aged , New York City/epidemiology , Patient Participation , Race Factors , United States
8.
Surg Obes Relat Dis ; 16(3): 414-419, 2020 Mar.
Article in English | MEDLINE | ID: mdl-31917198

ABSTRACT

BACKGROUND: It is unknown whether previously noted racial disparities in the use of metabolic and bariatric surgery (MBS) for the management of pediatric obesity could be mitigated by accounting for primary insurance. OBJECTIVES: To examine utilization of pediatric MBS across race and insurance in the United States. SETTING: Retrospective cross-sectional study. METHODS: The National Inpatient Sample was used to identify patients 12 to 19 years old undergoing MBS from 2015 to 2016, and these data were combined with national estimates of pediatric obesity obtained from the 2015 to 2016 National Health and Nutrition Examination Survey. Severe obesity was defined as class III obesity, or class II obesity plus hypertension, dyslipidemia, or type 2 diabetes. RESULTS: A total of 1,659,507 (5.0%) adolescents with severe obesity were identified, consisting of 35.0% female, 38.0% white, and 45.0% privately insured adolescents. Over the same time period, 2535 MBS procedures were performed. Most surgical patients were female (77.5%), white (52.8%), and privately insured (57.5%). Black and Hispanic adolescents were less likely to undergo MBS than whites (odds ratio .50, .46, respectively; P < .001 both), despite adjusting for primary insurance. White adolescents covered by Medicaid were significantly more likely to undergo MBS than their privately insured counterparts (odds ratio 1.66; P < .001), while the opposite was true for black and Hispanic adolescents (odds ratio .29, .75, respectively; P < .001 both). CONCLUSIONS: Pediatric obesity disproportionately affects racial minorities, yet MBS is most often performed on white adolescents. Medicaid insurance further decreases the use of MBS among nonwhite adolescents, while paradoxically increasing it for whites, suggesting expansion of government-sponsored insurance alone is unlikely to eliminate this race-based disparity.


Subject(s)
Bariatric Surgery , Diabetes Mellitus, Type 2 , Insurance , Obesity, Morbid , Pediatric Obesity , Adolescent , Adult , Child , Cross-Sectional Studies , Female , Healthcare Disparities , Humans , Male , Nutrition Surveys , Obesity, Morbid/surgery , Pediatric Obesity/epidemiology , Pediatric Obesity/surgery , Retrospective Studies , United States/epidemiology , Young Adult
9.
J Surg Res ; 241: 235-239, 2019 09.
Article in English | MEDLINE | ID: mdl-31035137

ABSTRACT

BACKGROUND: Many articles in the surgical literature were faulted for committing type 2 error, or concluding no difference when the study was "underpowered". However, it is unknown if the current power standard of 0.8 is reasonable in surgical science. METHODS: PubMed was searched for abstracts published in Surgery, JAMA Surgery, and Annals of Surgery and from January 1, 2012 to December 31, 2016, with Medical Subject Heading terms of randomized controlled trial (RCT) or observational study (OBS) and limited to humans were included (n = 403). Articles were excluded if all reported findings were statistically significant (n = 193), or if presented data were insufficient to calculate power (n = 141). RESULTS: A total of 69 manuscripts (59 RCTs and 10 OBSs) were assessed. Overall, the median power was 0.16 (interquartile range [IQR] 0.08-0.32). The median power was 0.16 for RCTs (IQR 0.08-0.32) and 0.14 for OBSs (IQR 0.09-0.22). Only 4 studies (5.8%) reached or exceeded the current 0.8 standard. Two-thirds of our study sample had an a priori power calculation (n = 41). CONCLUSIONS: High-impact surgical science was routinely unable to reach the arbitrary power standard of 0.8. The academic surgical community should reconsider the power threshold as it applies to surgical investigations. We contend that the blueprint for the redesign should include benchmarking the power of articles on a gradient scale, instead of aiming for an unreasonable threshold.


Subject(s)
Randomized Controlled Trials as Topic/standards , Research Design/standards , Specialties, Surgical , Data Interpretation, Statistical , Humans , Randomized Controlled Trials as Topic/statistics & numerical data , Research Design/statistics & numerical data , Sample Size
11.
J Surg Res ; 229: 337-344, 2018 09.
Article in English | MEDLINE | ID: mdl-29937011

ABSTRACT

BACKGROUND: Current global surgery initiatives focus on increasing surgical workforce; however, it is unclear whether this approach would be helpful globally, as patients in low-resource countries may not be able to reach hospitals in a timely fashion without formal Emergency Medical Services (EMS). We hypothesize that increased surgical workforce correlates with decreased road traffic deaths (RTDs) only in countries with EMS. METHODS: Estimated RTDs were obtained from the Global Status Report on Road Safety 2013, which estimated the RTD rate in 2010 (RTD 2010). The classification of EMS was defined by the Global Status Report on Road Safety 2009. The density of surgeons, anesthesiologists, and obstetricians (SAO density) and 2010 income classification were accessed from the World Bank. Multivariable regression analysis was performed adjusting for different countries, income levels, and trauma system characteristics. Sensitivity analysis was performed. RESULTS: One-fourth of the countries reported not having formal EMS (n = 41, 23.4%). On adjusted analysis, SAO density was not associated with changes in RTD 2010 in countries without EMS (n = 25, P = 0.50). However, in countries with EMS, each increase in SAO density per 100,000 population decreased RTDs by 0.079 per 100,000 population (n = 97, P <0.001). Income was the only other factor resulting in reduced mortality rates (P = 0.004). Sensitivity analysis confirmed these findings. CONCLUSIONS: Increases in surgical workforce reduce RTDs only when EMS exist. Surgical workforce and EMS must be seen as part of the same system and developed together to maximize their effect in reducing RTDs. Global health initiatives should be tailored to individual country need. LEVEL OF EVIDENCE: Level II (Ecological study).


Subject(s)
Accidents, Traffic/mortality , Accidents, Traffic/prevention & control , Emergency Medical Services/organization & administration , Global Health/statistics & numerical data , Health Services Accessibility/organization & administration , Health Services Needs and Demand/organization & administration , Emergency Medical Services/statistics & numerical data , Health Services Accessibility/statistics & numerical data , Health Services Needs and Demand/statistics & numerical data , Health Workforce/organization & administration , Health Workforce/statistics & numerical data , Humans , Specialties, Surgical/organization & administration , Specialties, Surgical/statistics & numerical data , Transportation of Patients/organization & administration , Transportation of Patients/statistics & numerical data
12.
J Vasc Surg ; 68(6): 1649-1655, 2018 12.
Article in English | MEDLINE | ID: mdl-29914833

ABSTRACT

BACKGROUND: In uncomplicated type B aortic dissection (UTBAD), the "gold standard" has been nonoperative treatment with medical therapy, although this has been questioned by studies demonstrating improved outcomes in those treated with thoracic endovascular aortic repair (TEVAR). This study assessed long-term survival after acute UTBAD comparing medical therapy, open repair, and TEVAR. METHODS: The California Office of Statewide Hospital Planning Development database was analyzed from 2000 to 2010 for adult patients with acute UTBAD. Patients with nonemergent admission for aortic dissection, type A dissection, trauma, bowel ischemia, lower extremity ischemia, acidosis, or shock were excluded. The cohort was stratified by treatment type at index admission into medical therapy, open surgical repair, and TEVAR. Multivariable regression and survival analyses were used to evaluate the association of treatment type with long-term overall survival. RESULTS: There were 9165 cases, 95% medical therapy, 2% open repair, and 2.9% TEVAR. The mean age was 66 ± 15 years, with 39% female, 2.4% cocaine users, 18% with congestive heart failure, and 17% with Charlson Comorbidity Index >3. Mean inpatient costs were $57,000 for medical therapy, $200,000 for open repair, and $130,000 for TEVAR (P < .01). Inpatient mortality was 6.5% overall, 6.3% for medical therapy, 14% for open repair, and 7.1% for TEVAR (P < .01). One-year and 5-year survivals were 84% and 60% in medical therapy, 76% and 67% in open repair, and 85% and 76% in TEVAR (log-rank, P < .01). On risk-adjusted multivariable analysis, TEVAR had improved survival compared with medical therapy (hazard ratio, 0.68; 95% confidence interval, 0.6-0.8; P < .01), with no difference between open repair and medical therapy (hazard ratio, 1.0; 95% confidence interval, 0.8-1.3; P < .01). CONCLUSIONS: This statewide study on survival after acute UTBADs shows an independent survival advantage for TEVAR over medical therapy. These data add further evidence for a paradigm shift in acute management of type B dissection in favor of early TEVAR.


Subject(s)
Aortic Aneurysm, Thoracic/surgery , Aortic Dissection/surgery , Blood Vessel Prosthesis Implantation , Cardiovascular Agents/therapeutic use , Endovascular Procedures , Aged , Aged, 80 and over , Aortic Dissection/diagnostic imaging , Aortic Dissection/mortality , Aortic Dissection/physiopathology , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/mortality , Aortic Aneurysm, Thoracic/physiopathology , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/mortality , California/epidemiology , Cardiovascular Agents/adverse effects , Databases, Factual , Endovascular Procedures/adverse effects , Endovascular Procedures/mortality , Female , Humans , Male , Middle Aged , Retrospective Studies , Time Factors , Treatment Outcome
14.
World J Surg ; 42(8): 2344-2347, 2018 08.
Article in English | MEDLINE | ID: mdl-29411066

ABSTRACT

INTRODUCTION: Perioperative mortality rate (POMR) is a suggested indicator for surgical quality worldwide. Currently, POMR is often sampled by convenience; a data-driven approach for calculating sample size has not previously been attempted. We proposed a novel application of a bootstrapping sampling technique to estimate how much data are needed to be collected to reasonably estimate POMR in low-resource countries where 100% data capture is not possible. MATERIAL AND METHODS: Six common procedures in low- and middle-income countries were analysed by using population database in New York and California. Relative margin of error by dividing the absolute margin of error by the true population rate was calculated. Target margin of error was ±50%, because this level of precision would allow us to detect a moderate-to-large effect size. RESULTS AND DISCUSSION: Target margin of error was achieved at 0.3% sampling size for abdominal surgery, 7% for fracture, 10% for craniotomy, 16% for pneumonectomy, 26% for hysterectomy and 60% for C-section. POMR may be estimated with fairly good reliability with small data sampling. This method demonstrates that it is possible to use a data-driven approach to determine the necessary sampling size to accurately collect POMR worldwide.


Subject(s)
Health Resources , Surgical Procedures, Operative/mortality , Datasets as Topic , Female , Hospital Mortality , Humans , Perioperative Period , Reproducibility of Results , Sample Size
15.
J Am Coll Surg ; 226(4): 641-649.e1, 2018 04.
Article in English | MEDLINE | ID: mdl-29360616

ABSTRACT

BACKGROUND: Differences in amputation rates for limb ischemia between white and black patients have been extensively studied. Our goal was to determine whether biases in provider decision-making contribute to the disparity. We hypothesized that the magnitude of the disparity is affected by surgeon and hospital factors. STUDY DESIGN: Analysis of the New York Statewide Planning and Research Cooperative System database was performed for 1999 to 2014. Black and white patients with ICD9 codes for peripheral vascular disease, who received either an amputation or salvage procedure, were included. The primary endpoint was treatment choice. RESULTS: We analyzed 215,480 inpatient admissions. The overall amputation rate was 38.0%, and blacks were significantly more likely to receive amputations than whites on unadjusted (42.6% vs 28.6%, p < 0.001), and multivariable analyses (odds ratio [OR] 1.45, 95% CI 1.31 to 1.60, p < 0.001). This difference was more pronounced among high total vascular volume surgeons (OR 1.74, 95% CI 1.50 to 2.00, p < 0.001), but not among those with low total vascular volume (OR 1.06, 95% CI 0.90 to 1.24, p = 0.49); high volume hospitals (OR 1.57, 95% CI 1.39 to 1.78, p < 0.001), but not among those with low amputation volume (OR 0.96, 95% CI 0.73 to 1.27, p < 0.80); and surgeons who treat fewer black patients (OR 1.58, 95% CI 1.44 to 1.73, p < 0.001) vs surgeons who see more black patients (OR 1.43, 95% CI 1.30 to 1.57, p < 0.0.001). CONCLUSIONS: Black patients are significantly more likely to receive an amputation than a salvage procedure when presenting with significant peripheral vascular diseases. High procedural volume does not seem to reduce unequal treatment; diversity of surgeon practice does.


Subject(s)
Amputation, Surgical/statistics & numerical data , Black or African American , Healthcare Disparities/ethnology , Limb Salvage/statistics & numerical data , Peripheral Vascular Diseases/surgery , White People , Adolescent , Adult , Aged , Aged, 80 and over , Bias , Female , Humans , Leg/blood supply , Male , Middle Aged , Peripheral Vascular Diseases/ethnology , Young Adult
17.
Surgery ; 163(1): 150-156, 2018 01.
Article in English | MEDLINE | ID: mdl-29128168

ABSTRACT

BACKGROUND: Previous associations between surgeon volume with adrenalectomy outcomes examined only a sample of procedures. We performed an analysis of all adrenalectomies performed in New York state to assess the effect of surgeon volume and specialty on clinical outcomes. METHODS: Adrenalectomies performed in adults were identified from the New York Statewide Planning and Research Cooperative System from 2000-2014. Surgeon specialty, volume, and patient demographics were assessed. High volume was defined using a significance threshold at ≥4 adrenalectomies per year. Outcome variables included in-hospital mortality, duration of stay, and in-hospital complications. RESULTS: A total of 6,054 adrenalectomies were included. Median patient age was 56 years; 41.9% were men and 68.3% were white. Urologists (n = 462) performed 46.8% of adrenalectomies, general surgeons (n = 599) performed 35.0%, and endocrine surgeons (n = 23) performed 18.1%. Significantly more endocrine surgeons were high-volume compared with urologists and general surgeons (65.2% vs 10.2% and 6.7%, respectively, P < .001). High-volume surgeons had significantly lower mortality compared with low-volume surgeons (0.56% vs 1.25%, P = .004) and a lower rate of complications (10.2% vs 16.4%, P = < .001). Endocrine surgeons were more likely to perform laparoscopic procedures (34.8% vs 22.4% general surgeons and 27.7% US, P < .001) and had the lowest median hospital duration of stay (2 days vs 4 days general surgeons and 3 days urologists, P < .001). After risk adjustment, low surgeon volume was an independent predictor of inpatient complications (odds ratio = 0.96, P = .002). CONCLUSION: Patients with adrenal disease should be referred to surgeons based on adrenalectomy volume regardless of specialty, but most endocrine surgeons that perform adrenalectomy are high-volume for the procedure.


Subject(s)
Adrenalectomy/statistics & numerical data , Adrenalectomy/education , Aged , Female , Humans , Male , Middle Aged , Practice Patterns, Physicians' , Specialties, Surgical
19.
Ann Surg ; 266(4): 603-609, 2017 10.
Article in English | MEDLINE | ID: mdl-28692470

ABSTRACT

OBJECTIVE: To investigate the effect of subspecialty practice and experience on the relationship between annual volume and inpatient mortality after hepatic resection. BACKGROUND: The impact of annual surgical volume on postoperative outcomes has been extensively examined. However, the impact of cumulative surgeon experience and specialty training on this relationship warrants investigation. METHODS: The New York Statewide Planning and Research Cooperative System inpatient database was queried for patients' ≥18 years who underwent wedge hepatectomy or lobectomy from 2000 to 2014. Primary exposures included annual surgeon volume, surgeon experience (early vs late career), and surgical specialization-categorized as general surgery (GS), surgical oncology (SO), and transplant (TS). Primary endpoint was inpatient mortality. Hierarchical logistic regression was performed accounting for correlation at the level of the surgeon and the hospital, and adjusting for patient demographics, comorbidities, presence of cirrhosis, and annual surgical hospital volume. RESULTS: A total of 13,467 cases were analyzed. Overall inpatient mortality was 2.35%. On unadjusted analysis, late career surgeons had a mortality rate of 2.62% versus 1.97% for early career surgeons. GS had a mortality rate of 2.98% compared with 1.68% for SO and 2.67% for TS. Once risk-adjusted, annual volume was associated with reduced mortality only among early-career surgeons (odds ratio 0.82, P = 0.001) and general surgeons (odds ratio 0.65, P = 0.002). No volume effect was seen among late-career or specialty-trained surgeons. CONCLUSIONS: Annual volume alone likely contributes only a partial assessment of the volume-outcome relationship. In patients undergoing hepatic resection, increased annual volume did not confer a mortality benefit on subspecialty surgeons or late career surgeons.


Subject(s)
Clinical Competence , Hepatectomy/mortality , Hepatectomy/statistics & numerical data , Hospital Mortality , Postoperative Complications/mortality , Specialization , Female , Hepatectomy/adverse effects , Humans , Male , Middle Aged , New York/epidemiology , Outcome Assessment, Health Care
20.
Microsurgery ; 31(7): 510-6, 2011 Oct.
Article in English | MEDLINE | ID: mdl-21769924

ABSTRACT

BACKGROUND: Three-dimensional computed tomographic angiography (3D CTA) can be used preoperatively to evaluate the course and caliber of perforating blood vessels for abdominal free-flap breast reconstruction. For postmastectomy breast reconstruction, many women inquire whether the abdominal tissue volume will match that of the breast to be removed. Therefore, our goal was to estimate preoperative volume and weight of the proposed flap and compare them with the actual volume and weight to determine if diagnostic imaging can accurately identify the amount of tissue that could potentially to be harvested. METHODS: Preoperative 3D CTA was performed in 15 patients, who underwent breast reconstruction using the deep inferior epigastric artery perforator flap. Before each angiogram, stereotactic fiducials were placed on the planned flap outline. The radiologist reviewed each preoperative angiogram to estimate the volume, and thus, weight of the flap. These estimated weights were compared with the actual intraoperative weights. RESULTS: The average estimated weight was 99.7% of the actual weight. The interquartile range (25th to 75th percentile), which represents the "middle half" of the patients, was 91-109%, indicating that half of the patients had an estimated weight within 9% of the actual weight; however, there was a large range (70-133%). CONCLUSION: 3D CTA with stereotactic fiducials allows surgeons to adequately estimate abdominal flap volume before surgery, potentially giving guidance in the amount of tissue that can be harvested from a patient's lower abdomen.


Subject(s)
Epigastric Arteries/diagnostic imaging , Free Tissue Flaps/blood supply , Imaging, Three-Dimensional , Mammaplasty , Tomography, X-Ray Computed , Abdominal Wall , Female , Fiducial Markers , Humans , Mastectomy , Middle Aged
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