Plastic Surgeon Closure of Index Spinal Cases: A Single-Institution Review of 928 Cases.

PURPOSE: The role of the plastic surgeon in wound management following complications from prior spinal surgeries is well established. The present study evaluates wound complications following plastic surgeon closure of the primary spinal surgery in a large patient population. METHODS: Spinal surgeries closed by a single plastic surgeon at a large academic hospital were reviewed. Descriptive statistics were applied and outcomes in this sample were compared with previously published outcomes using 2-sample z tests. RESULTS: Nine hundred twenty-eight surgeries were reviewed, of which 782 were included. Seven hundred fifteen operations were for degenerative conditions of the spine, 22 for trauma, 30 for neoplasms, and 14 for congenital conditions. Four hundred twenty-one were lumbosacral procedures (53.8%) and 361 (46.2%) cervical. Fourteen patients (1.8%) required readmission with 30 days. This compares favorably to a pooled analysis of 488049 patients, in which the 30-day readmission rate was found to be 5.5% (z=4.5, P<0.0001). Seven patients (0.89%) had wound infection and 3 (0.38%) wound dehiscence postoperatively, compared with a study of 22,430 patients in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database who had an infection incidence of 2.2% (z=2.5, P=0.0132) and 0.3% dehiscence rate (z=0.4, P=0.6889). The combined incidence of wound complications in the present sample, 1.27%, was less than the combined incidence of wound complications in the population of 22,430 patients (z=2.2, P=0.029). CONCLUSIONS: Thirty-day readmissions and wound complications are intensely scrutinized quality metrics that may lead to reduced reimbursements and other penalties for hospitals. Plastic surgeon closure of index spinal cases decreases these adverse outcomes. Further research must be done to determine whether the increased cost of plastic surgeon involvement in these cases is offset by the savings represented by fewer readmissions and complications.

Preoperative breast size affects reconstruction status following mastectomy.

Much research has been devoted to why women choose not to be reconstructed following mastectomy. The effect of breast size has not been well explored. The authors aimed to assess the relationship between breast size and reconstructive choices. A single-center retrospective review of women undergoing mastectomy between 2011 and 2014 was performed. Demographics, surgical variables, and reconstruction decisions were analyzed using t tests, Mann-Whitney U tests, and chi-squared tests. Significant (P < .05) variables were included in a multivariable logistic regression model. About 610 patients were analyzed. The median mastectomy specimen weight was 572 g (62-5230 g), which did not correlate with BMI (P = .44). Women who underwent reconstruction had lighter mastectomy specimens, averaging 643 vs 848 g (P < .0001). A regression controlling for ethnicity, insurance status, number of comorbidities, age at mastectomy, cancer stage, BMI, specimen weight, and mastectomy laterality was constructed. Lower specimen weight (P = .005), lower cancer stage (P = .008), bilateral mastectomy (P = .042), and younger age at mastectomy (P < .0001) were significantly associated with reconstruction. Women with larger breasts were less likely to be reconstructed regardless of their BMI and comorbidities. Larger breasted women may be considered worse prosthetic reconstruction candidates due to increased complications and suboptimal aesthetic outcomes but may find the increased invasiveness and recovery of autologous reconstruction an unattractive alternative. Furthermore, it is possible that surgeons may be less supportive of breast reconstruction for larger breasted women if there are concerns about safety or the aesthetic quality of the result. In the future, qualitative research must be done to determine why more larger breasted women choose not to be reconstructed as well as develop better ways to increase their reconstructive options.