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  • Ovid Technologies (Wolters Kluwer Health)  (25)
  • Chung, Kevin C.  (25)
  • 2015-2019  (25)
  • 2018  (25)
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  • Ovid Technologies (Wolters Kluwer Health)  (25)
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  • 2015-2019  (25)
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  • 2018  (25)
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  • 1
    Online Resource
    Online Resource
    Postoperative Ketorolac in Breast and Body Contouring Procedures: A Nationwide Claims Analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Plastic & Reconstructive Surgery Vol. 142, No. 4 ( 2018-10), p. 472e-480e
    Details
    In: Plastic & Reconstructive Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 142, No. 4 ( 2018-10), p. 472e-480e
    Abstract: Nonsteroidal antiinflammatory drugs are useful alternatives to narcotics for analgesia. However, concerns remain regarding their safety. The authors evaluated ketorolac use and complications. We hypothesized that no association between ketorolac and morbidity exists in patients undergoing body contouring. Methods: Truven MarketScan claims database was analyzed for patients undergoing breast and body contouring surgery. Patients selected received ketorolac and were enrolled a minimum of 90 days. The authors performed a multivariable logistic regression to calculate risk of morbidity, adjusting for clinical and sociodemographic factors. Results: Among the 106,279 patients enrolled, 4924 (4.6 percent) received postoperative ketorolac. In multivariable regression analysis, ketorolac was not associated with hematoma (OR, 1.20; 95 percent CI, 0.99 to 1.46; p 〉 0.05). There was an increased rate of reoperation within 72 hours (OR, 1.22; 95 percent CI, 1.00 to 1.49; p 〈 0.05; number needed to harm, 262 patients). Ketorolac was associated with fewer readmissions (OR, 0.76; 95 percent CI, 0.62 to 0.93; p 〈 0.05; number needed to treat, 87 patients), with a reduction in the rate of pain as a readmission diagnosis (0.6 percent versus 4.3 percent; p = 0.021). Ketorolac was associated with seroma, but this association may not be causal (OR, 1.28; 95 percent CI, 1.05 to 1.57; p 〈 0.05; number needed to harm, 247 patients). Ketorolac provided an estimated savings of $157 per patient. Conclusions: The benefits of ketorolac likely outweigh the risks after surgery. Absolute differences in reoperation rates were low, and improved rates of hospital admission impact cost savings. The authors advocate postoperative ketorolac once the wound is hemostatic. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
    Type of Medium: Online Resource
    ISSN: 0032-1052
    URL: Article
    DOI: 10.1097/PRS.0000000000004806
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2037030-1
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  • 2
    Online Resource
    Online Resource
    Abstract 47: Utilization of Mammography Prior to Elective Breast Surgery: A National Claims-Based Analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Plastic and Reconstructive Surgery - Global Open Vol. 6, No. 4S ( 2018-04), p. 37-38
    Details
    In: Plastic and Reconstructive Surgery - Global Open, Ovid Technologies (Wolters Kluwer Health), Vol. 6, No. 4S ( 2018-04), p. 37-38
    Type of Medium: Online Resource
    ISSN: 2169-7574
    URL: Article
    DOI: 10.1097/01.GOX.0000533912.96936.2e
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2723993-7
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  • 3
    Online Resource
    Online Resource
    Abstract: A Critical Assessment of Surveys in Plastic and Reconstructive Surgery: A Systematic Review
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Plastic and Reconstructive Surgery - Global Open Vol. 6, No. 9S ( 2018-09), p. 145-146
    Details
    In: Plastic and Reconstructive Surgery - Global Open, Ovid Technologies (Wolters Kluwer Health), Vol. 6, No. 9S ( 2018-09), p. 145-146
    Type of Medium: Online Resource
    ISSN: 2169-7574
    URL: Article
    DOI: 10.1097/01.GOX.0000547015.87859.74
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2723993-7
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  • 4
    Online Resource
    Online Resource
    Antibiotic Prophylaxis after Immediate Breast Reconstruction: The Reality of Its Efficacy
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Plastic & Reconstructive Surgery Vol. 141, No. 4 ( 2018-04), p. 865-877
    Details
    In: Plastic & Reconstructive Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 141, No. 4 ( 2018-04), p. 865-877
    Abstract: Numerous techniques are used to prevent infection after immediate implant-based breast reconstruction. Postoperative antibiotic prophylaxis is commonly prescribed to decrease the risk of reconstructive failure, despite conflicting evidence regarding its effectiveness. The authors studied whether postoperative antibiotic prophylaxis decreases the risk of infection-related explantation in the setting of immediate prosthesis-based breast reconstruction. Methods: Using Truven MarketScan databases, the authors identified all patients who underwent immediate implant reconstruction between January of 2010 and June of 2014 with at least 6 months of follow-up. Postoperative antibiotic prophylaxis was defined as any oral antibiotic course to be taken postoperatively based on prescriptions filled within 14 days preoperatively through 24 hours after discharge. Reconstructive failure, defined as explantation because of infection, was the primary outcome. Secondary outcomes of interest included wound complications, infection, and readmission for infection. Multivariable regression analyses controlled for demographic variables/comorbidities. Results: Of the 7443 patients, 6049 (81 percent) filled prescriptions for postoperative antibiotic prophylaxis. These patients were equally likely to develop a wound complication (OR, 0.93; 95 percent CI, 0.71 to 1.23) or infection (OR, 0.89; 95 percent CI, 0.70 to 1.14), undergo explantation because of infection (OR, 0.82; 95 percent CI, 0.57 to 1.18), or require readmission for infection (OR, 1.21; 95 percent CI, 0.82 to 1.78) compared with those who did not receive antibiotics. There was no significant difference in the risk of infection-related outcomes based on postoperative antibiotic prophylaxis duration. Conclusions: Postoperative antibiotic prophylaxis was not associated with a reduced risk of infection or explantation following prosthesis-based breast reconstruction. Given rising rates of antibiotic resistance, focusing instead on technical considerations and the management of comorbid conditions may more effectively enhance the safety of breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
    Type of Medium: Online Resource
    ISSN: 0032-1052
    URL: Article
    DOI: 10.1097/PRS.0000000000004204
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2037030-1
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    Online Resource
  • 5
    Online Resource
    Online Resource
    The Effect of Impactful Articles on Clinical Practice in the United States: Corticosteroid Injection for Patients with Lateral Epicondylitis
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Plastic & Reconstructive Surgery Vol. 141, No. 5 ( 2018-05), p. 1183-1191
    Details
    In: Plastic & Reconstructive Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 141, No. 5 ( 2018-05), p. 1183-1191
    Abstract: Following publication of high-level evidence demonstrating that it is not an effective treatment for lateral epicondylitis, a reduction in the corticosteroid injection rate would be expected. The authors aimed to clarify current clinical practice pattern for lateral epicondylitis and identify factors that influence the introduction of evidence into clinical practice. Methods: In this administrative claims analysis, the authors used 2009 to 2015 Truven MarketScan data to extract claims for corticosteroid injection, physical therapy, platelet-rich plasma injection, and surgery for lateral epicondylitis. The authors performed multivariable analysis using a generalized estimating equation model to identify the variables that potentially affect the odds of receiving a given treatment. Results: Among 711,726 claims, the authors found that the odds of receiving a corticosteroid injection increased slightly after publication of contradictory evidence (OR, 1.7; 95 percent CI, 1.04 to 1.11 in 2015). Being male (OR, 1.21; 95 percent CI, 1.19 to 1.23), older (OR, 1.16; 95 percent CI, 1.13 to 1.19), and having managed care insurance (OR, 1.15; 95 percent CI, 1.13 to 1.18) significantly contributed to increased odds of receiving corticosteroid injections. Patients seen at facilities in the South (OR, 1.33; 95 percent CI, 1.30 to 1.36 compared with the Northeast) and by plastic/orthopedic surgeons (OR, 2.48; 95 percent CI, 2.43 to 2.52) also had increased odds of receiving corticosteroid injection. Conclusions: Corticosteroid injection use did not decrease after publication of impactful articles, regardless of provider specialty or other patient-related factors. This finding emphasizes that there are various barriers for even high-level evidence to overcome the inertia of current practice.
    Type of Medium: Online Resource
    ISSN: 0032-1052
    URL: Article
    DOI: 10.1097/PRS.0000000000004317
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2037030-1
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  • 6
    Online Resource
    Online Resource
    Unplanned Emergency Department Visits within 30 Days of Mastectomy and Breast Reconstruction
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Plastic & Reconstructive Surgery Vol. 142, No. 6 ( 2018-12), p. 1411-1420
    Details
    In: Plastic & Reconstructive Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 142, No. 6 ( 2018-12), p. 1411-1420
    Abstract: Unplanned emergency department visits are often overlooked as an indicator of care quality. The authors’ objectives were to (1) determine the rate of 30-day emergency department visits following mastectomy with or without immediate reconstruction, (2) perform a risk analysis of potential factors associated with emergency department return, and (3) assess for potentially preventable visits with a focus on returns for pain. Methods: Using the Healthcare Cost and Utilization Project data, the authors identified adult women who underwent mastectomy with or without reconstruction. Multivariable logistic regression was performed to evaluate risk of unplanned emergency department visits. The authors identified and sorted diagnostic codes to investigate why patients were seeking emergency department care. In addition, the authors performed a subgroup analysis on patients returning with a pain-related diagnosis to evaluate risk. Results: Of 159,275 cases of mastectomy with or without immediate reconstruction, 4917 (3.1 percent) experienced an unplanned return to the emergency department within 30 days of operation. A substantial proportion of those who returned (23 percent) presented with a pain-related diagnosis. Only 0.9 percent of cases with a 30-day emergency department return were readmitted. Conclusions: Numerous patients return to the emergency department within 30 days of mastectomy with or without immediate reconstruction. There is a need for policy makers and physicians to implement strategies to reduce discretionary emergency department use, specifically among younger or publicly insured patients. Combining unplanned emergency department visits with readmission rates as a care quality indicator warrants consideration. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
    Type of Medium: Online Resource
    ISSN: 0032-1052
    URL: Article
    DOI: 10.1097/PRS.0000000000004970
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2037030-1
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  • 7
    Online Resource
    Online Resource
    Effect of Posthospital Syndrome on Health Care Utilization After Abdominal Contouring Surgery
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Annals of Plastic Surgery Vol. 81, No. 6 ( 2018-12), p. e4-e11
    Details
    In: Annals of Plastic Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 81, No. 6 ( 2018-12), p. e4-e11
    Abstract: Posthospital syndrome (PHS) is a transient condition after acute hospitalizations when patients are physiologically deconditioned. The objective of this study was to determine if having PHS at the time of abdominal contouring surgery increased the incidence of postoperative adverse medical events. Methods We conducted a retrospective cohort study of patients enrolled in the MarketScan Databases who underwent outpatient functional or cosmetic abdominal contouring surgery (ie, abdominoplasty, liposuction, or panniculectomy) from April 2010 to August 2015. Patients were separated into 2 groups based upon PHS exposure, defined by hospitalization within 90 days before surgery. Differential health care utilization within 30 days after surgery was compared between cohorts. Results Among the 18,947 patients included in the final cohort, 1045 patients (6%) had PHS at the time of abdominal contouring surgery. Patients with PHS experienced more emergency department visits (0.16 vs 0.08 visits; adjusted odds ratio, 1.60; P 〈 0.001) and more episodes of hospitalization (0.11 vs 0.04 episodes; adjusted odds ratio, 1.70; P 〈 0.001) within 30 days postoperatively. The mean unadjusted health care utilization after abdominal contouring surgery for patients with PHS was US $7888 (SD, 17,659) versus US $2943 (SD, 9096) in patients without PHS. After controlling for confounders, such as comorbidity burden, PHS was associated with US $3944 greater cost than patients without PHS ( P 〈 0.001). Conclusions Among patients undergoing outpatient abdominal contouring surgery, having PHS increased the incidence of adverse medical events requiring medical attention in the 30-day postoperative period. These findings support the inclusion of PHS in preoperative evaluation and preparation for patients seeking abdominal contouring surgery.
    Type of Medium: Online Resource
    ISSN: 1536-3708 , 0148-7043
    URL: Article
    DOI: 10.1097/SAP.0000000000001613
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2063013-X
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  • 8
    Online Resource
    Online Resource
    Abstract: Pathologic Evaluation of Reduction Mammaplasty Specimens and Subsequent Diagnosis of Malignant Breast Disease: A Nationwide Analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Plastic and Reconstructive Surgery - Global Open Vol. 6, No. 9S ( 2018-09), p. 115-115
    Details
    In: Plastic and Reconstructive Surgery - Global Open, Ovid Technologies (Wolters Kluwer Health), Vol. 6, No. 9S ( 2018-09), p. 115-115
    Type of Medium: Online Resource
    ISSN: 2169-7574
    URL: Article
    DOI: 10.1097/01.GOX.0000546974.50033.a2
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2723993-7
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  • 9
    Online Resource
    Online Resource
    Validity of the Novel Taiwan Lymphoscintigraphy Staging and Correlation of Cheng Lymphedema Grading for Unilateral Extremity Lymphedema
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Annals of Surgery Vol. 268, No. 3 ( 2018-09), p. 513-525
    Details
    In: Annals of Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 268, No. 3 ( 2018-09), p. 513-525
    Abstract: The aim was to validate the new Taiwan Lymphoscintigraphy Staging, correlate it with Cheng Lymphedema Grading (CLG) and evaluate the treatment outcomes of unilateral extremity lymphedema. Background: No consensus has been reached for diagnosis and staging for patients with lymphedema among medical specialties. Methods: We included 285 patients with unilateral extremity lymphedema using lymphoscintigraphy. Lymphoscintigraphy was correlated to clinical symptoms and signs, and classified into normal lymphatic drainage, partial obstruction, and total obstruction. Inter- and intraobserver reliability of Taiwan Lymphoscintigraphy Staging, correlation between Taiwan Lymphoscintigraphy Staging and clinical findings were conducted. Patients were categorized in “surgical” (n = 154) or “nonsurgical” (n = 131) groups for outcome evaluation. Results: Lymphoscintigraphy found 11 patients (3.9%) with normal lymphatic drainage, 128 (44.9%) with partial obstruction, and 146 (51.2%) with total obstruction. Taiwan Lymphoscintigraphy Staging showed high interobserver agreement [intraclass correlation coefficient: 0.89 (95% confidence interval, 0.82–0.94)], and significantly correlated to computed tomography volumetric difference ( r = 0.66, P 〈 0.001) and CLG [intraclass correlation coefficient: 0.79 (95% confidence interval 0.72–0.84)]. At a mean follow-up of 31.2 ± 2.9 months, significant improvement in the circumferential difference (from 23.9% ± 17.6% to 14.6% ± 11.1%; P = 0.03) with a mean circumferential reduction rate of 40.4% ± 4.5% was found in surgical group. At a mean follow-up of 26.6 ± 8.7 months, the nonsurgical group had increase of mean circumferential difference from 24.0% ± 17.2% to 25.3% ± 19.0% ( P = 0.09), with a mean circumferential reduction rate was −1.9% ± 13.0%. Conclusions: The Taiwan Lymphoscintigraphy Staging is a reliable diagnostic tool, correlated with clinical findings and CLG, aiding in the selection of the appropriate treatment to achieve favorable long-term outcomes in unilateral extremity lymphedema.
    Type of Medium: Online Resource
    ISSN: 0003-4932 , 1528-1140
    URL: Article
    DOI: 10.1097/SLA.0000000000002917
    RVK:
    XA 23900
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2641023-0
    detail.hit.zdb_id: 2002200-1
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  • 10
    Online Resource
    Online Resource
    Older Patient Preferences for Internal Fixation after a Distal Radius Fracture: A Qualitative Study from the Wrist and Radius Injury Surgical Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Plastic & Reconstructive Surgery Vol. 142, No. 1 ( 2018-07), p. 34e-41e
    Details
    In: Plastic & Reconstructive Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 142, No. 1 ( 2018-07), p. 34e-41e
    Abstract: Distal radius fracture treatments provide similar functional outcomes. It has been hypothesized that the use of internal fixation is increasing because of physician preferences. The multisite randomized Wrist and Radius Injury Surgical Trial provides a unique opportunity to examine patient preferences in the absence of surgeon influence. The authors’ objective was to investigate patient preference for internal fixation even after being informed of the equipoise among treatments. Methods: The authors performed 30 semistructured interviews with older individuals, all older than 60 years, approached at their institution for the Wrist and Radius Injury Surgical Trial. The authors’ sample included three groups: those with a preference for internal fixation ( n = 11), those with preference for nonsurgical treatment ( n = 6), and those without a preference who consented to surgical randomization ( n = 13). We used grounded theory for data collection and analysis. Results: All participants indicated their chief concern was regaining full function. Patients based their preferences for internal fixation on multiple values, including obstacles to recovery, autonomy, aesthetics, and pain relief. Some patients who did not select internal fixation reflected on their experiences, questioning whether they would have had a potentially different outcome with internal fixation treatment. Conclusions: Without evidence for a superior treatment, patients focus on factors that pertain to recovery rather than outcomes, with most preferring the volar locking plating system. To best align with patient values, physicians should focus their discussion with patients on aspects of the recovery period rather than functional outcomes. Evidence from the Wrist and Radius Injury Surgical Trial will provide high-level information about patient-reported, functional, and radiographic outcomes.
    Type of Medium: Online Resource
    ISSN: 0032-1052
    URL: Article
    DOI: 10.1097/PRS.0000000000004454
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2037030-1
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