Andrew R. Bauder

A Risk Model and Cost Analysis of Incisional Hernia After Elective, Abdominal Surgery Based Upon 12,373 Cases: The Case for Targeted Prophylactic Intervention

Objectives:Incisional hernia (IH) remains a common, highly morbid, and costly complication. Modest progress has been realized in surgical technique and mesh technology; however, few advances have been achieved toward understanding risk and prevention. In light of the increasing emphasis on prevention in todays health care environment and the billions in costs for surgically treated IH, greater focus on predictive risk models is needed. Methods:All patients undergoing gastrointestinal or gynecologic procedures from January 1, 2005 to June 1, 2013, within the University of Pennsylvania Health System were identified. Comorbidities and operative characteristics were assessed. The primary outcome was surgically treated IH after index procedures. Patients with prior hernia, less than 1-year follow-up, or emergency surgical procedures were excluded. Cox hazard regression modeling with bootstrapped validation, risk factor stratification, and assessment of model performance were conducted. Results:A total of 12,373 patients with a 3.5% incidence of surgically treated IH (follow-up 32.2 ± 26.6 months) were identified. The cost of surgical treatment of IH and management of associated complications exceeded

An Algorithm for Managing Syndromic Craniosynostosis Using Posterior Vault Distraction Osteogenesis

17.5 million. Notable independent risk factors for IH were ostomy reversal (HR = 2.76), recent chemotherapy (HR = 2.04), bariatric surgery (HR = 1.78), smoking history (HR = 1.74), liver disease (HR = 1.60), and obesity (HR = 1.96). High-risk patients (20.6%) developed IH compared with 0.5% of low-risk patients (C-statistic = 0.78). Conclusions:This study demonstrates an internally validated preoperative risk model of surgically treated IH after 12,000 elective, intra-abdominal procedures to provide more individualized risk counseling and to better inform evidence-based algorithms for the role of prophylactic mesh.

An Evidence-Based Algorithm for Managing Syndromic Craniosynostosis in the Era of Posterior Vault Distraction Osteogenesis.

Background: The authors hypothesize that early posterior vault distraction osteogenesis safely confers considerable cranial vault remodeling, sufficient to enable fronto-orbital advancement to be delayed to a later age, with improved outcomes. Methods: The authors conducted a retrospective cohort study of children with syndromic craniosynostosis treated before (2003 to 2008) or after (2009 to 2014) implementation of posterior vault distraction osteogenesis. Results: Sixty children with syndromic craniosynostosis presented during the study period. Forty met inclusion criteria with care continuity and complete records: 22 before and 18 after implementation of posterior vault distraction osteogenesis. Only 11 patients (61 percent) who underwent initial posterior vault distraction osteogenesis required frontal advancement, at a mean follow-up of 4.0 years of age, compared with 22 patients (100 percent) before implementation of posterior vault distraction osteogenesis. Kaplan-Meier survival analysis indicated significant delay of first fronto-orbital advancement in the posterior vault distraction osteogenesis cohort compared with the pre–posterior vault distraction osteogenesis cohort (p = 0.011). Comparing treatment in the first 5 years of life among posterior vault distraction osteogenesis versus non–posterior vault distraction osteogenesis subcohorts of patients older than 5 years, there were significantly fewer fronto-orbital advancements performed (0.6 versus 1.5 per patient; p = 0.023). Conclusion: Using early posterior vault distraction osteogenesis for patients with syndromic craniosynostosis significantly reduces the average number of fronto-orbital advancement procedures in the first 5 years of life, delays initial fronto-orbital advancement, and is likely to reduce the total number of major craniofacial procedures. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Long-Term Growth of Costochondral Rib Grafts in Mandibular Reconstruction for Craniofacial Microsomia.

RESULTS: Age at initial evaluation ranged from 3-12 months. Complete correction was achieved in 75% of patients with conservative treatment (n=3186). 25% transitioned to helmet therapy (n=1062). Average helmet treatment duration was 5 months with 95% having complete correction of deformity with a single helmet. 5% of patients required a second helmet for additional correction (n=49) with 0.01% requiring a third helmet to achieve complete correction (n=8). Risk factors for failure of conservative therapy included advanced age, torticollis, and severity of cephalic ratio and diagonal difference.

Posterior Vault Distraction Osteogenesis Conveys Anterior Benefit in Apert Syndrome.

INTRODUCTION: Costochondral rib grafting is the most common surgical technique for reconstructing the Pruzansky-Kaban 2b/3a mandibular deformity in craniofacial microsomia (CFM). However, graft growth is thought to be unpredictable, with possible overor undergrowth with time. Secondary procedures, including mandibular distraction osteogenesis (DO), may be utilized to augment graft growth. We seek to understand the intrinsic growth properties of costochondral grafts in CFM and the role of mandibular distraction to refine symmetry of the grafted mandible.

An Analysis of Posterior Vault Distraction and Its Effects on the Posterior Fossa and Cranial Base.

BACKGROUND: The volumetric advantages of posterior vault distraction osteogenesis (PVDO) are well established. Our clinical experience further suggests that PVDO may confer morphologic changes to the anterior cranium that may delay or defer the need for fronto-orbital advancement (FOA). We sought to evaluate the effects of PVDO on anterior cranial morphology and timing of FOA in patients with Apert syndrome.

Muscle versus Fasciocutaneous Free Flaps in Lower Extremity Traumatic Reconstruction: A Multicenter Outcomes Analysis

52 Chiari deformations. The mean surgical age was 12-months, hospital stay < 2.4 days, and no major morbidities or mortalities were noted. The average follow up was 5.7 years: two patients developed syringomyelia, requiring decompressions; two had planned secondary remodeling procedures (complex synostoses) and one isolated synostosis underwent secondary remodeling during a subsequent Chiari decompression.