Ian C. Hoppe

Application of the h-Index in Academic Plastic Surgery.

Background The h-index is a measure designed to assess the quantity and significance of an individual’s academic contributions. The objective of this study was to determine whether the h-index of plastic surgeons correlates with academic rank and whether there is a difference based on academic rank, residency training model, sex, geographic region, faculty size, and departmental status. Methods A database of all US academic plastic surgeons was created. The rank and sex of each surgeon were obtained, as were characteristics of their plastic surgery program. The Scopus database was queried to determine each surgeon’s h-index. Results The 592 plastic surgeons in our database had a mean h-index of 8.97. The h-index increased with academic rank: 4.59 for assistant professors, 9.10 for associate professors, and 15.30 for professors. There was no significant difference in the h-index between chairpersons and chiefs. Plastic surgeons on faculty in integrated plastic surgery programs had significantly higher h-indices (9.64) than those at traditional programs (6.28). Those who were on faculty at larger programs also had higher h-indices. Male plastic surgeons had higher h-indices (9.57) than did female plastic surgeons (6.07), although this was insignificant when taking other variables into account. There was no correlation between the h-index and location or departmental status. Conclusions The h-index of plastic surgeons seems to correlate with academic rank and has potential as a tool to measure academic productivity within plastic surgery. Plastic surgeons on faculty in integrated plastic surgery programs, those at larger programs, and male plastic surgeons tend to have higher h-indices. The difference between sexes seems to be, at least in part, due to the higher number of men in high academic positions. There does not seem to be a regional difference with regard to h-indices or a difference with regard to departmental status.

Analysis of comprehensibility of patient information regarding complex craniofacial conditions.

Purpose:Health care consumers are increasingly turning to the Internet for information regarding medical and surgical procedures. When an elective procedure is under consideration, the Internet is often the first resource used by a patient. Caregivers of craniofacial patients are typically overwhelmed during the surgical planning process. A firm understanding of craniofacial condition and the associated procedures is crucial to obtain satisfactory outcomes.Furthermore, health care providers are increasingly referring their patients to on-line sources of patient education material. Currently, the National Institutes of Health suggests the information be at the fourth- to sixth-grade reading level to maximize comprehension. Much of the information available regarding health care targeted at patients is written at a 10th-grade reading level or higher. The purpose of this study was to evaluate readily available on-line patient education information for readability; being aware of this information will aid craniofacial surgeons in appropriately educating their patients. Methods:Texts were extracted from commonly used craniofacial educational Web sites regarding reconstructive procedures. Three objective and accepted methods (SMOG, Flesch-Kincaid, and Dale-Chall) were used to assess readability of each condition and its corresponding procedures text. Results:The results from all 3 of the methods used were higher than the recommended seventh-grade reading level. The mean reading level for eMedicine was 13.8, 15.2, and 15 for the Flesch-Kincaid, SMOG, and Dale-Chall methods, respectively. Likewise, the mean reading levels for FACES were 7.5, 10.7, and 8.3; and for World Craniofacial Foundation, the levels were 11.9, 13.8, and 13. Conclusions:Patient education and understanding is a critical factor in planning for surgery; this is especially true of reconstructive craniofacial procedures. Craniofacial surgery is a diverse field, and its surgeons have correspondingly diverse practices. It is up to each individual surgeon to determine what is appropriate for his or her patients. Our results show that on-line educational material is at a level that is substantially higher than the national reading average. The ultimate impact of this fact will vary from practice to practice, but all surgeons should be aware of the possible conflicts between information distributed and the patients ability to comprehend that information. This may assist surgeons in preoperative evaluations by discussing conditions with more level appropriate means.

Virginal mammary hypertrophy: a meta-analysis and treatment algorithm.

Background: Virginal mammary hypertrophy, a rapid enlargement of one or both breasts that usually presents in the adolescent years, is a rare condition that has been reported sporadically in the medical literature. Currently, there are no patient- or disease-oriented evidence-based guidelines for the treatment of this condition. This meta-analysis examines the published case reports and presents a cumulative algorithm for the diagnosis and treatment of this uncommon condition. Methods: A literature search was performed using PubMed, with multiple keywords. Information regarding patient age, menarchal state, mass of excision, surgical technique, number of operations, pharmacologic intervention, and recurrence was extracted from each case report and analyzed using SPSS 15.1 statistical software. Results: A significant relationship was found (p < 0.01), as was an odds ratio of 7.0, for the likelihood of recurrence using a reduction mammaplasty as opposed to a mastectomy. Conclusions: Based on the evidence presented in this article, certain interventions are more effective for the treatment of virginal mammary hypertrophy. On diagnosis of virginal mammary hypertrophy, tamoxifen therapy may be considered based on previous literature, barring any medical contraindications. A subcutaneous mastectomy with complete removal of breast tissue is the procedure least likely to lead to recurrence but is more deforming. Reduction mammaplasty gives an improved aesthetic breast, but it is important to counsel the patient on the likelihood of increased recurrence. Tamoxifen therapy following surgery may decrease the recurrence rate.

A Survey of Patient Comprehension of Readily Accessible Online Educational Material Regarding Plastic Surgery Procedures

PURPOSE When an elective procedure is under consideration, the Internet may often be the first resource utilized by a patient. OBJECTIVES The goal of the present study was to examine the comprehension of readily available online educational material by the patient population in a single plastic surgery clinic. METHODS Two 5-question surveys were constructed: 1 for breast augmentation and 1 for rhinoplasty, each based on explanatory passages from patient education sections of the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS) websites. Demographic data were also collected. One hundred patients who presented to the University Hospital in Newark, New Jersey, completed the survey. RESULTS Mean patient age was 38.8 years. Mean number of completed educational years was 11.7. Across all groups, the mean score recorded was 3.41 out of a possible 5, with 1 point being assigned for each correct answer. The mean score was 3.54 for the ASPS website and 3.28 for the ASAPS website. The mean score was 3.26 for the breast augmentation survey and 3.56 for rhinoplasty. Neither difference was significant. CONCLUSIONS No significant difference in scores was noted between websites or procedures. Patients understood the majority of the information presented in the passage provided to them. It is unrealistic to expect a patient to answer all questions correctly, although 23% of participants did. Patients appear to understand the material and are able to subsequently apply this knowledge to an objective measure of comprehension.

Readability of Patient Information Regarding Breast Cancer Prevention from the Web site of the National Cancer Institute

The increasing use of the Internet for gathering information regarding preventative health measures creates a unique dilemma. Access to the Internet is almost universal in the USA. Web sites presenting health information regarding breast cancer must create information that is understandable to the general public, meaning a reading level of around seventh grade. Text was obtained from the National Cancer Institutes Web site, and an examination of the texts grade level was performed. The text was written at between a 10th and 12th grade level. This indicates that information regarding breast cancer prevention obtained from the National Cancer Institutes web site is written at far too high of a level.

Examination of life-threatening injuries in 431 pediatric facial fractures at a level 1 trauma center

Purpose Pediatric facial fractures represent a challenge in management due to the unique nature of the growing facial skeleton. Oftentimes, more conservative measures are favored to avoid rigid internal fixation and disruption of blood supply to the bone and soft tissues. In addition, the great force required to fracture bones of the facial skeleton often produces concomitant injuries that present a management priority. The purpose of this study was to examine a level 1 trauma center’s experience with pediatric facial trauma resulting in fractures of the underlying skeleton with regards to epidemiology and concomitant injuries. Methods A retrospective review of all facial fractures at a level 1 trauma center in an urban environment was performed for the years 2000 to 2012. Patients aged 18 years or younger were included. Patient demographics were collected, as well as location of fractures, concomitant injuries, and surgical management strategies. A significance value of 5% was used. Results During this period, there were 3147 facial fractures treated at our institution, 353 of which were pediatric patients. Upon further review, 68 patients were excluded because of insufficient data for analysis, leaving 285 patients for review. The mean age of patients was 14.2 years with a male predominance (77.9%). The mechanism of injury was assault in 108 (37.9%), motor vehicle accident in 68 (23.9%), pedestrian struck in 41 (14.4%), fall in 26 (9.1%), sporting accident in 20 (7.0%), and gunshot injury in 16 (5.6%). The mean Glasgow Coma Scale (GCS) on arrival to the emergency department was 13.7. The most common fractures were those of the mandible (29.0%), orbit (26.5%), nasal bone (14.4%), zygoma (7.7%), and frontal bone/frontal sinus (7.5%). Intracranial hemorrhage was present in 70 patients (24.6%). A skull fracture was present in 50 patients (17.5%). A long bone fracture was present in 36 patients (12.6%). A pelvic or thoracic fracture was present in 30 patients (10.5%). A cervical spine fracture was present in 10 patients (3.5%), and a lumbar spine fracture was present in 11 patients (3.9%). Fractures of the zygoma, orbit, nasal bone, and frontal sinus/bone were significantly associated with intracranial hemorrhage (P < 0.05). Fractures of the zygoma and orbit were significantly associated with cervical spine injury (P < 0.05). The mean GCS for patients with and without intracranial hemorrhages was 11.0 and 14.6, respectively (P < 0.05). The mean GCS for patients with and without cervical spine fractures was 11.2 and 13.8, respectively (P < 0.05). Conclusions Pediatric facial fractures in our center are often caused by interpersonal violence and are frequently accompanied by other more life-threatening injuries. The distribution of fractures parallels previous literature. Midface fractures and a depressed GCS showed a strong correlation with intracranial hemorrhage and cervical spine fracture. A misdiagnosed cervical spine injury or intracranial hemorrhage has disastrous consequences. On the basis of this study, it is the authors’ recommendation that any patient sustaining a midface fracture with an abnormal GCS be evaluated for the aforementioned diagnoses.

An analysis of leading, lagging, and coincident economic indicators in the United States and its relationship to the volume of plastic surgery procedures performed.

AbstractIn plastic surgery, 2 predominant practice environments exist, namely, the academic setting and private practice. These 2 groups cater their practice toward the needs and demands of 2 very different patient populations. The goal of this paper is to examine well-established economic indicators and delineate their relationship, if any, with the volume of different plastic surgical procedures performed in the United States. Information from the American Society of Plastic Surgeons’ annual reports on plastic surgery statistics was collected from the year 2000 through 2010 and compared to readily available and established economic indicators. There was a significant positive relationship with total cosmetic procedures and gross domestic product (GDP), GDP per capita, personal income, consumer price index (CPI) (all), and CPI (medical). There was a significant positive relationship between cosmetic surgical procedures and the issuance of new home permits and the average prime rate charged by banks. There was a significant positive relationship with cosmetic minimally invasive procedures and GDP, GDP per capita, personal income, CPI (all), and CPI (medical). There was a significant negative relationship between reconstructive procedures and GDP, GDP per capita, personal income, CPI (all), and CPI (medical). Cosmetic minimally invasive procedures seem to be decided on relatively quickly during good economic times. Cosmetic surgical procedures seem to be more planned and less related to the economic environment. The plastic surgeon may use this relationship to tailor the focus of his or her practice to be best situated for economic fluctuations.

Age and sex-related differences in 431 pediatric facial fractures at a level 1 trauma center.

INTRODUCTION Age and sex-related changes in the pattern of fractures and concomitant injuries observed in this patient population is helpful in understanding craniofacial development and the treatment of these unique injuries. The goal of this study was to examine all facial fractures occurring in a child and adolescent population (age 18 or less) at a trauma center to determine any age or sex-related variability amongst fracture patterns and concomitant injuries. METHODS All facial fractures occurring at a trauma center were collected over a 12-year period based on International Classification of Disease, rev. 9 codes. This was delimited to include only those patients 18 years of age or younger. Age, sex, mechanism, and fracture types were collected and analyzed. RESULTS During this time period, there were 3147 patients with facial fractures treated at our institution, 353 of which were in children and adolescent patients. Upon further review 68 patients were excluded due to insufficient data for analysis, leaving 285 patients for review, with a total of 431 fractures. The most common etiology of injury was assault for males and motor vehicle accidents (MVA) for females. The most common fracture was of the mandible in males and of the orbit in females. The most common etiology in younger age groups includes falls and pedestrian struck. Older age groups exhibit a higher incidence of assault-related injuries. Younger age groups showed a propensity for orbital fractures as opposed to older age groups where mandibular fractures predominated. Intracranial hemorrhage was the most common concomitant injury across most age groups. CONCLUSION The differences noted in etiology of injury, fracture patterns, and concomitant injuries between sexes and different age groups likely reflects the differing activities that each group engages in predominantly. In addition the growing facial skeleton offers varying degrees of protection to the cranial contents as force-absorbing mechanisms develop.

Debridement of Chronic Wounds: A Qualitative Systematic Review of Randomized Controlled Trials

This article reviews the current evidence available regarding wound debridement of chronic wounds and collates data from existing randomized controlled trials.

Examination of possible predictors of complications after free tissue transfer to the head and neck for oncologic defects.

IntroductionThe advent of vascularized free tissue transfer marked an incredible addition to the breadth of options available to the reconstructive surgeon when treating head and neck defects. The goal of this study is to determine if readily available laboratory tests may be used to stratify the risk for developing complications after free tissue transfer in specific patients. MethodsInstitutional review board approval was obtained for a retrospective chart review of all patients who underwent free tissue transfer for reconstruction of oncologic head and neck defects between 2001 and 2010 by the senior author (R.O.D.). ResultsThere were 107 free tissue transfers to the head and neck for oncologic defects during this period. A significant relationship was found between a preoperative hemoglobin less than 10 mg/dL and a postoperative albumin less than 2.5 mg/dL and complications. ConclusionsPreoperative hemoglobin less than 10 mg/dL and postoperative albumin less than 2.5 mg/dL seem to be useful as indicators of an increased likelihood of developing postoperative complications. Correction of these values preoperatively and postoperatively may lead to improved surgical outcomes.