Samuel O. Poore

Risk factors for unplanned readmission following head and neck microvascular reconstruction: Results from the National Surgical Quality Improvement Program, 2011-2014.

Unplanned readmissions are associated with decreased healthcare quality and increased costs. This nationwide study examines causes for unplanned readmission among head and neck cancer patients undergoing immediate microsurgical reconstruction.

The Affordable Care Act: a primer for plastic surgeons.

Summary: The Patient Protection and Affordable Care Act, sometimes referred to as Obamacare, was signed into law on March 23, 2010. It represents the most extensive overhaul of the country’s health care system since the passage of Medicare and Medicaid in 1965. The Affordable Care Act has two goals. The first goal is to reduce the uninsured population in the United States. Key elements to covering the uninsured include the following: (1) expanding Medicaid coverage for low-income individuals and (2) establishing health insurance marketplaces for moderate-income individuals with subsidies and tax cuts in an effort to make health insurance more affordable. The second goal of the Affordable Care Act is to address concerns about quality and the overall cost of U.S. health care. It is imperative that plastic surgeons thoroughly understand the impact that the Affordable Care Act will undoubtedly have on the country, on our patients, and on our clinical practices. Plastic surgery will see many changes in the future. This will include an overall increase in the number of insured patients, a push toward joining accountable care organizations, and a shift in payment systems to bundled reimbursement for episodes of care. In this article, the authors describe how these changes are likely to occur and what plastic surgeons must do to be part of the change.

Community-acquired methicillin-resistant staphylococcus aureus: diagnosis and treatment update for plastic surgeons.

Learning Objectives: After studying this article, the participant should be able to: 1. Identify risk factors associated with community-acquired methicillin-resistant Staphylococcus aureus. 2. Recognize the clinical presentation of patients with community-acquired methicillin-resistant S. aureus. 3. Understand the treatment and indications for decolonization of patients who have community-acquired methicillin-resistant S. aureus infections. Summary: Community-acquired methicillin-resistant Staphylococcus aureus has evolved over the past 10 years as a new health threat seen by plastic surgeons and is an increasing cause of soft-tissue infections. This pathogen has several distinct virulence factors and unique antimicrobial susceptibilities that distinguish methicillin-resistant S. aureus from traditional hospital-acquired methicillin-resistant S. aureus. This article reviews the epidemiology, risk factors, clinical presentation, and treatment of community-acquired methicillin-resistant S. aureus.

Patient safety in the operating room: I. Preoperative.

Background: Beyond the controlled trauma of surgery, the operating room can be a hazardous place for patients and health care workers alike. Modern plastic surgery requires a thorough knowledge of various perioperative risks and methods to minimize these risks. As the importance of teamwork becomes more evident, clear communication skills preoperatively, intraoperatively, and postoperatively become equally critical. To facilitate an improvement in perioperative patient safety, this article will review aspects of communication, including crew resource management, root cause analysis, and surgical-site verification. In addition, the authors will discuss patient positioning, antiseptic hand and patient preparations, and barriers, such as surgical scrubs, gowns, gloves, and drapes. Methods: The authors reviewed the literature regarding operating room safety, both primary research and secondary reviews, via multiple PubMed queries and literature searches. Topics most relevant to inpatient plastic surgery were included in the final analysis and summarized, as a full review of each topic is beyond the scope of this article. Results: Many possible interventions were identified, with the goal of reducing perioperative complications, such as wrong site surgery, neuropathies, myopathies, compartment syndromes, pressure ulcers, surgical-site infections, and blood-borne disease transmissions among plastic surgeons and their patients. Conclusions: There are ample opportunities for the reduction of preventable adverse events in plastic surgery. This article aims to provide its reader with the tools to research adverse events and a basic education in avoiding specific preoperative events. A second article addressing intraoperative and postoperative patient safety follows.

Patient safety in the operating room: II. Intraoperative and postoperative.

Background: The perioperative environment can be hazardous to patients and providers alike. Although many risks are best addressed preoperatively, some hazards require constant attention by the surgeon, anesthesiologist, and staff in the operating room. In a previous article, the authors discussed preoperative aspects of patient safety. In this article, the authors review intraoperative and postoperative risks and techniques to decrease these risks. Methods: The authors reviewed the literature regarding operating room safety, both primary research and secondary reviews, via multiple PubMed queries and literature searches. Topics most relevant to inpatient plastic surgery were included in the final analysis and summarized, as a full review of each topic is beyond the scope of this article. Results: Several intraoperative and postoperative risks were identified, in addition to methods designed to decrease the incidence of those risks, complications, and other adverse events among plastic surgeons and their patients. Conclusions: In this article covering intraoperative and postoperative hazards, the authors build upon a previous article addressing preoperative risks to patients during inpatient plastic surgery. Although neither article covers an exhaustive list of potential risks, the goal is to provide the modern plastic surgeon with the means to prevent common adverse events, as well as the tools to research new hazards.

Plastic Surgeons’ Perceptions of the Affordable Care Act: Results of a National Survey

Background: The Affordable Care Act (ACA) aims to expand coverage to the uninsured, improve quality, and contain costs. The goal of this study was to ascertain how plastic surgeons perceive the ACA. Methods: An electronic questionnaire was e-mailed to members of the American Society of Plastic Surgeons between May and June 2014. The survey was anonymous and voluntary and included questions to assess understanding and opinions of the ACA. Results: The survey was sent to 3070 members of the American Society of Plastic Surgeons, and the response rate was 17%. Sixty-eight percent agree or strongly agree that they understand the basic concepts of the ACA. The majority of respondents disagree (38% strongly disagree, 31% disagree) with the notion that the ACA will positively affect their practice, and 51% agree with the statement, “I do not support the ACA, and I believe it did too much.” Two thirds (66%) believe that the ACA deserves a grade of D or F. When answers were analyzed across demographics, 42% of respondents with “Academic” practice background identify with the statement, “I support the ACA but I think it needs more work,” compared to 15% of those who selected “Solo Practice” (p <0.001). Conclusions: The ACA will affect all specialties, including plastic surgery. The results of this survey suggest that many plastic surgeons believe that they have a baseline understanding of current health-care reform. The majority of surveyed surgeons do not support the Act. It is imperative that plastic surgeons possess the knowledge of the ACA; its changes, both current and impending, will likely affect patient mix, coverage of procedures, and reimbursement.

The clinical conundrum of perioperative pain management in patients with opioid dependence: lessons from two cases.

Sir:Patients receiving medication to treat opioid dependence present unique perioperative pain management challenges. As illustrated by the following two case examples, these challenges are significant for providers of all specialties, including plastic surgeons.The patient in the first case was a 2

The radial forearm snake flap: A novel approach to oral cavity and oropharyngeal reconstruction that reduces forearm donor site morbidity

Radial forearm free flaps are a versatile option for head and neck reconstruction, but often complicated by donor‐site problems including skin‐graft loss and wound breakdown. We introduce the radial forearm “snake” flap as a technique enabling primary donor site closure and compare wound healing outcomes to flap donor sites requiring split thickness skin graft (STSG) closure.

The Imperative of Academia in the Globalization of Plastic Surgery.

AbstractAlthough vertical health care delivery models certainly will remain a vital component in the provision of surgery in low-and-middle-income countries, it is clear now that the sustainability of global surgery will depend on more than just surgeons operating. Instead, what is needed is a comprehensive approach, that is, a horizontal integration that develops sustainable human resources, physical infrastructure, administrative oversight, and financing mechanisms in the developing world. We propose that such a strategy for development would necessarily involve an active role by academic institutions of high-income countries.

A low-cost, small volume circuit for autologous blood normothermic perfusion of rabbit organs.

We have designed a laboratory extracorporeal normothermic blood perfusion system for whole organs (e.g., kidney) that achieves pulsatile flow, low levels of hemolysis, and a blood priming volume of 60 mL or less. Using this uniquely designed extracorporeal circuit, we have achieved perfusion of two isolated ex vivo constructs. In the first experiment, we successfully perfused a rabbit epigastric flap based on the femoral vessels. In the second experiment, we were able to perfuse the isolated rabbit kidney for 48 h (range for all kidneys was 12-48 h) with excellent urine output, normal arterial blood gasses at 24 h, and normal ex vivo kidney histology at the conclusion of the experiments. These parameters have not been achieved before with any known or previously published laboratory extracorporeal circuits. The study has implications for prolonged organ perfusion prior to transplantation and for tissue engineering of vascularized tissues, such as by the perfusion of decellularized organs.