Background Understanding trends in surgical volumes can help Ambulatory Surgery Centers (ASCs) prevent clinician burnout and provide adequate staffing while maintaining the quality of patient care throughout the year. Health insurance deductibles reset in January each year and may contribute to an annual rhythm where the levee of year-end deductibles is breached in the last few months of every year, resulting in a flood of cases and several accompanying challenges. This study aims to identify and analyze monthly and yearly surgical volume patterns in ASCs and explore a relationship with the deductible reset. Methods De-identified, aggregate visit data for 2016–2019 were obtained retrospectively from 14 ambulatory surgery centers within the same benchmarking consortium in the Southeast. The ASCs subspecialty types consisted of orthopedics, urology, otolaryngology, and multispecialty. Kaiser Family Foundation survey data from 2016 to 2019 was used to inform deductible trends. Augmented Dickey-Fuller tests, linear regressions, and two-sample T-tests were conducted to explore and establish patterns in surgical volume between 2016 and 2019. Results Overall, average orthopedic surgical volume increased 38.04% from January to December in 2016–2019 with an average difference of 64 cases (95% CI: 47–80), while that of all ASCs combined increased 19.24% within the same timeframe with an average difference of 37 cases (95% CI: 21–52). Average health insurance deductibles rose 12% from $1476 to $1655 within the same timeframe. Regression analysis showed a stronger association between year and volume for orthopedic ASCs (R (Claxton et al., 2019) [2] = 0.796) than for all ASCs combined (R (Claxton et al., 2019) [2] = 0.645). Regression analysis also showed a stronger association between month and volume for orthopedic ASCs (R (Claxton et al., 2019) [2] = 0.488–0.805) than for all ASCs combined (R (Claxton et al., 2019) [2] = 0.115–0.493). Conclusion This study is first to identify regular and predictable yearly and monthly increases in orthopedic ASCs surgical volume. The study also identifies yearly increases in surgical volume for all ASCs. The combination of increasing yearly demand for orthopedic surgery and growing association between month and volume leads to an unnecessary year-end rush. The study aims to inform future policy decisions as well as help ASCs better manage resources throughout the year.

Background: The first case of COVID-19 was reported in Wuhan, China in December 2019. The disease has spread to 210 countries and has been labeled as a pandemic by WHO. Modelling, evaluating, and predicting the rate of disease transmission is crucial for epidemic prevention and control. Our aim is to assess the impact of interstate and foreign travel and public health interventions implemented by the United States government in response to the Covid-19 pandemic. Methods: A disjoint mutually exclusive compartmental model is developed to study the transmission dynamics of the novel coronavirus. A system of non-linear differential equations was formulated and the basic reproduction number R0 was computed. The stability of the model was evaluated at the equilibrium points. Optimal controls were applied in the form of travel restrictions and quarantine. Numerical simulations were conducted. Results: Analysis shows that the model is locally asymptomatically stable, at endemic and foreigners free equilibrium points. Without any mitigation measures, infectivity and subsequent hospitalization of the population increase while placing interstates individuals and foreigners under quarantine, decreases the chances of exposure and subsequent infection, leading to an increase in the recovery rate. Conclusion: Interstate and foreign travel restrictions, in addition to quarantine, help in effectively controlling the epidemic.

Frequently, aches, and pain are symptoms, like alarms alerting the occurrences of dangerous events which can cause cell death, tissue destruction, and inflammation. Physicians treat the underlying diseases which cause the pain and aches in order to restore health. On some occasions, the treatments are directed at aches and pains themselves, and are thus symptomatic relief. For surgeons, pain is an inevitable consequence of what we do in the operating room. Postoperative pain management represents an important part of the Enhanced Recovery After Surgery (ERAS) protocols. Furthermore, opioid epidemic has cost a great burden on the society and the healthcare system, which also places an emphasis on using non-opioid analgesics to achieve adequate pain relief. Unlike other vital signs, there is no objective, direct measurement of pain, even though pain is considered the fourth vital sign. Pain is a perceived sensation, as a result of nociception, a complex process which can extend from other somatosensory modalities such as thermoception, chemoception, and mechanoception. Whenever the stimulus magnitude exceeds nominal physiologic boundaries, cell death, and tissue injury follow, as does afferent nociceptive signals. This review is to provide craniofacial surgeons with an update on pain, what pain is, how to assess it, pharmacology of pain relief, and specifically, the proper use of opioids and non-narcotic analgesic agents. The goal is to allow for the optimal, rational use of these medications to relief pain with the minimum short and long term risks. With evidence-based, data-driven approach, supplemented by group experience pooled from senior surgeons after 100,000 patient-hours, the objective is to answer the following: (1) What is pain? (2) How does opioid work? (3) What is the role of narcotic analgesics in craniofacial ERAS? (4) When should non-opioids be used and how?

A 53-year-old African American male smoker presented with epigastric pain, tarry stools, and laboratory results indicative of acute pancreatitis. Chest X-ray showed a right perihilar mass with pleural effusion. Computed tomography scan showed multiple large right paratracheal and hilar nodes with internal calcification. The patient underwent a fiberoptic bronchoscopy with biopsies which were negative for malignancy. Mediastinoscopy was performed and revealed amyloidosis. Evaluation for multiple myeloma showed elevated kappa and lambda light chains and diffuse polyclonal gammopathy, but there was no monoclonal spike on serum protein electrophoresis. Bone marrow and abdominal fat pad were negative for amyloid, and the patient continues to lack chronic underlying systemic disease with no symptoms on cardiac or pulmonary examination.

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