Improving plastic surgery resident education and quality of care with outcomes feedback using the surgery report card: An initial experience

Halani, Sameer H.; Cho, Min Jeong; Garibay, Maycie; Nevin, Julia; Zhang, Andrew Y.

doi:10.1016/j.bjps.2020.02.019

Cited by 5 publications

(8 citation statements)

References 30 publications

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“…One significant contributing factor to our higher-than-average infection rate is our preoperative selection criteria. The breast reconstruction population at our institution is known to have a higher BMI and higher percentage of diabetics compared to the national average, 1 and several published studies, as well as our current study, demonstrate that patients with a higher BMI and with a diagnosis of diabetes are at a much higher risk of postoperative complications following breast surgery. 6 , 10 It must be considered, on the other hand, that many studies clearly show significant improvements to a breast cancer patient’s well-being following breast reconstruction with TEs at the time of mastectomy.…”

Section: Discussionsupporting

confidence: 66%

“…Our study of 412 immediate TE breast reconstructions performed at a major safety-net hospital demonstrated an overall infection rate of 18.4% which is at the high end of published ranges; an average rate of 8.3% of breasts was recently reported in a meta-analysis (range 2.4%-20.0%). 1 …”

Section: Discussionmentioning

confidence: 99%

“…Postoperative infection remains a common and potentially devastating complication following prosthetic-based breast reconstruction after oncologic mastectomy. 1 Of all breast reconstruction techniques currently available, immediate tissue expander (TE) reconstruction has been reported to have the highest rate of infection. 2 The consequences of TE-associated infection can be significant, resulting in delays in cancer treatment, costly hospital admissions, poor aesthetic outcomes, and complete failure of the reconstructive process.…”

mentioning

confidence: 99%

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Tissue Expander-Based Breast Reconstruction at a Major Safety-Net Hospital: Managing the Outsized Risk of Infection

Urquia

Henderson

Farewell

et al. 2022

Aesthetic Surgery Journal Open Forum

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Background Immediate tissue expander (TE) breast reconstruction is reported to have the highest rate of postoperative infection among reconstructive modalities. The risk of infection is higher among patients treated at safety-net hospitals. Objectives The goal of this study was to identify significant contributing factors to the elevated infection risk at our major safety-net institution. Methods A retrospective chart review was conducted on all TE-based reconstruction patients with a diagnosis of postoperative infection between 2015 and 2019. Preoperative, perioperative, and postoperative risk factors for infection were determined and compared across patient and procedure demographics. Results Two hundred and forty-three patients, for a total of 412 breast reconstructions, were included in our study. Significant preoperative selection factors were identified to contribute to the elevated risk of infection, including the following: older age, higher BMI, diabetes. Significant intraoperative and postoperative contributing factors included greater mastectomy weight, larger TE’s and intraoperative fill volume, and longer drain duration. Doxycycline treatment for infected patients resulted in a significantly higher rate of resolution. Conclusions Safety-net hospital population patients undergoing TE breast reconstruction are at higher risk for postoperative infection. Personal and procedural risk factors are identified. Balancing the benefits of immediate breast reconstruction with TEs with the elevated risk of postoperative infection remains challenging. Implementation of more stringent eligibility criteria may help mitigate the risk of infection.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Tissue Expander-Based Breast Reconstruction at a Major Safety-Net Hospital: Managing the Outsized Risk of Infection

Urquia

Henderson

Farewell

et al. 2022

Aesthetic Surgery Journal Open Forum

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“…9,20 Previous studies conducted at our institution showed a high average BMI in our patient population. 23 In our current study, the factor most significantly associated with undergoing autologous reconstruction was a higher BMI. The majority of autologous reconstruction performed at our academic center is abdominal-based, with 86% of these reconstructions being deep inferior epigastric perforator (DIEP) free flap-based.…”

Section: Discussionmentioning

confidence: 99%

“…We have found that our institution has higher rates of obesity, diabetes, and smokers, compared to the general population, as well as higher than average complication rates within our breast reconstruction patient population. 23 To combat this rise in complications, the following criteria must be met by patients to pursue breast reconstruction at our institution: body mass index (BMI) less than 40 kg/m 2 , hemoglobin A1c (HbA1c) less than 7%, and nonsmoking status before breast reconstruction. Greater control of existing comorbidities associated with increased risk for complications is indicated by American Society of Anesthesiologists (ASA) scores less than III.…”

Section: Introductionmentioning

confidence: 99%

Breaking Barriers to Breast Reconstruction among Socioeconomically Disadvantaged Patients at a Large Safety-net Hospital

Meade

Cummins

Farewell

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: Socioeconomic disparities remain prevalent among those who undergo breast reconstruction. At our institution, patients must meet certain criteria to become eligible for breast reconstruction. The purpose of this study was to determine the impact of socioeconomic factors on breast reconstruction eligibility, enrollment, choice, and completion at our large safety-net institution. Methods: A retrospective chart review of patients who underwent partial or total mastectomy at a large safety-net hospital from 2016 to 2019 was completed. Surgical and demographic data were compared across varying socioeconomic factors. Results: A total of 645 patients were included in the study. More patients of a racial minority had government-based insurance than White patients (89% versus 81%; P = 0.01). Those with government-based insurance had higher average hemoglobin A1c values (6.26 versus 6.0; P = 0.03), proportion of American Society of Anesthesiologists scores greater than III (46% versus 40%; P = 0.01), and smokers (23% versus 9%; P = 0.02) than those with private insurance. Diabetic patients, patients with an American Society of Anesthesiologists greater than III, and active smokers were significantly less likely to receive a plastic surgery consult. Patients with government-based insurance underwent immediate tissue expander placement at mastectomy at rates lower than those with private insurance (57% versus 69%; P = 0.01). Conclusions: Barriers remain for socioeconomically disadvantaged patients to be eligible for, undergo, and complete breast reconstruction. Obesity, diabetes, smoking, and poor overall health were identified as the main barriers and were associated with racial minorities, government-based insurance, and lower incomes. Concerted effort through multidisciplinary teams is needed to maximize eligibility of socioeconomically disadvantaged breast cancer patients for reconstruction.

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The Effect of Early Cultures and Dual-port Expanders on Two-stage, Prepectoral Breast Reconstruction: The 25/25 Study

Moyer,

Sisson

2024

Plastic and Reconstructive Surgery - Global Open

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Background: Two-stage tissue expander to implant surgery remains the predominant technique for breast reconstruction. Unfortunately, there is a high incidence of reconstruction failure which portends a financial and emotional burden. Most failures are related to postmastectomy skin flap necrosis and infection. Recently, a dual-port tissue expander was introduced to the market, and the authors hypothesize that early cultures from the peri-implant fluid will guide antibiotic treatment and decrease reconstruction failure. Methods: This is a cohort study of 50 consecutive patients treated for breast cancer or genetic susceptibility via a two-stage, prepectoral technique. The first 25 patients (46 breasts) were treated with a variety of tissue expanders, and the subsequent 25 patients (47 breasts) received a dual-port expander. Routine cultures from the drain port were taken from the dual-port group at the second postoperative visit, and cultures were taken in the control group only when signs of infection were present. All other procedures and interventions were similar. Results: Fifty patients, totaling 93 breasts, completed the study with a mean follow-up of 145 days. There were no statistically significant demographic or pathologic differences between groups. Fifteen tissue expanders were explanted in the control group and five in the dual-port cohort (32.6% versus 10.6%, P = 0.012). All bacteria in the control group failures were either methicillin-resistant Staphylococcus aureus or Staphylococcus epidermidis, whereas failures in the dual-port group varied. Conclusion: Treatment of routine, early cultures from a dual-port expander led to a statistically significant decrease in tissue expander explantation.

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Improving plastic surgery resident education and quality of care with outcomes feedback using the surgery report card: An initial experience

Cited by 5 publications

References 30 publications

Tissue Expander-Based Breast Reconstruction at a Major Safety-Net Hospital: Managing the Outsized Risk of Infection

Tissue Expander-Based Breast Reconstruction at a Major Safety-Net Hospital: Managing the Outsized Risk of Infection

Breaking Barriers to Breast Reconstruction among Socioeconomically Disadvantaged Patients at a Large Safety-net Hospital

The Effect of Early Cultures and Dual-port Expanders on Two-stage, Prepectoral Breast Reconstruction: The 25/25 Study

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