Ledibabari Mildred Ngaage

Background: Dupuytren’s contracture is a fibroproliferative disorder that often results in contractions of the fourth and fifth digits of the hand. While there is no definitive cure, symptomatic relief can be achieved via open fasciotomy, percutaneous aponeurotomy, or through collagenase Clostridium Histolyticum injections (CCH). Despite these therapeutic options, the insurance coverage of these modalities is not clearly defined. Methods: The authors evaluated American insurance companies’ coverage for the treatment of Dupuytren’s and compared the coverage of open fasciotomy, percutaneous aponeurotomy, or CCH. A cross-sectional analysis of US insurance policies for coverage of Dupuytren’s treatment was performed. Companies were selected based on those with the largest enrollment and their market share. Results: Of the 100 companies examined, only 5% of companies had an established policy that covered an open fasciotomy treatment, 6% had a policy that covered a percutaneous fasciotomy, whereas 37% had a policy for CCH. There were significantly more policies for CCH compared to open fasciotomy and percutaneous fasciotomy (CCH vs open fasciotomy: ppn = 5 (100%); percutaneous fasciotomy n = 5 (83.3%); CCH n = 30 (81.1%). Conclusion: There are noted coverage discrepancies between companies for the coverage of Dupuytren’s management. This variability is overall lacking in surgical, minimally invasive, and injection options.

Pediatric bariatric surgery is increasingly recognized as a safe and effective option for the management of obesity and obesity-related conditions. However, insurance coverage is a key barrier to accessing these procedures. Criteria are variable and often not evidence-based. In an effort to characterize common patterns in insurance coverage, we report coverage criteria for adolescents relative to adults.

Background: Breast reconstruction is commonly performed for a multitude of noncancerous indications, such as correction of congenital deformities, acquired tissue disease, burns, and trauma. However, breast reconstruction for noncancerous indications is often considered cosmetic or not explicitly mentioned in insurance policies. The goal of this study was to assess variability in insurance coverage of breast reconstruction for noncancerous indications. Methods: The authors conducted a cross-sectional analysis of 102 US insurance companies, including Medicare and Medicaid, for coverage of breast reconstruction for noncancerous indications (Poland syndrome, fibrocystic breast disease, burns and trauma). Insurance companies were selected based on their state enrollment data and market share. A Web-based search and individual telephone interviews were conducted to identify the policy. Medical necessity criteria were abstracted from publicly available policies. Results: Half of the insurers (49%, n = 50) had no policy for Poland syndrome, 46% (n = 47) had no policy for burns and trauma, and 82% (n = 84) had no policy for fibrocystic breast disease. Fifty-two percent (n = 22) of policies providing coverage for Poland syndrome, 24% (n = 13) of policies providing coverage for burns and trauma, and 58% (n = 7) of policies providing coverage for fibrocystic breast disease had specific, stringent criteria for medical necessity. Thirty-six percent (n = 15) of policies covering Poland syndrome, 47% (n = 26) of policies covering burns and trauma, and 33% (n = 4) of policies covering fibrocystic breast disease include coverage of the contralateral breast. Conclusions: There is a paucity of publicly available information on insurance coverage of breast reconstruction for noncancerous indications and a lack of consensus between top US insurance companies on what constitutes medical necessity for surgical correction.

Background: Occupational health hazards are ubiquitously found in the operating room, guaranteeing an inevitable risk of exposure to the surgeon. Although provisions on occupational health and safety in healthcare exist, they do not address non-traditional hazards found in the operating room. In order to determine whether surgeons or trainees receive any form of occupational health training, we examine the associations between occupational health training and exposure rate. Study design: A cross-sectional survey was distributed. Respondent characteristics included academic level, race/ethnicity, and gender. The survey evaluated seven surgical disciplines and 13 occupational hazards. Multivariable logistic regression was used to examine the association between academic level, surgical specialty, and exposure rate. Results: Our cohort of 183 respondents (33.1% response rate) consisted of attendings (n = 72, 39.3%) and trainees (n = 111, 60.7%). Surgical trainees were less likely to have been trained in cytotoxic drugs (OR 0.22, ppp = 0.009), radiation (OR 0.40, p = 0.007), and surgical smoke (OR 0.41, p = 0.041) than attending surgeons. Additionally, trainees were more likely to experience frequent exposure to bloodborne pathogens (OR 5.26, pppp = 0.011), to name a few. Conclusion: Although surgeon safety is not a domain in residency training, standardized efforts to educate and change the culture of safety in residency programs is warranted. Our study demonstrates a disparity between trainees and attendings with a recommendation to provide formal training to trainees independent of their anticipated risk of exposure.

Introduction: Plastic surgery emergencies, such as facial trauma, burns, and gunshot wounds, are commonly presenting injuries to the emergency department. However, these topics are rarely part of medical school curriculums and few educational conferences exist on these topics. Hence, we created a novel international medical student conference entitled “Emergencies in Plastic Surgery”. We then evaluated its effectiveness in improving confidence in management of plastic surgery-related emergencies. Method: We administered pre- and post-event online questionnaires to delegates evaluating self-reported confidence for Facial Trauma, Gunshot Wounds, Burns, Tendon Repair, Splinting, and Lacerations on a 5-point Likert-scale. Responses were matched before statistical analysis. Results: Of the 85 attendees, three quarters responded (76%, n = 65). The conference significantly increased confidence ratings in all topics (p < 0.001). Prior to the conference, Lacerations had the highest confidence scores (2.36 ± 1.19) whereas Facial Trauma scored the lowest (1.79 ± 0.858). Facial Trauma had the greatest improvement in confidence (mean difference = 2.09 ± 0.974), whereas Lacerations yielded the lowest improvement (mean difference 1.21 ± 1.28). Facial Trauma also yielded the greatest mean satisfaction rating (4.68 ± 0.594). Conclusions: The conference improved student confidence in all plastic surgery emergencies topics. More complex topics, e.g. facial trauma, yielded the greatest satisfaction and improvement in confidence.

There is a significant gender gap in research conducted by women in plastic surgery. Previous work has not explored female authorship trends in cosmetic plastic surgery. We asked how authorship trends in cosmetic plastic surgery compare with those in plastic surgery overall, over the last 10 years. All the articles published in Journal of Plastic Reconstructive and Aesthetic Surgery (JPRAS), Facial Plastic Surgery and Aesthetic Medicine (JAMA facial plastics), and Aesthetic Surgery Journal. (ASJ) in 2009, 2014, and 2019 were retrieved. The gender of the first and last author was determined. In addition, article type and total number of authors were extracted. Chi-square or Fisher exact test were performed to determine differences between groups Linear regression models were used to investigate whether total number of authors, or female last authorship predicted female first authorship. A total of 4358 articles were reviewed. Of these, 16.6% (n = 723) were published by a female first and/or last author. Percent of female first and/or last author increased with time, from only 12.2% in 2008, to 15.9% in 2014, reaching 21.7% in 2019. A total of 25% (n = 181) of randomized controlled trials were published by a female first and/or last author compared with only 14% (n = 440) of case studies. Female first and last authorship both increased across the 10-year study period, but there were consistently more female first authors than female last authors in all 3 surveyed years (P < .001). There was an 86% increased chance of female first authorship if the last author was also female (P < .001), and a 7% increased likelihood of female first authorship (P = .002). Women have a lower representation in the cosmetic plastic surgery literature than men. This gender disparity gap, however, is decreasing. While encouraging, opportunities for improvement remain.

The independent plastic surgery pathway recruits candidates with 5 years of surgical training who are typically more advanced in research than their integrated counterparts. Research productivity helps to discriminate between applicants. However, no studies exist detailing the academic attributes of matched independent plastic surgery candidates. We performed a cohort study of 161 independent plastic surgery fellows from accredited residency programs from the 2015 to 2017 application cycles. We performed a bibliometric analysis utilizing Scopus, PubMed, and Google Scholar to identify research output measures at the time of application. The cohort was predominantly men (66%) with a median of 3 articles and a H-index of 1 at the time of application. Interestingly, 16% of successful candidates had no published articles at the time of application, and this did not change significantly over time (P = .0740). Although the H-index remained stable (R 0.13, P = .1095), the number of published journal articles per candidate significantly decreased over 3 consecutive application cycles (R −0.16, P = .0484). Analysis of article types demonstrated a significant increase in basic science articles (R 0.18, P = .0366) and a concurrent decrease in editorial-type publications (R = −0.18, P = .0374). Despite the decline in publication volume of matched independent plastic surgery fellows, the quality of their research portfolio has remained constant. Matched applicants appear to be shifting focus from faster-to-publish articles to longer but higher impact projects. In selecting a training route, applicants must weigh the highly competitive integrated path against the dwindling number of independent positions.

Introduction: Differences in academic qualifications are cited as the reason behind the documented gender gap in industry sponsorship to academic plastic surgeons. Gendered imbalances in academic metrics narrow among senior academic plastic surgeons. However, it is unknown whether this gender parity translates to industry payments. Methods: We conducted a cross-sectional analysis of industry payments disbursed to plastic surgeons in 2018. Inclusion criteria encompassed (i) faculty with the rank of professor or a departmental leadership position. Exclusion criteria included faculty (i) who belonged to a speciality besides plastic surgery; (ii) whose gender could not be determined; or (iii) whose name could not be located on the Open Payment Database. Faculty and title were identified using departmental listings of ACGME plastic surgery residency programs. We extracted industry payment data through the Open Payment Database. We also collected details on H-index and time in practice. Statistical analysis included odds ratios (OR) and Pearson’s correlation coefficient (R). Results: We identified 316 senior academic plastic surgeons. The cohort was predominately male (88%) and 91% held a leadership role. Among departmental leaders, women were more likely to be an assistant professor (OR 3.9, p = 0.0003) and heads of subdivision (OR 2.1, p = 0.0382) than men. Industry payments were distributed equally to male and female senior plastic surgeons except for speakerships where women received smaller amounts compared to their male counterparts (median payments of $3,675 vs $7,134 for women and men respectively, p<0.0001). Career length and H-index were positively associated with dollar value of total industry payments (R = 0.17, p = 0.0291, and R = 0.14, p = 0.0405, respectively). Conclusion: Disparity in industry funding narrows at senior levels in academic plastic surgery. At higher academic levels, industry sponsorship may preferentially fund individuals based on academic productivity and career length. Increased transparency in selection criteria for speakerships is warranted.

Background: Research productivity forms a vital part of the resident selection process and can markedly affect the chance of a successful match. Current reports regarding the publication record among prospective orthopaedic surgery residents are likely inaccurate. Potential applicants have a poor understanding of the strength of their research credentials in comparison to other candidates. Methods: We identified matched applicants from the 2013 to 2017 orthopaedic surgery residency application cycles. We performed a bibliometric analysis of these residents using Scopus, PubMed, and Google Scholar to identify published articles and calculate the h-index of each applicant at the time of application. Details were collected on medical school, advanced degrees, publication type, first authorship, and article relatedness to orthopaedic surgery. Results: We included 3,199 matched orthopaedic surgery applicants. At the time of application, the median h-index was 0, the median number of publications was 1, and 40% of successful candidates did not hold any publications. The h-index (R 0.08, P < 0.0001) and median number of publications of matched orthopaedic surgery residency candidates significantly increased (R 0.09, P < 0.0001) across application cycles. Furthermore, the proportion of matched applicants without publications at the time of application significantly decreased (R −0.90, P = 0.0350). Conversely, the percentage of articles first-authored by applicants decreased (R −0.96, P = 0.0093), but article relatedness to orthopaedic surgery remained constant (R 0.82, P = 0.0905). Strikingly, notable changes were observed in the type of articles published by successful applicants: the proportion of preclinical studies decreased (R −0.07, P = 0.0041), whereas clinical research articles increased (R 0.07, P = 0.0024). Conclusion: The publication count held by successful orthopaedic surgery applicants is substantially lower than the nationally reported average. Matched orthopaedic surgery candidates demonstrate increasingly impressive research achievements each application cycle. However, increased academic productivity comes at the cost of reduced project responsibility and a shift toward faster-to-publish articles.