Kavitha Ranganathan

Mentorship is a cornerstone of surgical education, fostering professional growth, research productivity, and career guidance. In plastic surgery, mentorship profoundly impacts career choices and professional development, yet structured one-on-one programs are notably limited. Challenges such as time constraints, mismatched expectations, and disparities in representation often hinder traditional mentorship models. To address these issues, we developed a computational algorithm to facilitate team-based mentorship in plastic surgery. This algorithm utilizes a weighted Jaccard similarity index and recursive stability optimization to optimize compatibility among participants by aligning career goals, clinical interests, and mentorship priorities. A survey of 171 Professional Resource Opportunities in Plastic and Reconstructive Surgery Education and Leadership (PROPEL) members informed the pilot matching process, resulting in 36 teams with a median pooled similarity score of 0.823. Our approach offers distinct advantages, including equitable opportunity, scalability, and reduced administrative burden. Future efforts should focus on integrating qualitative feedback, evaluating long-term outcomes, and exploring advanced technologies such as natural language processing to refine the model further.

Background: Financial toxicity (FT) is the economic burden of medical care that negatively affects patients' well‐being and quality of life. FT disproportionately impacts surgical patients. Although prior studies have quantified FT, few have explored patient‐identified interventions to mitigate it. This study explores solutions to FT through qualitative interviews with surgical patients. Methods: A multicenter prospective study was conducted to characterize FT in adult surgical trauma patients across three tertiary care centers in India. A total of 854 patients were surveyed. Semi‐structured interviews were conducted amongst a randomized subset of these patients within 1 year of surgery. Interviews were recorded, transcribed, translated, and coded. Recurring themes were identified using a qualitative thematic analysis with a deductive approach. Results: A total of 39 patients were interviewed, with a median age of 37.7 years (SD 14.6). Almost all reported needing to borrow money or sell assets to cope with FT resulting from surgical care, leading to long‐term social distress. Themes for patient‐proposed solutions emerged: (1) addressing insurance deficits, (2) providing direct non‐medical cost support, (3) increasing social support schemes, and (4) infrastructure for acute financial assistance. Conclusions: Surgical trauma patients in India face substantial postoperative FT, necessitating contextualized solutions. Increasing awareness and use of existing government schemes is crucial. Patients facing FT should be identified upon admission and educated about financial options. Comprehensive support strategies such as governmental resources, monetary support systems, and social services are essential. Implementing patient‐reported solutions to mitigate FT is vital to improving patient outcomes after surgery.

Importance: Food insecurity, defined as uncertain access to enough food for a healthy life, is a growing issue in the US. While its link to chronic conditions is well documented, little is known regarding its impact on surgical patients.Objective: To assess food insecurity, identify associated characteristics, and measure the rate of Supplemental Nutrition Assistance Program (SNAP) enrollment among surgical patients using a nationally representative sample.Design, Setting, and Participants: This was a cross-sectional study using National Health Interview Survey (NHIS) data from 2011 through 2018. These data were analyzed from February 2024 through April 2025. Multivariable logistic regression models were used to analyze the association between surgery, food insecurity, and enrollment in SNAP. Data for this study came from the NHIS, a nationally representative survey used for health information, health access, and health behaviors of the civilian, noninstitutionalized US population, enabling broad applicability to surgical patients. The study included 254 283 individuals with data on surgery within the past year and 30-day food insecurity. Surgical and nonsurgical cohorts were created based on answers to, “During the past 12 months, have you had surgery or other surgical procedures as an inpatient or outpatient?”Exposures: The main exposure included undergoing surgery in the past year. Other exposures were age, race, sex, employment status, household income, marital status, number of family members in the household, geographic region, health status, and insurance status.Main Outcomes and Measures: The proportion of food insecurity among the surgical cohort was the main outcome. Secondary outcomes included factors linked to food insecurity and SNAP enrollment, especially for those with incomes below 200% of the federal poverty level.Results: Surgical patients (13 180 male [40.2%] and 19 643 female [59.8%]) reported higher food insecurity prevalence (11.6%) than nonsurgical patients (100 924 male [45.6%] and 120 536 female [54.4%]) (10.5%). Adjusted analyses indicated significantly higher odds of food insecurity among surgical patients (odds ratio, 1.12; 95% CI, 1.07-1.18; P < .001). Food insecurity was strongly linked to lower income and poor health. SNAP enrollment was 16% overall and 40% among surgical patients with incomes less than 200% federal poverty level, associated with younger, low-income, unemployed, less educated, or publicly insured patients.Conclusions and Relevance: Food insecurity is a significant burden among surgical patients. Interventions, including food insecurity screening, may improve food access and health outcomes in this cohort.

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Importance: Food insecurity, which is the lack of consistent access to sufficient and nutritious food, impacts over 1.3 billion individuals worldwide. The impact of food insecurity on primary care and medical subspecialties is recognized, but its influence on surgical outcomes remains underexplored.Objective: To investigate the association between food insecurity and postoperative clinical outcomes in adult surgical trauma patients.Design, Setting, and Participants: This prospective longitudinal cohort study was conducted from October 2021 to June 2023 and surveyed patients at admission and at 1 and 3 months postoperatively. This multicenter study was conducted across 3 public and private tertiary care centers in India. Adult patients who underwent inpatient operative intervention for traumatic injury were included through consecutive sampling.Exposures: Food insecurity, which was identified using the validated Hunger Vital Sign tool. This was determined at admission as preoperative food insecurity. Also assessed was a subset of participants who were food secure at admission but then became food insecure during the follow-up period.Main Outcomes and Measures: Postoperative complications and length of stay. These outcomes were tracked during hospitalization and also at 1 month and 3 months after discharge to compare between time points.Results: A total of 848 patients (median [IQR] age, 32 [24-45] years; 692 male [82%]) were included in this analysis. Of the total cohort, 174 participants (21%) reported experiencing food insecurity in the year before admission. Patients with food insecurity had significantly higher rates of postoperative complications compared with those without food insecurity (41.4% [72 of 174] vs 12.5% [84 of 671]; odds ratio [OR], 3.68; 95% CI, 2.24-6.05). Additionally, patients with food insecurity had a longer median (IQR) length of stay (13 [6-28] days vs 5 [3-9] days; incidence rate ratio, 1.51; 95% CI, 1.31-1.74). Furthermore, new-onset food insecurity at 1 month postoperatively was associated with an increased risk of new complications at 3 months postoperatively (OR, 5.06; 95% CI, 2.21-11.13).Conclusions and Relevance: Results demonstrate that food insecurity was significantly associated with increased postoperative complications and longer hospital stays in surgical trauma patients. Routine screening for food insecurity and targeted interventions like medically tailored meals, food prescription programs, and philanthropic food resources may mitigate the detrimental impact of food insecurity on surgical outcomes.

Background: Financial toxicity is the detrimental impact of health care costs that must be mitigated to achieve universal health coverage. Catastrophic health expenditure (CHE) is widely used to measure financial toxicity but does not capture patient perspectives of unaffordable health care costs. Financial hardship (FH), a patient-reported outcome measure, is currently underutilized but may be an important adjunct metric. The authors compare CHE to FH as metrics evaluating financial toxicity. Methods: A prospective, multicenter cohort study was conducted across 3 public and private tertiary-care hospitals in India. Adult surgical trauma inpatients in plastic and orthopedic surgery departments were assessed. The development of CHE, health expenditures >10% of annual income, and FH, the patient-reported impact of financial toxicity in the form of asset liquidation, debt acquisition, and job loss, were compared by the health system and using logistic regression models. Results: Among 744 surgical trauma patients, low income, longer hospital stays, and increased injury severity were significantly associated with the likelihood of incurring CHE and FH (P<0.05). Only FH was significantly associated with lack of insurance (OR: 0.22; 95% CI: 1.14–2.71). Public hospitals had higher rates of FH than CHE (55% versus 23%). Private hospitals had more CHE than FH (53% versus 32%). Conclusions: FH is an important metric of financial toxicity that provides important adjunct information to CHE for at-risk populations. FH is particularly informative for public institutions with low direct medical costs. Nuanced utilization of CHE and FH provides a more comprehensive, patient-oriented approach to evaluating unaffordable health care costs that can help shape financial risk protection policy.