Nargiz Seyidova

Background: Endoscopic repair of craniosynostosis has emerged as a common surgical option due to its minimally invasive nature and safety profile. However, its indications related to patient age necessitate early diagnosis and referral, potentially exacerbating access disparities among socioeconomically and racially marginalized populations. To evaluate demographic, socioeconomic, and hospital-related factors influencing the utilization of endoscopic versus open craniosynostosis repair in a national inpatient cohort. Methods: A retrospective analysis was conducted using the National Inpatient Sample (2018-2021). Patients undergoing craniosynostosis repair were categorized by surgical approach (endoscopic vs open). Demographic, socioeconomic, and hospital characteristics were compared using chi-square tests and binary logistic regression. Results: From a sample of 1099 patients, 183 (16.6%) underwent endoscopic repair. Endoscopic patients were significantly more likely to be under 1-year-old, White, privately insured, and from high-income zip codes ( P < .001 for all). Endoscopic procedures were more frequently performed at private, not-for-profit hospitals ( P = .029), and less frequently at government, nonfederal hospitals (adjusted P = .048). Disparities persisted in a subgroup analysis of patients under 1 year. Conclusion: Significant racial, socioeconomic, and institutional disparities exist in access to endoscopic craniosynostosis repair in the United States. These disparities persist even among clinically eligible patients, suggesting systemic barriers in early diagnosis and referral. Efforts to expand equitable access must address both social determinants and structural healthcare inequities to ensure timely, optimal care for all patients.

Introduction: The volume of cervical spine procedures continues to grow. Plastic and reconstructive surgeons (PRSs) commonly address complex wound-related issues in such cases. The present study investigates whether routine PRS closure of cervical spinal wounds improves outcomes compared with those performed without. Methods: Data of patients operated on for cervical spine procedures by the senior author (P.J.T.) between January 2016 and June 2023 were analyzed. Only posterior surgical approaches were included. Demographics, medical status, procedure indication, and surgical characteristics were reviewed. Wound-related and medical complications were examined within a 30-day postoperative period, along with incidences of unplanned reoperation or readmission. Outcomes were compared with 12,943 CPT-matched cases reported by the American College of Surgeons National Surgical Quality Improvement Program. Results: Five hundred eighty-eight cases were included: 511 (87%) were performed for degenerative spine conditions, 60 (10%) for traumatic injuries, 7 (1%) for neoplasms, 7 (1%) for congenital conditions, and 3 (0.5%) for infected cyst management. The PRS group demonstrated a greater prevalence of diabetes (27% vs 22%, P = 0.016) and chronic obstructive pulmonary disease (10% vs 6%, P < 0.001). Those who received PRS closure were less likely to return to the operating room (1% vs 3%, P = 0.005) or experience a wound-related readmission (2% vs 5%, P < 0.001). Conclusion: PRS closure of cervical spine cases minimizes the risk of reoperation and readmission, even among a population with comorbidities known to be associated with wound-related complications. Improved outcomes were especially observed for more complex wounds requiring local flap closure. Thus, there is strong evidence to support PRS involvement in cervical spine surgery.

Gluteal augmentation with autologous fat grafting, colloquially referred to as Brazilian butt lift (BBL), is an increasingly common procedure with a highly reported complication profile. This study aims to analyze the prevalence and characteristics of complications that accompany these surgeries in ambulatory surgery facilities. Adults patients who experienced fat grafting complications from 2019-2021 were identified in formerly QUAD A, formerly known as the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), database. Patients and complications were analyzed based on sociodemographic, surgery and facility-specific variables using descriptive statistics and logistic regression. Overall, 436 fat grafting procedures with complications were reported to QUAD A, with an overall complication rate of 0.93%. Of these complications, 153 (37.6%) were confirmed to be from gluteal augmentation procedures. Notably, the number of gluteal augmentation with fat grafting complications decreased from the year 2019 (48) to 2020 (36), then nearly doubled from 2020 to 2021 (69). The majority of patients were female (96.7%) with a mean age of 42.0 years and a mean BMI of 28.3 kg/m². Wound infection was the most commonly documented complication (22.3%). Of the patients who experienced complications, 35.9% presented to a hospital for their complications and 12.6% required reoperation. Four deaths were described. There was no association between sociodemographic or surgical variables and increased odds of readmission or reoperation (p>0.05). Gluteal augmentation accounts for a large proportion of complications from fat grafting procedures. Increased reporting requirements may aid in future determination of incidences of complications and improve patient safety.

Background: Despite improvements in microsurgical techniques and broad application of free tissue transfer for reconstruction in the adult population, there is currently a paucity of literature regarding microsurgical reconstruction in the pediatric population, notably a limited number of case series evaluating outcomes following head and neck reconstruction. Methods: A retrospective analysis of National Surgical Quality Improvement Program Pediatric (NSQIP-P) database from 2015 to 2020 was performed. Pediatric patients undergoing head and neck reconstruction with microvascular muscle and fasciocutaneous flaps were identified using Current Procedural terminology codes (CPT). Multivariate logistic regressions were conducted to assess postoperative outcomes of interest. Results: A total of 120 head and neck free flap reconstructions were performed in the pediatric population. Most free flaps were microvascular muscle (n = 82, 68%) followed by fasciocutaneous (n = 38, 32%) flaps. The surgical complication rate was 8% (n = 9) and was primarily due to wound infection 6% (n = 7), whereas medical related complication rate was 14% (n = 17) with majority of patients requiring blood transfusion 12% (n = 14). The median length of stay was 4 days, and ventilator dependence was found to be significantly different among microvascular free flap types. Patients with underweight BMI and ASA Class >2 had higher odds (OR 59.7 and 17.0, P < .05 respectively) of developing any complication for microvascular muscle flaps. Conclusion: Analysis of a national cohort of pediatric patients revealed a low flap-related complication rate. Although free flap reconstruction in the pediatric population is technically demanding, microsurgical free tissue transfer in this population is safe and should be considered if indicated.