Aneeq S. Chaudhry

Introduction: Accurate quantification of intraoperative blood loss is critical for guiding resuscitation. Although estimated blood loss (EBL) is known to be inaccurate, its reliability compared with calculated blood loss (CBL) across surgical techniques remains underexplored. This study examined discrepancies between EBL and CBL in the repair of open versus minimally invasive craniosynostosis. Methods: A single institution retrospective review included 186 open and 79 minimally invasive craniosynostosis repairs. EBL was obtained from intraoperative documentation. Weight-adjusted CBL was calculated using pre- and postoperative hematocrit values. Absolute and relative differences between EBL and CBL were compared with paired t tests. Threshold analyses assessed the proportion of cases in which EBL underestimated CBL by >50%, >70%, or >80% using the χ ² tests. Results: EBL consistently underestimated CBL in both techniques. In open repairs, the mean EBL was 173 mL versus a CBL of 474 mL, a mean underestimation of 301 mL ( P P =0.0019). However, minimally invasive repairs demonstrated greater proportional underestimation (75% versus 57% P =0.0003) and were more likely to exceed the 50%, 70%, and 80% discrepancy cutoffs (all P <0.01). Conclusion: Craniosynostosis repair carries substantial transfusion risk, and even modest blood loss can significantly affect infants. EBL markedly underestimated CBL in both craniosynostosis techniques, with disproportionately greater relative underestimation in minimally invasive cases. These findings highlight the need for more reliable intraoperative blood loss assessment, especially in minimally invasive cases, as deceptively low EBL values may underestimate resuscitation needs and compromise patient safety.

Background: The neck is a visible marker of aging and a growing focus in aesthetic medicine. Compared to the face, neck skin quality has been underexplored, despite its aesthetic importance in the aging process. This study evaluated whether modifiable health-related risk factors better predict neck skin quality than chronological age. Methods: In a cross-sectional study, adults aged ≥ 55 years completed a survey on demographics, metabolic health, sun exposure, sunscreen use, tobacco/alcohol use, exercise, and stress, plus the FACE-Q™ Appraisal of the Neck. Neck skin elasticity parameters (Young’s modulus, viscoelasticity, retraction time) were objectively measured under standardized conditions. Univariate tests and multivariable linear regression (adjusted for age, gender, ethnicity) assessed associations between elasticity and risk factors. Results: Thirty-six participants (mean age 64.3 ± 7.8) were included. Young’s modulus was lower in males, in diabetes/metabolic syndrome, and with ≥ 3 sun-induced skin changes, and was inversely related to BMI. Viscoelasticity was lower in diabetes/metabolic syndrome, with ≥ 3 sun-induced changes, and without daily neck sunscreen use. Age was not significantly associated with any objective parameter. FACE-Q scores trended with higher viscoelasticity. In multivariable models, daily neck sunscreen predicted greater viscoelasticity, while obesity predicted the opposite. Conclusions: In older adults, neck skin viscoelasticity relates more to modifiable risk factors, particularly photoprotection and obesity, than to chronological age. Incorporating risk factor screenings into aesthetic consultations may help promote healthy behaviors that prolong the results of rhytidectomies, and objective tools like viscoelasticity can aid longitudinal monitoring. Level of evidence: Level III, prognostic study.

Background: Nontobacco nicotine use, including electronic cigarettes and vaping devices, has increased substantially in recent years. While the adverse effects of combustible tobacco on wound healing are well established, less is known about postoperative risks associated with nontobacco nicotine dependence (NTND). This study evaluated the association between NTND and postoperative complications following reconstructive and aesthetic breast surgery procedures. Methods: A retrospective cohort analysis was performed using the TriNetX research database. Patients undergoing reconstructive or aesthetic breast surgery were identified using Current Procedural Terminology codes and stratified by documented NTND within 1 year before surgery. Patients without nicotine dependence served as controls. Propensity score matching (1:1) was used to balance demographic and clinical covariates. Postoperative complications were assessed at 30 days, 90 days, and 1 year. Results: Among 227,098 patients, 4801 had NTND and 222,297 served as controls. After 1:1 matching, 4467 patients remained in each cohort. Across all timepoints, NTND was associated with higher rates of surgical site complications, wound-related complications, wound dehiscence or delayed healing, infection, and unplanned readmission (all P <0.01). Seroma, hematoma, and postoperative bleeding occurred less frequently among patients with NTND. Conclusions: Nontobacco nicotine dependence was associated with higher rates of wound complications, infection, and unplanned health care utilization following reconstructive and aesthetic breast surgery. These findings highlight the importance of assessing nicotine exposure during preoperative risk evaluation and counseling.

Background: Rhinoplasty is one of the most commonly performed facial plastic surgery procedures. Postoperative pain management frequently includes opioid prescriptions, although opioid exposure has been associated with impaired wound healing and increased postoperative complications in several surgical populations. This study aims to evaluate the association between perioperative opioid prescriptions and postoperative complications following rhinoplasty procedures. Methods: A retrospective cohort study using the TriNetX Research Network identified patients undergoing rhinoplasty between 2005 and 2025 using Current Procedural Terminology codes. Patients were stratified by documented opioid prescriptions within 2 weeks postoperatively. Individuals with prior opioid-related disorders or malignancy were excluded. Outcomes were assessed during early (1–30 d) and late (31–365 d) postoperative intervals. Results: A total of 419,449 rhinoplasty patients were identified, including 312,053 with perioperative opioid exposure and 107,396 controls. After propensity score matching, 85,201 patients remained in each cohort. During the early postoperative period, opioid exposure was associated with higher rates of overall complications (RR 2.11, 95% CI 1.94–2.29, P P P P =0.0008), emergency department visits or readmissions (RR 2.23, P P P =0.0049), infection (RR 1.48, P =0.0003), and wound disruption (RR 1.36, P =0.0044). Conclusions: Perioperative opioid prescriptions were associated with increased postoperative complications following rhinoplasty. These findings support continued efforts to optimize opioid-sparing analgesic strategies in rhinoplasty-related procedures

Chronic wounds account for a considerable burden on the overall US healthcare system, affecting an estimated 10.2 million people and costing as much as $148 billion dollars in 2022 alone. Elderly patients suffer disproportionately, as nearly 85% of the chronic wound population is over the age of 65 years old. Despite the burden chronic wounds place on elderly patients and the overall healthcare system, the full mechanism of wound healing changes as one ages has not been fully elucidated. The major deficits in wound healing in the elderly are a function of both skin structural changes and alterations in wound healing kinetics resulting from molecular shifts in gene profiles. Elderly individuals exhibit reduced skin integrity, characterized by a disorganized epidermis, thinned dermis and subcutaneous fat, and a less stable basement membrane, impairing protection from external insults. Simultaneously, wound healing is disrupted across all four stages, as low‐level persistent inflammation from increased fibroblast senescence delays the onset of the proliferative phase and limits overall healing capacity. We hope that this review can bridge the knowledge gap in this field and ultimately lead to future discoveries in aiding the prevention of aging skin and the improvement in wound healing outcomes.

Background: Facial fracture repair is commonly performed following traumatic injury. Postoperative pain is frequently managed with opioid prescriptions. However, opioid exposure has been associated with impaired wound healing and increased postoperative complications in several surgical populations. This study aims to evaluate the association between perioperative opioid prescriptions and postoperative complications following facial fracture repair procedures. Methods: A retrospective cohort study using the TriNetX Research Network identified patients undergoing facial fracture repair between 2005 and 2025 using Current Procedural Terminology codes. Patients were stratified by documented opioid prescriptions within 2 weeks postoperatively. Individuals with prior opioid-related disorders or malignancy were excluded. Outcomes were assessed during early (1–30 d) and late (31–365 d) postoperative intervals. Results: A total of 207,750 patients undergoing facial fracture repair were identified. This included 162,449 patients with perioperative opioid exposure and 45,301 controls. After propensity score matching, 35,869 patients remained in each cohort. During the early postoperative period, opioid exposure was associated with higher rates of overall complications (OR: 1.75, P < 0.0001), surgical site complications (OR: 2.07, P < 0.0001), infection (OR: 3.00, P < 0.0001), wound disruption (OR: 2.35, P < 0.0001), and emergency department visits or readmissions (OR: 1.67, P < 0.0001). During late follow-up, opioid exposure remained associated with higher rates of surgical site complications (OR: 1.37, P < 0.0001), infection (OR: 2.05, P < 0.0001), and wound disruption (OR: 2.10, P < 0.0001). Conclusions: Perioperative opioid prescriptions were associated with increased postoperative complications following facial fracture repair. These findings support continued efforts to optimize opioid-sparing analgesic strategies in patients undergoing facial trauma reconstruction.

Background: Biologic and targeted immune-modulating agents are increasingly used to manage autoimmune diseases like rheumatoid arthritis, psoriasis, and inflammatory bowel disease. As more patients receiving these therapies undergo elective breast augmentation and implant-based reconstruction, the effect of biologic exposure on postoperative outcomes remains unclear. Objectives: This study evaluated whether preoperative use of biologic or immune-modulating agents is associated with increased complications following reconstructive and aesthetic breast surgery procedures. Methods: A retrospective cohort analysis was performed using the TriNetX database. Patients who underwent breast reconstruction or augmentation were identified by Current Procedural Terminology codes and stratified by preoperative exposure to biologic or immune-modulating agents within 6 months of surgery. Agents included tumor necrosis factor-α, interleukin, Janus kinase, mammalian target of rapamycin, and calcineurin inhibitors, among others. Propensity score matching (1:1) controlled for demographic and clinical covariates. Postoperative complications were assessed at 30 days, 90 days, and 6 months and included wound dehiscence, infection, seroma or hematoma, implant revision, and hospital readmission. Results: Among 211,105 patients, 4024 had biologic exposure and 207,081 were controls. After propensity score matching, 3980 patients remained in each cohort. Complication rates were comparable between groups at all timepoints (P > .05). Biologic exposure was not associated with increased risk of wound, infectious, implant revision, or hospital readmission complications. Conclusions: Preoperative biologic or immune-modulating therapy was not associated with a significant increase in postoperative surgical complications after breast reconstruction or augmentation procedures. Continuing these therapies in appropriate patients appears safe and may reduce unnecessary treatment interruptions. Level of Evidence: 3 (Therapeutic): For image description, please refer to the figure legend and surrounding text.

Background: Antidepressant medications are widely prescribed, yet their perioperative effects in facial plastic surgery remain poorly defined. Certain antidepressant classes have been associated with altered platelet function and potential changes in wound healing. This study evaluated the association between preoperative antidepressant exposure and postoperative complications following aesthetic facial plastic surgery procedures. Methods: A retrospective cohort analysis was conducted using the TriNetX Research Network. Patients undergoing rhinoplasty, blepharoplasty, or rhytidectomy were identified using procedural codes. Antidepressant exposure, including selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, monoamine oxidase inhibitors, and atypical antidepressants, was defined as documented use within 6 months before surgery. Propensity score matching (1:1) adjusted for demographic and clinical covariates. Postoperative complications were assessed at 30 days, 90 days, 6 months, and 1-year. Risk ratios (RR) with 95% CIs were calculated. Results: After matching, 18,064 patients were included in each cohort. At 1-year, antidepressant exposure was associated with higher rates of any surgical site complication (3.40% versus 2.30%; RR 1.48, 95% CI: 1.30–1.69; P RR 1.44, 95% CI: 1.26–1.65; P RR 1.34; P =0.0047), seroma or hematoma (0.28% versus 0.16%; RR 1.73; P =0.0175), and unplanned readmission (3.85% versus 3.27%; RR 1.18; P =0.0114). Infection was the most consistent signal across all follow-up intervals. Conclusions: Preoperative antidepressant exposure was associated with increased postoperative morbidity following aesthetic facial plastic surgery. These findings highlight the importance of incorporating antidepressant use into perioperative risk assessment and patient counseling.

Spinal cord injury (SCI) predisposes patients to pressure injuries (PIs) often requiring surgery. Multiple factors influence postoperative complications and recurrence, though their associations remain unclear. We performed a PRISMA‐guided systematic review and meta‐analysis to assess predictors of acute postoperative complications and PI recurrence in SCI patients undergoing surgery. PubMed, Scopus and Embase were searched. Studies with ≥ 15 participants were eligible; 24 ( n = 2566 subjects) were included, with 15 ( n = 1976 subjects) quantitatively synthesized. Risk of bias was assessed with the Newcastle‐Ottawa Scale. A random‐effects model meta‐analysis was performed, and odds ratios (OR) were pooled when > 2 studies were available; otherwise, findings were narratively synthesized. Moderate‐quality evidence showed prior flap reconstruction increased complication risk (aOR = 4.98). Low‐quality evidence linked diabetes (OR = 1.39) and smoking (OR = 1.35) with complications. Higher recurrence risk was associated with prior flap reconstruction (OR = 1.80) and thoracic injury (OR = 2.21), while cervical injury was protective (OR = 0.37). Prior flap reconstruction resulted as the strongest predictor of complications and significantly increased the odds of recurrence. These findings underscore the importance of a multidisciplinary approach for preventing the first occurrence of flap reconstruction and subsequent procedures.

Medical malpractice imposes a substantial clinical and economic burden worldwide. Pressure injuries (PIs) are amongst the most frequently litigated adverse events and represent a major source of preventable patient harm. To characterise the medicolegal landscape of PI‐related malpractice, the Westlaw legal database was queried for cases litigated between 1990 and 2024. A total of 590 cases met inclusion criteria, with data extracted from court documents. The mean patient age was 71 years; 53.4% were female and 46.6% male. Nursing homes were the most commonly named defendants (59.8%), followed by hospitals and outpatient surgical practices (37.3%) and individual physicians (14.1%). The mean settlement was $383 099, compared with a mean jury award of $2 100 787. Adverse legal outcomes were strongly associated with allegations of inadequate care, poor clinical outcomes and gross provider negligence. When prevention and timely management fail, the consequences extend beyond patient harm to substantial legal and financial liability. Targeted interventions such as standardised risk assessment, rigorous documentation, staff education, appropriate staffing ratios and institutional accountability may mitigate both PI incidence and litigation risk. Strengthening these measures represents a critical opportunity to improve patient safety whilst reducing medicolegal exposure.