Prophylactic Antibiotics for Uncomplicated Upper-Extremity Lacerations: A Retrospective Cohort Study of Private Insurance Claims.

Purpose: Despite limited evidence for their effectiveness, antibiotics are frequently prescribed after uncomplicated upper-extremity lacerations. We analyzed rates of prophylactic antibiotic prescriptions and risk factors for infection after upper-extremity lacerations that were acutely repaired in emergency departments (ED).

Methods: Using the IBM MarketScan Commercial Claims and Encounters database, we conducted a retrospective cohort study of adult patients with uncomplicated upper-extremity lacerations repaired in the ED between 2010 and 2020.

Patient experience with hospital care following the Maryland global budget revenue model: A difference-in-difference analysis.

Introduction: As a result of the success of Maryland's full risk capitated payment model experiment (Global Budget Revenue) in constraining healthcare costs, there is momentum for expanding the reach of such models. However, as these models are implemented, studies analyzing their long-term effects suggest unintended spillover effects that may ultimately influence patient experiences. The aim of this study was to determine whether implementation of the GBR was associated with changes in patient experience.

Site of Ambulance Origination and Billing for Out-of-Network Services.

Importance: The No Surprises Act implemented in 2022 aims to protect patients from surprise out-of-network (OON) bills, but it does not include ground ambulance services. Understanding ground ambulance OON and balance billing patterns from previous years could guide legislation aimed to protect patients following ground ambulance use.

Objective: To characterize OON billing from ground ambulance services by evaluating whether OON billing risk differs by the site of ambulance origination (home, hospital, nonhospital medical facility, or scene of incident).

Prevalence and Cost of Routine Preoperative Care for Low-Risk Cataract Surgery a Decade after Choosing Wisely.

Purpose: Examine the frequency and cost of procedural clearance tests and examinations in preparation for low-risk cataract surgery among members of a commercial healthcare organization in the United States. Determine what characteristics most strongly predict receipt of preoperative care and the probability that preoperative care impacts postsurgical adverse events.

Design: Retrospective healthcare claims analysis and medical records review from a large, blended-health organization headquartered in Western Pennsylvania.

Bone Health Screening Prior to Medicare Eligibility-Osteoporosis Screening and Fracture Prevention After Distal Radius Fractures in Patients Aged 50-59.

Purpose: Current guidelines recommend bone mineral density (BMD) testing after fragility fractures in patients aged 50 years or older. This study aimed to assess BMD testing and subsequent fragility fractures after low-energy distal radius fractures (DRFs) among patients aged 50-59 years.

Methods: We used the 2010-2020 MarketScan dataset to identify patients with initial DRFs with ages ranging between 50 and 59 years.

The impact of a statewide payment reform on transcatheter aortic valve replacement (TAVR) utilization and readmissions.

Background: Transcatheter aortic valve replacement (TAVR) is an increasingly used but relatively expensive procedure with substantial associated readmission rates. It is unknown how cost-constrictive payment reform measures, such as Maryland's All Payer Model, impact TAVR utilization given its relative expense. This study investigated the impact of Maryland's All Payer Model on TAVR utilization and readmissions among Maryland Medicare beneficiaries.

Gender and Ethnic Diversity in Plastic Surgery: Temporal Trends among Speakers at National and Regional Plastic Surgery Conferences.

Background: Scientific leadership among women and underrepresented minorities is lacking in plastic surgery. It is unknown whether the underrepresentation of women and ethnic minorities extends into academic conferences. The authors evaluated the temporal trends of female and ethnic minority representation at plastic surgery conferences in the United States.

Predictors and Consequences of Intraoperative Anastomotic Failure in DIEP Flaps.

Background:  Successful intraoperative microvascular anastomoses are essential for deep inferior epigastric perforator (DIEP) flap survival. This study identifies factors associated with anastomotic failure during DIEP flap reconstruction and analyzes the impact of these anastomotic failures on postoperative patient outcomes and surgical costs.

Methods:  A retrospective cohort study was conducted of patients undergoing DIEP flap reconstruction at two high-volume tertiary care centers from January 2017 to December 2020.

Is the Centralization of Complex Surgical Procedures an Unintended Spillover Effect of Global Capitation? - Insights from the Maryland Global Budget Revenue Program.

Objective: To determine if global budget revenue (GBR) models incent the centralization of complex surgical care.

Summary Background: In 2014, Maryland initiated a statewide GBR model. While prior research has shown improvements in cost and outcomes for surgical care post-GBR implementation, the mechanism remains unclear.

Vital Sign Measurement and Response to Abnormal Measures in Surgical Specialty Clinics.

This cohort study assesses patient presentation to subspeciality clinics and whether normal vital signs and abnormal vital signs are addressed.

Compliance and Variability of Hospital Price Transparency in Total Knee and Hip Arthroplasty in the United States.

Introduction: On January 1, 2019, in an effort to improve price transparency, the Centers for Medicare and Medicaid Services (CMS) mandated that hospitals display chargemasters and pricing for diagnosis-related groups (DRGs) online. We examined the compliance of the 50 top orthopaedic hospitals, ranked by US News, with CMS's mandate and compared pricing.

Methods: The chargemaster and pricing of DRG codes related to total knee arthroplasty (TKA) and total hip arthroplasty (THA) (469, 470, 461, 462, 466, 467, and 468) were evaluated in the top 50 orthopaedic hospitals in the United States.

Infections after mastectomy and tissue expander placement: A multivariate regression analysis.

Background: While breast surgery is considered a clean case, tissue expander-based breast reconstruction (TE-BR) has infection rates quoted up to 31%, decidedly higher than the typical 1% to 2% rate of surgical site infections. Through multivariate regression, we sought to analyze risk factors that contribute to infections following TE placement.

Methods: A retrospective study reviewed all patients undergoing mastectomy with immediate or delayed TE placement over a 22-month period.

Treatment of Facial Fractures at Safety-Net Hospitals: A National Analysis of Inpatient Burden and Cost.

Purpose: Safety-net hospitals (SNHs) are vital in the care of trauma populations, but little is known about the burden of facial trauma presenting to SNHs. The authors sought to characterize the presentation and treatment of facial fractures across SNHs and determine the association between SNH care and healthcare utilization in patients undergoing fracture repair.

Methods: Adult patients presenting with a facial fracture as their primary admitting diagnosis from the year 2012 to 2015 were identified in the National Inpatient Sample.

The Impact of Payment Reform on Pediatric Craniofacial Fracture Care in Maryland.

Study Design: Retrospective, quasi-experimental difference-in-differences investigation.

Objective: Pediatric craniofacial fractures are often associated with substantial morbidity and consumption of healthcare resources. Maryland's All Payer Model (APM) represents a unique case study of the health economics surrounding pediatric craniofacial fractures.

Assessment of Costs and Care Quality Associated With Major Surgical Procedures After Implementation of Maryland's Capitated Budget Model.

Importance: In 2014, Maryland implemented the all-payer model, a distinct hospital funding policy that applied caps on annual hospital expenditures and mandated reductions in avoidable complications. Expansion of this model to other states is currently being considered; therefore, it is important to evaluate whether Maryland's all-payer model is achieving the desired goals among surgical patients, who are an at-risk population for most potentially preventable complications.

Objective: To examine the association between the implementation of Maryland's all-payer model and the incidence of avoidable complications and resource use among adult surgical patients.

Decision aid for women with newly diagnosed breast cancer seeking breast reconstruction surgery: A prospective, randomized, controlled, single-blinded, pilot study.

Background: Women undergoing immediate breast reconstruction for breast cancer often experience anxiety when faced with reconstruction and the type of reconstruction to choose. The purpose of this study is to analyze the impact of a decision aid on decisional conflict in women with newly diagnosed breast cancer seeking breast reconstruction.

Methods: Newly diagnosed breast cancer patients seeking breast reconstruction at a single center were prospectively randomized into two groups.

Perspectives of Women Who Forgo Post-mastectomy Breast Reconstruction: A Mixed Methods Analysis.

Unlabelled: Despite a growing body of evidence suggesting improved psychosocial well-being and survival after post-mastectomy breast reconstruction (PMBR), rates remain stagnant at approximately 40%. Although PMBR access and utilization have been well reported, there is much less known from the point of view of women who decide not to undergo PMBR. This study uses a mixed methods approach to fill that gap by investigating the patient-level decisions that lead to foregoing PMBR.

Exploring provider- and practice-level drivers of cost-consciousness in breast cancer reconstruction-secondary analysis of a survey of the American Society of Plastic Surgeons.

Background: The role of physicians in dampening health care costs is a renewed focus of policy-makers. We examined provider- and practice-level factors affecting four domains of cost-consciousness among plastic surgeons performing breast reconstruction.

Methods: Secondary analysis was performed on the survey responses of 329 surgeons who routinely performed breast reconstruction.

The Impact of Policy Reform on Utilization of Popular Reconstructive Procedures.

Objectives: Medicaid beneficiaries systematically face challenges in accessing healthcare, especially with regard to specialty services like reconstructive surgery. This study evaluated the impact of 2 healthcare reform policies, Medicaid expansion and global hospital budgeting, on utilization of reconstructive surgery by Medicaid patients.

Methods: Utilization of reconstructive surgery by Medicaid patients in New Jersey (Medicaid expansion/no global budget), Maryland (Medicaid expansion/with global budgets), and Florida (no Medicaid expansion/no global budget) between 2012 and 2016 was compared using quasi-experimental, interrupted time-series modeling.

Impact of payer status and hospital volume on outcomes after head and neck oncologic reconstruction.

Background: High-volume centers improve outcomes in head and neck cancer (HNCA) reconstruction, yet it is unknown whether patients of all payer status benefit equally.

Methods: We identified patients undergoing HNCA surgery between 2002 and 2015 using the National Inpatient Sample. Outcomes included receipt of care at high-volume centers, receipt of reconstruction, and post-operative complications.

Early Discontinuation of Breast Free Flap Monitoring: A Strategy Driven by National Data.

Background: Multiple single-institution studies have revealed that breast free flap compromise usually occurs within the first 48 postoperative hours. However, national studies analyzing the rates and timing of breast free flap compromise are lacking. This study aimed to fill this gap in knowledge to better guide postoperative monitoring.

Tissue Expander-Based Breast Reconstruction in the Prepectoral Versus Subpectoral Plane: An Analysis of Short-Term Outcomes.

Background: Breast reconstruction is becoming an increasingly important and accessible component of breast cancer care. We hypothesize that prepectoral patients benefit from lower short-term complications and shorter periods to second-stage reconstruction compared with individuals receiving reconstruction in the subpectoral plane.

Methods: An institutional review board-approved retrospective review of all adult postmastectomy patients receiving tissue expanders (TEs) was completed for a 21-month period (n = 286).

Presentation of a Large and Debilitating Fungating Anogenital Lesion.

Case Report: A 65-year-old Caucasian man presented with a debilitating anogenital lesion.

Differential Diagnosis: The differential diagnosis of anogenital lesions includes infectious (syphilis, herpes simplex virus), noninfectious (hidradenitis suppuritiva, lymphedema), benign (condyloma acuminata), and malignant pathologies (squamous cell carcinoma, Kaposi sarcoma).

Diagnostic Assessment, Management, And Outcome: Biopsy of an anogenital lesion will determine any oncologic potential.