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Background: In response to the cancellation of away rotations and the shift to virtual interviews due to the coronavirus disease of 2019 (COVID-19) pandemic, residency programs have pursued other methods of sharing program details, most notably with the use of social media. This study aimed to evaluate the extent of social media utilization in the setting of the COVID-19 pandemic by plastic surgery residency programs. Methods: Instagram, Twitter, and Facebook accounts of plastic surgery programs, program directors, and chiefs were identified. Number of followers, total posts, and posts since March 1, 2020, were extracted. Account content was categorized as informational, social, operative, research, self-promotional, guest lecture, education, or other. Spearman’s coefficient was used to determine correlations among account data. Differences among regions and program pathways were evaluated using the Kruskal-Wallis test. Results: Since March 1, 2020, 17 Instagram, five Twitter, and three Facebook accounts have been created. Instagram was most widely used and followed (1720 posts, 1235.7 ± 735.9 followers) compared with Twitter (722 tweets, 325.6 ± 451.0 followers) and Facebook (430 posts, 338.3 ± 363.3 followers). Although the majority of content was informational (45.1 percent), Instagram contained more social content (21 percent), Twitter contained more research (21 percent), and Facebook contained more self-promotional content (25 percent). Integrated-only programs on average posted more on Instagram (21.5 ± 15.1 posts) than did independent-only programs (9.4 ± 8.5 posts), and post volume moderately correlated with number of followers. There were no statistically significant differences among regional means. Conclusion: Plastic surgery residency programs have incorporated social media into their recruitment strategies and will likely continue to increase and diversify their posts to effectively engage with future applicants.

Background: Although guidelines support aortic valve replacement (AVR) in patients with severe aortic regurgitation (AI) and left ventricular ejection fraction (LVEF) < 50%, severe left ventricular dysfunction (LVEF < 35%) is thought to confer very high surgical risk. The survival benefit associated with surgical intervention, however, is unknown. We evaluated long term outcomes of this patient population with and without surgical intervention. Methods: To capture patients who did and did not undergo AVR, we queried a single institutions echocardiography database to identify all patients with severe AR and LVEF < 35%. Manual chart review was performed to identify key demographic, clinical, and operative details. This retrospective cohort was then merged with institutional patient data. Due to small sample size and population heterogeneity, corrected group prognosis method was applied, which calculates the adjusted survival curve for each individual using fitted Cox proportional hazard model. Average survival adjusted for co-morbidities and age was then calculated using the weighted average of the individual survival curves. Results: Of 43 echocardiograms representing 41 unique patients, 40 patients met inclusion criteria. Of those, 18 (45.0%) underwent AVR and 22 (55.0%) were managed medically. After multivariate adjustment, end stage renal disease (HR = 17.633, p =0.0335) and peripheral arterial disease (HR = 6.050, p =0.0180) were associated with increased long term mortality. AVR was associated with decreased mortality (HR = 0.143, p =0.0490, see Figure 1). The mean survival for patients undergoing AVR was 6.3 years. The mean follow-up time was 6.58 years. Conclusions: Even after adjustment for clinical characteristics and patient age, AVR is associated with increased survival for patients with severe systolic dysfunction and severe aortic insufficiency. Although treatment selection bias cannot be completely eliminated with this retrospective cohort design, these results support performing surgery on this high-risk patient group.

Introduction: Medicare’s Hospital Readmissions Reduction Program assesses financial penalties for hospitals based on risk-standardized readmission rates after specific episodes of care, including acute myocardial infarction (AMI). Whether the algorithm accurately identifies patients with AMI who have preventable readmission is unknown. Methods: Using administrative data from Medicare, we conducted physician-adjudicated chart reviews of all patients considered 30 day readmissions after AMI attributed to one hospital from July 2012-June 2015. We extracted information about revascularization during index hospitalization. For patients readmitted to the index hospital or an affiliate, we also extracted reason for readmission. Results: Of 199 admissions, 66 (33.2%) received PCI and 19 (9.6%) underwent CABG on index hospitalization. The remainder of patients did not receive any intervention, i.e. 39 patients (19.6%) were declined due to procedural risk, 15 (7.5%) because of goals of care and 14 (7.0%) refused revascularization. Forty-six patients (23.1%) had troponin elevation in the absence of an MI and did not have an indication for revascularization. The most common diagnoses of the 161 (80.9%) patients readmitted to the index hospital or an affiliate were infections and cardiac and non-cardiac chest discomfort (Table 1). Conclusions: Our results demonstrate that many AMI patients who count towards the Medicare penalty do not receive revascularization during the index hospitalization because of high procedural risk or patient preference. Focusing on these patients may improve readmission metric performance. Furthermore, adding administrative codes for prohibitive procedural risk may improve accuracy of the metric as a measure of quality.