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Background: Depression and anxiety have a complex association with opioid dependence, though their impact on acute postoperative pain is unclear. The present study investigated the impact of depression and anxiety on acute postoperative pain and opioid requirements following deep inferior epigastric perforator (DIEP) flap breast reconstruction., Methods: Patients receiving DIEP flap breast reconstruction were retrospectively identified from 2019 to 2023. Patients were classified into the psychiatric comorbidity (PC) group based on a history of depression or anxiety diagnoses, or the control group. Pain (0-10 Numerical Rating Scale [NRS]) scores and cumulative inpatient opioid requirements (in morphine milli-equivalents [MMEs]) were compared between groups. Linear regression analysis assessed the association of psychiatric comorbidities with pain outcomes., Results: In total, 557 patients were included, of which 11.4% reported a psychiatric history. The PC group was younger (50.0 vs. 52.7 years, p = 0.032) and more frequently reported current marijuana use (15.6% vs. 4.3%, p = 0.001) and former smoking (51.6% vs. 24.5%, p < 0.001). The PC group had higher mean (2.5 vs. 2.0, p < 0.001) and maximum pain scores (8.6 vs. 7.8, p = 0.003) than the control group, which corresponded to higher opioid requirements (256 vs. 223 MMEs, p = 0.041). Psychiatric comorbidities were associated with higher average and maximum pain scores (p < 0.01) while current marijuana use was associated with higher opioid requirements (p = 0.033)., Conclusion: Patients with depression or anxiety comorbidities tended to have greater acute postoperative pain and opioid consumption. Marijuana use was also more prevalent, potentially exacerbating pain outcomes, and risk of opioid dependence. These findings will inform patient discussions and targeted interventions to mitigate opioid misuse., (© 2024 Wiley Periodicals LLC.)

Background: The relationship between perioperative temperatures and postoperative pain is unknown. The present study investigated the relationship of intraoperative hypothermia and perioperative opioid requirements after immediate implant-based breast reconstruction., Methods: A retrospective chart review was conducted on patients undergoing immediate implant-based breast reconstruction from 2019-2023. Patients were classified into the hypothermic group (majority of procedure <36.0 °C) or normothermic group (majority of procedure ≥36.0 °C). Cumulative inpatient opioid requirements (morphine milli-equivalents [MMEs]) and frequency of patients requiring "high-dose opioids" (≥100 MMEs) were collected and compared between the groups., Results: In total, 536 patients (835 breasts) were included, among whom 135 (25.1%) were hypothermic. The hypothermic group had lower mean intraoperative (88.4 vs. 99.1 MMEs, P = 0.007) and postoperative (45.6 vs. 56.8 MMEs, P = 0.006) than the normothermic group. Mean (B = 14.6, P = 0.004) and nadir (B = 10.4, P = 0.038) intraoperative temperatures directly predicted higher opioid requirements while higher percentages of the procedure time spent under 36 °C (B = -27.6, P = 0.004) predicted lower opioid requirements. The hypothermic group was associated with 66% decreased odds of requiring high-dose opioids after adjusting for differences in patient and operative characteristics (P = 0.007)., Conclusion: Hypothermia is associated with decreased perioperative opioid requirements. Future studies should further investigate ideal temperature thresholds for warming protocols to minimize postoperative pain., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Racial and ethnic minority groups as well as gender minorities seeking gender-affirming care and surgery have historically had difficulties with healthcare access and experience. The intersection of these two groups may result in deficient healthcare for patients of minority racial and ethnic groups seeking gender-affirming surgery. This study sought to explore differences in gender-affirming genital surgery experience by race. The 2018-2021 Healthcare Utilization Project National Inpatient Survey was queried for gender-affirming surgeries. Demographic, inpatient safety, and hospital-level characteristics were collected. Results were stratified by race and evaluated for significant differences. A total of 4605 patients were included in the study, 3345 patients were identified as White (73%), 320 as Black/African American (7%), 485 as Hispanic/Latino (11%), and 110 as Asian/Pacific Islander (2%). Black/African American patients experienced a higher rate of inpatient medical complications than the overall population (1% vs. 3%, P = 0.004) and had a longer length of stay (3 vs. 5 days, P < 0.001). The highest total charges were observed among Black/African American patients ($130,873, IQR $119,235, P < 0.001). Black/African American patients also less often experienced routine discharge (94% vs. 81%, P < 0.001) and more often required a higher level of care upon discharge, such as home healthcare or transfer to another facility (6% vs. 17%, P < 0.001). While the healthcare population is becoming more diverse, healthcare disparities still exist among non-White individuals receiving gender-affirming genital surgery. The present data suggest that Black/African American patients receiving gender-affirming genital surgery have more complicated hospital and discharge courses, and experience higher total hospital charges., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

One of the more common and disruptive complications of gender-affirming vaginoplasty is postoperative bleeding. The present study aimed to evaluate the impact of intraoperative intravenous tranexamic acid (IV TXA) administration on postoperative bleeding events in a large sample of gender-affirming vaginoplasty patients. Patients undergoing gender-affirming vaginoplasty between June 2019 and July 2023 were evaluated retrospectively. IV TXA use, estimated blood loss, and bleeding complications were evaluated. Postoperative complications included minor hematomas, defined as hematomas requiring conservative treatment; major hematomas, defined as hematomas requiring intervention such as return to the operating room and readmission; major bleeding, defined as continuous bleeding from the surgical site requiring intervention; and readmission and reoperation related to bleeding. Statistical significance was set at p < 0.05. In total, 628 patients were included in the study, 271 did not receive IV TXA and 357 received IV TXA. Surgeon preference dictated IV TXA use. Significantly fewer patients in the IV TXA group had hematoma (18% vs. 2%, p < 0.001), minor hematoma (16% vs. 3%, p < 0.001), postoperative major bleeding (4% vs. 2%, p = 0.008), and readmission for bleeding (6% vs. 1%, p = 0.018). Logistic regression analysis revealed that IV TXA use was associated with decreased odds of developing any type of hematoma (OR 0.140, 95% CI 0.071-0.277, p < 0.001), minor hematoma (OR 0.126, 95% CI 0.059-0.270, p < 0.001), and postoperative bleeding (OR 0.348, 0.153-0.794, p = 0.012). The use of IV TXA reduced certain bleeding events and complications that can cause distress in the postoperative period in gender-affirming vaginoplasty patients., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Purpose: The Area Deprivation Index (ADI) ranks neighborhoods by deprivation based on US Census data. This study utilizes ADI scores to investigate the impact of neighborhood deprivation on complication rates following breast reconstruction., Patients and Methods: Patients who received implant-based reconstruction from 2019 to 2023 were identified at a single institution in New York. Patients were linked to a state-specific ADI score and categorized into groups: "High ADI" (6-10) and "Low ADI" (1-5). Patient characteristics and complication rates were compared between the ADI groups with Chi-Square analysis and t-tests. The predictive value of ADI scores on complication rates was assessed using logistic regression models., Results: In total, 471 patients were included, of which 16% (n = 73) were in the High ADI group, and 84% (n = 398) were in the Low ADI group. There were no baseline differences between the 2 groups, except that there were more patients of Hispanic descent in the High ADI group (30% vs. 15%, P < .01). The High ADI group had a higher overall complication rate than the Low ADI group (34% vs. 21%, P < .01), as well as higher individual rates of hematoma (12% vs. 3%, P < .01) and unexpected reoperations (18% vs. 7%, P < .01). After adjusting for differences in race, High ADI scores predicted hematoma, reoperations, and any complication (P < .05)., Conclusion: Patients living in neighborhoods with high ADI had a higher incidence of postoperative complications, independent of comorbidities and race. This measure of disparity should be considered when counselling patients about their risk of complications following procedures like implant-based breast reconstruction., Competing Interests: Disclosure The authors have no other potential conflicts of interest to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: The relationship between pursuing a research year (RY) and plastic surgery match outcomes is unclear. The present study investigated the association between a dedicated RY and the odds of matching into an integrated Plastic and Reconstructive Surgery (PRS) residency program., Methods: Electronic Residency Application Service applications to an integrated PRS residency program from 2017 to 2021 were evaluated. Match results were determined using online public sources. Students who had taken a RY were compared with those who had not (traditional). The relationship between pursuing a RY and matching was determined with logistic regression analyses., Results: In total, 974 applicants were included, of which 191 (20%) completed an RY. The RY group had significantly higher match rates (83% versus 74%, P = 0.008), more presentations (13 versus 5, P < 0.001), and more publications (11 versus 4, P < 0.001) than the traditional group. The RY group was 80% more likely to match than the traditional group (adjusted odds ratio [OR] = 1.8, P = 0.016). However, this benefit was eliminated after controlling for the number of publications. Subgroup analysis revealed that applicants who completed an RY had increased odds of matching into a top 20 PRS residency program (OR = 2.2, P < 0.001), with the strongest association observed among applicants with 15+ (OR = 2.6, P < 0.001) or 20+ publications (OR = 4.1, P < 0.001)., Conclusions: An RY is associated with 80% higher odds of matching and an increased number of publications. RYs seem to be most associated with benefits for applicants aiming to increase their publication numbers or to match into a top 20 residency program., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: The characteristics, complications, and postoperative analgesic needs of patients with a recent or active history of recreational cannabis use have not been explored explicitly in plastic surgery. In this study, the characteristics, complications, and postoperative analgesic needs within a population of breast reduction patients who use and do not use recreational cannabis were compared. Methods: A retrospective cohort study was carried out on patients who underwent breast reduction between 2019 and 2023. Demographics, comorbidities, recreational cannabis use, postoperative opioid use, and postoperative complications were collected. Patients with a recent history (<1 month since last cannabis use) or current cannabis use were then compared to patients with no history of cannabis use. Results: In total, 340 patients were included, 88 (26%) patients had a history of cannabis use and 252 (74%) did not. Patients in the cannabis-using group were significantly younger than in the non-cannabis-using group (28 years vs 40 years, P  < .01), and significantly more patients in the non-cannabis group had hypertension (20% vs 6% P  < .01). More patients in the cannabis-using group had hematomas (5% vs 1%, P  = .041) and fewer had t-point breakdown (4% vs 0%, P  = .046), but these figures lost statistical significance on multiple logistic regression analysis after controlling for possible confounding factors including demographics and comorbidities ( P  > .05). There were no significant differences in proportions of opioid use or by doses of opioids, even when converted to oral morphine equivalents ( P  > .05). Conclusion: The analgesic needs, postoperative pain levels, and complications between cannabis-using and non-cannabis-using cohorts were similar. Counseling on substance use preoperatively should still be encouraged, especially in younger patients seeking reduction mammaplasty., Competing Interests: Author Olachi Oleru was supported by the National Center for Advancing Translational Sciences (NCATS) TL1TR004420 NRSA TL1 Training Core in Transdisciplinary Clinical and Translational Sciences (CTSA)., (© 2024 The Author(s).)

Study Design: National database study., Objective: Road traffic accidents (RTAs) are a common and challenging cause of facial fractures in the United States. The present study sought to utilize the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) to investigate national trends, injury patterns and disparities in facial fractures secondary to RTAs. To date, this is the first study to do so., Methods: A retrospective analysis was conducted of patients with primary facial fractures secondary to RTAs using the 2018-2021 HCUP-NIS. Patients were classified into the RTA and non-RTA group. Demographics, injury patterns, and inpatient outcomes were compared., Results: In total, 154,185 primary facial fractures were identified, of which 17% (n = 26,115) were associated with RTAs. RTAs commonly involved cars (41%), followed by motorcycles (15%), pedestrians (11%), and bicyclists (10%). The RTA group was younger (34% vs 24% < 25 years, P < .01) and more frequently Hispanic (18% vs 15%, P < .01). The most common fracture types were mandibular (23%), frontal (14%), and orbital fractures (14%). The RTA group was 50% more likely to have multiple facial fractures (OR = 1.5, P < .01). The RTA group had a longer length of stay (5.3 vs 4.0 days, P < .01), admission charge ($127,932 vs $79,414, P < .01), and mortality rate (1.9% vs 1.4%, P < .01) than the non-RTA group., Conclusions: The present findings provide valuable insights, informing early involvement of craniofacial surgeons for the assessment of combination facial fractures and tailored treatment approaches for RTA patients., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Importance: The lack of underrepresented in medicine physicians in academic plastic surgery has been a topic of interest for many years, and accordingly outreach has been undertaken to address the pipeline from medical school to residency and beyond., Objective: This study aims to assess and identify the characteristics associated with plastic surgery match success for underrepresented in medicine applicants., Design: Residency application data for first time, US allopathic medical school seniors from the 2017-2018 to 2021-2022 applicant cycles were abstracted from Electronic Residency Application Service applications, and match results were determined using the National Residency Matching Program database and online public sources. Data included self-reported race, and multiple application characteristics. Multivariable logistic regression of application characteristics were used to assess the relationship between underrepresented in medicine status and successfully matching. Binary logistic regression was used in subgroup analyses of each application characteristic, and interactions regression was used to evaluate the relative weight of each characteristic on successfully matching., Results: Underrepresented in medicine applicants were 57% less likely to match than non-underrepresented in medicine applicants (OR 0.43, p = 0.001), though they were 60% less likely to match (OR adj 0.4, p = 0.216) when adjusted. Subgroup analysis revealed that odds of matching as an underrepresented in medicine applicant were significantly increased if the applicant had a home program, took a research year, and had an increased number of published research and presentations (ORs 0.43-0.48, all p < 0.05). Odds of matching as an underrepresented in medicine applicant were significantly decreased if the applicant went to a medical school ranked in the highest or lowest third (ORs 0.41-0.42, all p < 0.01); however, on interaction regression the odds of matching from a highly ranked medical school was increased (OR 3.5, 95% CI 0.98-12.55, p = 0.05)., Conclusions: The likelihood of matching as an underrepresented in medicine applicant is lower than the rest of the applicant population, and there are no individual applicant characteristics that can increase these odds to equal that of the general applicant population., (Copyright © 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)