Predictors of Plastic Surgery Applicant Success: An Analysis of the Texas STAR Database.

INTRODUCTION: Integrated plastic surgery residency is one of the most competitive medical specialties. Although previous studies have surveyed integrated plastic surgery residency program directors regarding desired applicant characteristics, there is a paucity of literature assessing detailed application characteristics and reported match outcomes from applicants in recent application cycles. This study examines application characteristics associated with matching into integrated plastic surgery residency from 2017 to 2023. METHODS: The authors accessed the Texas Seeking Transparency in Application to Residency database, which contains survey information from graduating medical students nationwide regarding residency application characteristics and specialties/programs to which applications were submitted. Characteristics of matched versus unmatched applicants between 2017 and 2023 were compared using χ 2 and 2-sided, independent t tests. Univariate logistic regression models were used to assess predictors of a successful match. RESULTS: A total of 381 integrated plastic surgery residency applicants responded to the Texas Seeking Transparency in Application to Residency survey from 2017 to 2023. Mean United States Medical Licensing Exam Step 2 CK scores; the number of away rotations, interview offers, and honored clerkships; and Alpha Omega Alpha membership rate were significantly associated with and predictive of matching. Preference signaling of programs was associated with an increased interview offer rate. CONCLUSIONS: Higher board examination scores, increasing numbers of honored clerkships, away rotations, and Alpha Omega Alpha membership were identified as statistically significant predictors of matching into integrated plastic surgery residency. Prospective applicants should use this information to help guide their efforts in these areas that appear to be associated with a successful transition to residency.

The impact of surgical elective exposure during medical school upon residency match rates.

Objective: This study aims to investigate potential differences in surgical subspecialty match rates between medical schools with and without elective rotations in the respective surgical subspecialties. Design: Data on duration of surgical rotations were retrieved from each school's public website. Fisher exact tests were performed to identify any statistically significant differences in surgical specialty match rates by allopathic versus osteopathic and elective clinical exposure. A linear regression was performed to determine the correlation between number of surgical electives offered and proportion of students matching in any surgical subspecialty. Results: The number of surgical electives offered by allopathic medical schools positively correlated with the proportion of students matching in any surgical specialty (R2 = 0.038, p = 0.018). Elective rotations in surgical subspecialties were associated with higher match rates in ophthalmology (OR 1.864, 95 % CI 1.196, 3.059, p < 0.01) and plastic surgery (OR 2.543, CI 95 % 1.061, 7.972, p < 0.05). Conclusion: There are significant differences in match distribution between allopathic and osteopathic medical schools for surgical subspecialties. This may be due to differences in clinical exposure to these specialties offered to students at their respective medical schools. Medical schools can support students' successful match into competitive surgical subspecialties by increasing students' exposure through elective rotations.

The Price of Productivity: Evaluating the Cost of a Research Year.

OBJECTIVE: Research years during medical school are becoming increasingly common amongst applicants to competitive residency programs. As many of these positions are unpaid, it is important to consider the financial implications of these experiences and the feasibility of participation from students of all backgrounds. This study aims to quantify the cost of a research year during medical school. DESIGN/SETTING: We identified the top 50 NIH-funded medical schools of 2022 and obtained cost-of-living information for each of their respective counties. Estimated loan interest accrual resulting from a research year was calculated using information on the cost of attendance to medical school and annual interest rates for federal education loans. Cost-of-living calculations were stratified by geographic region, and interest accrual calculations by timing of research year and attendance at public versus private medical schools. RESULTS: Top 50 NIH-funded medical schools in the West are located in counties with the highest mean and median costs of living, each approaching nearly $45,000 per year. Medical schools in the Midwest are located in counties with the lowest mean and median cost of living, at less than $36,000 annually. Estimated loan interest accrual resulting from a research year ranges from $3177 to $17,789, depending on timing of the research year and type of medical school attended. CONCLUSIONS: This study exemplifies the significant financial burden that a research year can impose on medical students. As more residency applicants pursuing competitive specialties opt for research years during medical school, it is important to consider the associated financial implications. Many research year opportunities are unpaid or underpaid, which may prevent interested individuals from participating; this is especially the case for those who are from lower socioeconomic backgrounds. Moving forward, it is imperative that we ensure the availability of equitable and funded research year opportunities for students of all backgrounds.

Impact of pre-burn statin use on metabolic and cardiovascular disorders.

INTRODUCTION: Statins are among the most widely prescribed medications with proven effectiveness in patients with hyperlipidemia and atherosclerotic cardiovascular diseases. We investigated the relationship between statin use, metabolic and cardiovascular outcomes after burn. METHODS: We utilized data from the TriNetX electronic health database. Burn patients with prior statin use were compared to patients without prior use and analyzed the occurrence of metabolic and cardiovascular disorders. RESULTS: Prior statin use burn patients were 1.33 times as likely to develop hyperglycemia, 1.20 times for cardiac arrhythmia, 1.70 times for coronary artery disease (CAD), 1.10 times for sepsis, and 0.80 times for death. High percent TBSA burn, male sex, and lipophilic statin use were associated with higher odds of outcome development. CONCLUSION: Prior statin use in severely burned patients is associated with an increased risk of developing hyperglycemia, arrhythmias, and CAD, with higher odds in males, higher TBSA burn, and lipophilic statin users.

Subfascial/Intramuscular Dual-Plane Gluteal Implantation and Supplemental Fat Grafting: A Novel Technique for Buttock Augmentation.

BACKGROUND: Much debate exists within the current literature as to which plane is safest and most effective for gluteal implant buttock augmentation. A novel subfascial/intramuscular (SF/IM) dual-plane technique appears to combine the benefits of each plane. OBJECTIVES: The aim of this study was to describe our experience with SF/IM plane gluteal implantation, and to discuss its indications, efficacy, and safety, and offer recommendations on its proper use. METHODS: A retrospective chart review was conducted of 175 consecutive cases of gluteal augmentation with solid silicone implants in the SF/IM pocket, with and without supplemental autologous fat transfer. Outcomes from all patients were analyzed to determine the rate of complication and need for surgical revision. RESULTS: In 175 cases of bilateral buttock augmentation with gluteal implantation using the SF/IM pocket, the most common complication was infection. This complication was seen in 13 cases (7.43%), 7 (4%) of which were superficial and did not require surgical intervention. Other complications included dehiscence, seroma, capsular contracture, and implant migration. CONCLUSIONS: The SF/IM gluteal implantation, in combination with liposculpture and autologous fat transfer into the overlaying subcutaneous space, allows for a durable cosmetic augmentation of the buttocks in patients lacking sufficient volume for augmentation with fat transfer alone. This technique was found to have complication rates similar to those of other established augmentation techniques, as well the cosmetic advantages of a large, stable pocket with thick, soft tissue coverage of the inferior pole.

Effects of Aerobic Exercise in the Intensive Care Unit on Patient-Reported Physical Function and Mental Health Outcomes in Severely Burned Children-A Multicenter Prospective Randomized Trial.

Severe burns are life-altering and can have lasting effects on patients' physical and mental health. Alterations in physical function, changes in appearance, and psychological disturbances resulting from severe burns are especially concerning in children, as they are still in the early stages of identity formation. Exercise in the nonburn population has been shown to improve quality of life and result in better physical and mental status. However, the effect of early exercise on the quality of life in pediatric burn patients requires more research. METHODS: Forty-eight children between the ages of seven and seventeen with ≥30% total body surface area (TBSA) burn were randomized in a 1:2 fashion to receive treatment with standard-of-care (SOC) or standard-of-care plus exercise (SOC+Ex). Surveys administered at admission and discharge collected patient-reported information regarding physical and mental health outcomes. The results are given as means +/- standard deviation. Significance was set at p < 0.05. RESULTS: The average age of the SOC and SOC+Ex groups were 12 ± 3 and 13 ± 4 years, respectively. The average %TBSA burned in the SOC and SOC+Ex groups were 54 ± 17 and 48 ± 14, respectively. The SOC+Ex group averaged 10 ± 9 exercise sessions (range of 1 to 38 sessions) with an attendance rate of 25% (10 sessions out of 40 BICU days). Both groups demonstrated significant improvement in patient-reported physical and mental outcomes during hospital admission (p < 0.05) However, additional exercise did not exhibit any additional benefits for measured levels. CONCLUSIONS: Our recommendation is for all pediatric patients in the BICU to continue with the SOC and consult with their physician over the benefits of additional aerobic exercise. This study suggests that perhaps there is potential for increasing the amount of exercise that can be administered to pediatric burn survivors beyond SOC as we did not find aerobic exercise to be of any harm to any patients if it is performed properly and under supervision.

Nonsurvival Distributions in Pediatric Burn Patients: A Comparative Study of Two National Databases.

A contemporary, age-specific model for the distribution of burn mortality in children has not been developed for over a decade. Using data from TriNetX, a global federated health research network, and the American Burn Association's Nation Burn Repository (NBR), we investigated nonsurvival distributions for pediatric burns in the United States. Pediatric burn patients aged 0 to 20 between 2010 and 2020 were identified in TriNetX from 41 Healthcare Organizations using ICD-10 codes (T.20-T.30) and identified as lived/died. These were compared to the nonsurvival data from 90 certified burn centers in the NBR database between 2016 and 2018. The patient population was stratified by age into subgroups of 0 to 4, 5 to 9, 10 to 14, and 15 to 20 years. Overall, mortality rates for pediatric burn patients were found to be 0.62% in NBR and 0.52% in TrinetX. Boys had a higher incidence of mortality than girls in both databases (0.34% vs 0.28% NBR, P = .13; 0.31% vs 0.21% TriNetX, P < .001). Comparison of ethnic cohorts between 2010 to 2015 and 2016 to 2020 subgroups showed that nonsurvival rates of African American children increased relative to white children (TriNetX, P < .001); however, evidence was insufficient to conclude that African American children die more frequently than other ethnicities (NBR, P = .054). When analyzing subgroups in TriNetX, burned children aged 5 to 9 had significantly increased frequency of nonsurvival (P < .001). However, NBR data suggested that children aged 0 to 4 experience the highest frequency of mortality (P < .001). The nonsurvival distributions between these two large databases accurately reflect nonsurvival rates in burned children.