Impact of surgical technique on outcome measures in chest masculinization: A systemic review and meta-analysis.

BACKGROUND: Among plastic surgeons, there are several conventional techniques for performing chest surgery. Research on surgical approaches has focused cis-gender patients with medical conditions, such as breast cancer or gynecomastia, but has never studied transgender populations. The aim of this study is to perform the first systematic review of gender-affirming surgery (GAS) in transgender populations and determine postoperative outcomes differences in relation to surgical technique. METHODS: Two reviewers independently searched Medline, Embase, CINAHL, Web of Science, and Cochrane databases for studies published prior to 2021. Studies selected for inclusion were retrospective or prospective studies of adult transgender men undergoing GAS that utilized appropriate operative techniques and reported complications and/or patient-reported outcomes. RESULTS: A total of 26 randomized controlled trials, including 40 distinct populations and 3055 patients, were identified. Surgical techniques compared double incision free nipple graft (DIFNG) (2053 patients [67.20%]), pedicled nipple techniques (PNT) (297 [9.72%]), and periareolar techniques (PAT) (705 [23.08%]). Pairwise analysis found the lowest complication rates associated with procedures utilizing DIFNG, followed by PNT, then PAT. Patients with PAT had significantly higher satisfaction scores than DIFNG. CONCLUSIONS: This is the first systematic review to evaluate outcomes of chest surgery techniques among the transgender population. Results indicate significantly more complications for PAT compared to DIFNG or PNT. Analysis of patient-reported outcomes was limited due to heterogeneity in reporting.

Perioperative rates of deep vein thrombosis and pulmonary embolism in normal weight vs obese and morbidly obese surgical patients in the era post venous thromboembolism prophylaxis guidelines.

BACKGROUND: The increasing prevalence of obesity translates into a greater number of obese patients undergoing general surgery procedures. We questioned if increased awareness and recent prophylaxis guidelines impacted the incidence of venous thromboembolism (VTE) in the obese patients. METHODS: A total of 33,325 patients who underwent 4 common general surgery procedures from 2005 to 2009 were identified from the American College of Surgeons' National Surgical Quality Improvement Program database. Rates of VTE between 5 body mass index cohorts were compared with univariable analysis. RESULTS: No significant difference existed between rates of deep vein thrombosis or pulmonary embolism (PE) across the body mass index categories (P = .32 and P = .06, respectively). With the exception of the positive linear trend in the rate of PE for patients undergoing abdominal wall hernia repair (P < .01), there was no difference in deep vein thrombosis or PE rate exhibited by procedure. CONCLUSION: VTE rates in the obese patients are similar to that of the general population with the exception of PE in those undergoing abdominal wall hernia repair.

Biological age--a concept whose time has come: a preliminary study.

OBJECTIVE: Chronology poorly predicts biological age (BA) or physiologic reserve (PR). An objective approach to the heterogeneity of aging would greatly help clinical decision making in the elderly. MATERIALS AND METHODS: The first pilot study evaluated 130 "healthy" volunteers, ages 70 to 95 years. A summary BA/PR index was developed, using measures of endurance, strength, flexibility, balance, cognition, depression, comorbidity, and exercise. The second study applied the BA/PR concept to prediction of death after a first elective coronary artery bypass graft, using a Veterans Administration database. RESULTS: The BA/PR index was a better predictor of 3-year functional outcomes and death than was chronological age. In the coronary artery bypass graft study, the inclusion of BA/PR variables significantly improved prediction of 6-month and long-term death for Veterans Administration patients. CONCLUSIONS: The usefulness of a biological age (BA/PR) approach in predicting outcomes in the elderly was supported. Needed research should develop tools for routine "tracking" of the aging process.

Correlation of survivin mRNA detection with histologic diagnosis in normal endometrium and endometrial carcinoma.

BACKGROUND: The objective of this study was to determine if survivin mRNA expression is a marker of endometrioid adenocarcinoma and if survivin mRNA levels correlate with tumor grade and stage. METHODS: Twenty-six samples of endometrioid adenocarcinoma and 18 cases of benign endometrium were obtained at surgery. RNA was extracted from tissues and was used for quantitative real-time RT-PCR, targeting a 91-bp sequence of survivin mRNA and the levels were standardized to the levels of ribosomal RNA. Statistical analysis of the correlation between histologic diagnosis and the corrected survivin mRNA levels was performed by the Fisher Exact test and the Kruskal-Wallis test. RESULTS: Survivin mRNA was detected in all specimens. Survivin mRNA levels were increased in proliferative endometrium (P = 0.0509) and was increased in correlation with ascending grade in endometrioid adenocarcinoma (P = 0.01). CONCLUSION: Survivin mRNA is not a specific marker of endometrial cancer, but may reflect an important mechanism in tumor progression of the endometrial mucosa.

Quality improvement in cardiac care.

Quality improvement in cardiac care has made considerable progress over the past 30 years. During that period, there has been the development of multi-institutional databases to monitor outcomes following cardiothoracic surgery. These databases initially began using only volume and unadjusted operative (30-day) mortality as outcome criteria. There has been a progressive increase in their sophistication, with the building of risk models based on preoperative variables, which accurately predict the risk of adverse outcomes. Other outcomes have been added including risk-adjusted mortality and morbidity; efficiency outcomes such as length of stay, quality of life, functional health status, neuropsychological outcomes; and long-term outcomes.