Plastic Surgery Outreach Clinics Expand Access to Cleft and Craniofacial Care in Mississippi.

ABSTRACT: Accessing treatment at ACPA (American Cleft Palate-Craniofacial Association)-approved centers is challenging for individuals in rural communities. This study aims to assess how pediatric plastic surgery outreach clinics impact access for patients with orofacial cleft and craniosynostosis in Mississippi. An isochrone map was used to determine mean travel times from Mississippi counties to the sole pediatric hospital and the only ACPA-approved team in the state. This analysis was done before and after the establishment of two outreach clinics to assess differences in travel times and cost of travel to specialized plastic surgery care. Two sample t-tests were used for analysis.The addition of outreach clinics in North and South Mississippi led to a significant reduction in mean travel times for patients with cleft and craniofacial diagnoses across the state's counties (1.81 hours vs 1.46 hours, P < 0.001). Noteworthy travel cost savings were observed after the introduction of outreach clinics when considering both the pandemic gas prices ($15.27 vs $9.80, P < 0.001) and post-pandemic prices ($36.52 vs $23.43, P < 0.001).The addition of outreach clinics in Mississippi has expanded access to specialized healthcare for patients with cleft and craniofacial differences resulting in reduced travel time and cost savings for these patients. Establishing specialty outreach clinics in other rural states across the United States may contribute significantly to reducing burden of care for patients with clefts and craniofacial differences. Future studies can further investigate whether the inclusion of outreach clinics improves follow-up rates and surgical outcomes for these patients.

Access to Certified Burn Centers in the United States: The Geospatial and Transport Cost of Transfer.

Specialized burn centers are critical to minimizing burn-associated morbidity and mortality. However, American Burn Association-verified burn centers are unequally distributed across the United States, and fewer centers are available for pediatric patients relative to adults. The economic burden of transporting patients to these centers contributes significantly to the high cost of burn care. This study quantifies inequitable burn care access in the contiguous United States due to age group and location as a function of physical proximity to a verified burn center and transportation cost. County-level distances to the nearest verified adult or pediatric burn center were determined and mapped. Distance calculations for each population were combined with transport cost data (2022 CMS Ambulance Fee Schedules) to estimate transportation costs for each population (adult vs pediatric, urban vs rural). Pediatric patients reside 30.5 miles further than adults from the nearest center, significantly increasing transportation costs. Ground and air transport costs also increased for rural versus urban patients. Notably, rural patients face almost double the cost of air transport. While physical proximity to burn care appears to differ only modestly across age and region, this marginal increase in distance is associated with significant economic impact. This study highlights physical and economic barriers to burn care access faced by rural and pediatric patients and underscores the critical need to improve equity in burn care access. Future studies should expand on this report's findings to more fully characterize the additional costs associated with inequitable burn care access.

Pediatric Palate Fractures: An Assessment of Patterns and Management at a Level 1 Trauma Center.

STUDY DESIGN: Literature discussing palate fractures in the pediatric population is limited. We performed a retrospective review of pediatric palatal fractures at our institution to better understand the impact of this fracture pattern in the pediatric patient. OBJECTIVES: The goal of our study is to analyze our institutional experience with pediatric palate fractures, focusing on epidemiology, concomitant injuries, and fracture management. METHODS: Records were collected for all palatal fractures in pediatric patients diagnosed between 2000 and 2016 at an urban Level I trauma center. Patient imaging was reviewed. Demographic characteristics and inpatient clinical data were recorded. RESULTS: Nine pediatric patients were diagnosed with fracture of the bony palate. Average age was twelve with male predominance (66%). Pedestrian struck injuries (33%) and motor vehicle accidents (33%) were the most common etiologies. Five patients sustained skull fractures. Three patients were found to have intracranial hemorrhage, two required emergent bolt placement. Two patients sustained cervical spine injury. One patient had severe facial hemorrhage requiring embolization. According to the Hendrickson classification, there were three type I fractures, two type II fractures, one type III fracture, one type IV fracture, and one type V fracture. Lefort I and/or alveolar fracture was present in every patient. Four patients underwent surgical treatment with open reduction and restoration of facial height with maxillomandibular fixation. Three patients underwent concomitant mandible fracture repair. CONCLUSIONS: Pediatric palatal fractures are rare and are usually accompanied by devastating concomitant injuries. Surgical repair of the palate in the pediatric patient is often necessary to restore facial height.

Pediatric Facial Fractures: An Assessment of Airway Management.

Pediatric facial fractures present unique and challenging management considerations, especially with regards to airway management. Anatomical differences in children increase both airway resistance and the difficulty of intubation. A surgical airway may be required if intubation is unable to be performed. The purpose of this study was to examine a single center's experience with pediatric facial fractures to determine the frequency of advanced airway use, as well as the risk factors that may predispose a patient to requiring an advanced airway. A retrospective review of all facial fractures at a level 1 trauma center was performed from 2000 to 2012. Patients age 18 years and younger were included. Patient demographics were collected, as well as location of fractures, concomitant injuries, services consulted, and surgical management strategies. Information was collected regarding the need for an advanced airway, including intubation and the need for a surgical airway. A total of 285 patients met inclusion criteria. Of these, 57 patients (20%) required emergency intubation and 5 (1.8%) required a surgical airway. Intubation was significantly related to fractures of the midface, frontal sinuses, spine, skull, and pelvis, as well as depressed Glasgow coma scores and traumatic brain injury. The need for a surgical airway is extremely uncommon (1.8%), and tracheostomy was only needed in the setting of penetrating head trauma. Both emergent intubation and tracheostomy are associated with complications, but these complications must be weighed against the potentially life-saving measure of securing an airway.

Digital store and forward imaging as a quality assessment tool for emergency plastic surgery consultations.

INTRODUCTION: Plastic surgery is a frequently consulted service in most emergency departments (EDs). The inclusion of a digital image with a plastic surgery consultation would allow the consultant to immediately assess the severity of the condition and either provide instruction to ED staff if minor or mobilize resources to facilitate operative management if more severe. METHODS: During a 4-month period, all plastic surgery consultations that were seen in person by one of 4 senior plastic surgery residents were included. In addition, an examination of all consultations seen during that time period at the plastic surgery clinic was undertaken to determine the quality of preclinic management. RESULTS: During the study period, 78 ED consultations were performed by the plastic surgery residents and included in the study. During the collection period, 374 patients were seen in the plastic surgery clinic. Of these, 154 patients were ED referrals. Evaluation by the senior author revealed that all consultations seen in the ED were appropriate and needed specialist management. Of the ED referrals sent to clinic, but not seen by a plastic surgery consultant in the ED several errors in patient management were noticed. CONCLUSIONS: The study demonstrated that ED consultations were appropriate for specialty evaluation in all cases, and that insufficient consultations were placed to provide optimal medical care. The role of telemedicine in creating more efficient and effective consultation processes is promising, but numerous legal barriers must be overcome before these modalities can be widely deployed.

An analysis of leading, lagging, and coincident economic indicators in the United States and its relationship to the volume of plastic surgery procedures performed: an update for 2012.

BACKGROUND: As physician compensation and reimbursement tightens throughout the United States, it is important for physicians to be aware of the influence that the economic environment has on the unique medical field of plastic and reconstructive surgery. This study will attempt to determine a relationship between the volume of different plastic surgical procedures and various economic indicators. METHODS: Information from the American Society of Plastic Surgeons' annual reports on plastic surgery statistics available on the Internet (http://www.plasticsurgery.org/Media/Statistics.html) was collected from the years 2000 through 2011. Yearly economic indicators were collected from readily available Web sites. RESULTS: In terms of the total number of plastic surgery procedures performed, there was a significant positive relationship with GDP, GDP per capita, personal income, consumer price index (CPI) (all), and CPI (medical), and a significant negative relationship with the issuance of new home permits. There was a significant positive relationship with total cosmetic procedures and GDP, GDP per capita, personal income, CPI (all), and CPI (medical), and a significant negative relationship with the issuance of new home permits. There was a significant positive relationship between cosmetic surgical procedures and the issuance of new home permits and the average prime rate charged by banks. There was a significant positive relationship with cosmetic minimally invasive procedures and GDP, GDP per capita, personal income, CPI (all), and CPI (medical), and a significant negative relationship with the issuance of new home permits. There was a significant negative relationship between reconstructive procedures and GDP, GDP per capita, personal income, CPI (all), and CPI (medical). CONCLUSIONS: Cosmetic minimally invasive procedures involve less downtime, are generally less expensive than surgical options, and are widely available, making it easier for patients to decide on them quickly during good economic times. Furthermore, it is apparent that plastic surgeons must be proficient at performing minimally invasive cosmetic procedures to maintain a clientele and offer patients a more affordable option during tough economic times. This may lead to further business growth during more favorable economic times.

An analysis of leading, lagging, and coincident economic indicators in the United States and its relationship to the volume of plastic surgery procedures performed.

In plastic surgery, 2 predominant practice environments exist, namely, the academic setting and private practice. These 2 groups cater their practice toward the needs and demands of 2 very different patient populations. The goal of this paper is to examine well-established economic indicators and delineate their relationship, if any, with the volume of different plastic surgical procedures performed in the United States. Information from the American Society of Plastic Surgeons' annual reports on plastic surgery statistics was collected from the year 2000 through 2010 and compared to readily available and established economic indicators. There was a significant positive relationship with total cosmetic procedures and gross domestic product (GDP), GDP per capita, personal income, consumer price index (CPI) (all), and CPI (medical). There was a significant positive relationship between cosmetic surgical procedures and the issuance of new home permits and the average prime rate charged by banks. There was a significant positive relationship with cosmetic minimally invasive procedures and GDP, GDP per capita, personal income, CPI (all), and CPI (medical). There was a significant negative relationship between reconstructive procedures and GDP, GDP per capita, personal income, CPI (all), and CPI (medical). Cosmetic minimally invasive procedures seem to be decided on relatively quickly during good economic times. Cosmetic surgical procedures seem to be more planned and less related to the economic environment. The plastic surgeon may use this relationship to tailor the focus of his or her practice to be best situated for economic fluctuations.