An Evaluation of the Presence of Diversity, Equity, and Inclusion Information on Plastic Surgery Residency Program Websites.

BACKGROUND: Increasing the diversity of plastic surgery trainees is an important step in providing optimal care for our increasingly diverse patient populations. Given that information presented on residency programs' websites can strongly influence applicants' decisions to apply to or rank a program, demonstrating a commitment to diversity, equity, and inclusion (DEI) on program websites may aid in recruiting applicants with URM background. METHODS: Using 8 DEI-related criteria, we evaluated the websites of 103 plastic surgery residency programs for the presence of DEI-related content during the month of June 2022. Each program was evaluated by 2 individual graders. We analyzed the data with confirmatory factor analysis in R using the Lavaan package. RESULTS: On average, programs fulfilled 2.1 ± 1.6 of the metrics with a range of 0-7 fulfilled per program. Our model revealed that the criteria were a high-quality (P < 0.0001) measure of DEI-related metrics. There was a significant association between program size and presence of DEI-related criteria (linear 0.039; quadratic -0.005; both P < 0.01), such that mid-sized programs (16-18 residents) had the highest quality of DEI advertising compared to both small and large programs. Programs associated with a USNWR Top 20 Hospital were less likely to achieve high level of DEI-related criteria than other programs (P < 0.0001). CONCLUSION: Mid-sized programs had greater DEI quality on their websites, while smaller and larger programs similarly had poorer assessed quality. There is room for all programs to improve the presence of DEI-related material on their websites, especially related to care of transgender populations.

Is the h-Index Enough? A Comprehensive Bibliometric Analysis of 871 Academic Plastic Surgeons and Their Departments/Divisions.

BACKGROUND: In plastic surgery academia, research output is heavily used as a metric of accreditation, from assessing residency applicants to evaluating faculty for promotion. The h index, defined as an author's h papers with at least h citations, is commonly used as a measure of academic success. However, the index itself disfavors junior researchers, favors publication quantity, and discounts highly cited works. Given the importance of bibliometrics within plastic surgery, there is a paramount need to adopt additional metrics to measure research productivity. The authors sought to validate the use of time-independent bibliometrics to complement the h index in measuring citation impact. METHODS: The genders and academic titles of plastic surgeons affiliated with US plastic surgery programs were recorded. Author publications were retrieved from Scopus. Bibliometrics software was used to calculate the following metrics per surgeon: h index, e index, and g index. Time-adjusted versions of these indices were used to correct for the number of years since first publication. Medians and interquartile ranges (IQRs) are reported. Departmental ranks were determined using the cumulative sum of time-corrected indices and compared with Doximity departmental research rankings. P < 0.05 was deemed significant. RESULTS: Indices were calculated for 871 academic plastic surgeons in 85 departments/divisions. Men had statistically greater h index (median, 13.0 [IQR, 7.0-21.0] vs 6.0 [IQR, 3.0-13]; P < 0.001), e index (18.3 [IQR, 10.0-28.7] vs 11.1 [IQR, 5.5-18.4]; P < 0.001), and g index (23.0 [IQR, 11.0-39.0] vs 11.0 [IQR, 5.0-22.0]; P < 0.001) than women. Professors had the highest median time-uncorrected indices. After adjusting for the number of years since an author's first publication, there were no significant differences in m quotient (men: 0.66 [IQR, 0.40-0.98] vs women: 0.57 [IQR, 0.33-0.90]; P = 0.05) and ec index (men: 0.93 [IQR, 0.62-1.3] vs women: 0.87 [IQR, 0.50-1.3]; P = 0.08) between genders. Departmental chairs had significantly higher indices than other faculty after correcting for time. The calculated program rankings were low to moderately correlated with that of Doximity (correlation coefficient τ = 0.49 [95% confidence interval, 0.37-0.59; P < 0.001]). CONCLUSIONS: Men and women have statistically similar citation patterns after correcting for the time. Citation differences between academic levels are less pronounced when controlling for time, suggesting comparable research quality between academic roles.

Conversion Rate of Abstracts Presented at Plastic Surgery The Meeting From 2010 to 2019: A 10-Year Analysis of Factors for Success.

BACKGROUND: Presentations are an important means of knowledge generation. Publication of these studies is important for dissemination of findings beyond meeting attendees. We analyzed a 10-year sample of presented abstracts at Plastic Surgery The Meeting and describe factors that improve rate and speed of conversion to peer-reviewed publication. METHODS: Abstracts presented between 2010 and 2019 at Plastic Surgery The Meeting were sourced from the American Society of Plastic Surgery Abstract Archive. A random sample of 100 abstracts from each year was evaluated. Abstract information and demographics were recorded. The title or author and keywords of each abstract were searched using a standardized workflow to find a corresponding published paper on PubMed, Google Scholar, and Google. Data were analyzed for trends and factors affecting conversion rate. RESULTS: A total of 983 presented abstracts were included. The conversion rate was 54.1%. Residents and fellows constituted the largest proportion of presenters (38.4%). There was a significant increase in medical student and research fellow presenters during the study period (P < 0.001). Conversion rate was not affected by the research rank of a presenter's affiliated institution (ß = 1.001, P = 0.89), geographic location (P = 0.60), or subspecialty tract (P = 0.73). US academics had a higher conversion rate (61.8%) than US nonacademics (32.7%) or international presenters (47.1%) (P < 0.001). Medical students had the highest conversion rate (65.6%); attendings had the lowest (45.0%). Research fellows had the lowest average time to publication (11.6 months, P = 0.007). CONCLUSIONS: Lower levels of training, factors associated with increased institution-level support, and research quality affect rate and time to publication. These findings highlight the success of current models featuring medical student and research fellow-led projects with strong resident and faculty mentorship.

Ongoing Challenges With Price Transparency in Hospital Charges for Hand Procedures.

In 2020, the Centers for Medicare & Medicaid Services issued a historic rule on price transparency that aimed to better inform Americans about their health care costs by requiring hospitals to publicly provide pricing information on their items and services. In this review article, we describe the current gaps in transparency that persist after the implementation of the rule, from incomplete pricing files to noncompliance despite the issuance of monetary penalties by Centers for Medicare & Medicaid Services. Price transparency is vital for hand and upper extremity procedures, given their cost variation and patient desire for more financial discussions with their physicians regarding these procedures. Further improvements and interventions by various stakeholders are necessary to improve the current state of hospital price transparency and cost information for these patients and for anyone who seeks to make informed health care decisions. Policymakers should enforce stronger financial interventions and penalties and promote the use of bundled payments to facilitate better compliance by hospitals through a more expanded and accessible display of health care service costs. To help increase health care financial literacy among consumers, hand surgeons and hospital staff should engage in more dialog regarding health care prices and financial considerations with their patients.

The Impact of Venous Reconstruction on Finger Replantation Success Rates Based on Level of Injury.

PURPOSE: The requirement for anatomic venous reconstruction in digit replantation is an ongoing area of research. In this study, we evaluated our institutional experience to study whether replantation success is affected by the presence or absence of vein repair, stratified by the level of injury. METHODS: A retrospective review was performed at an urban, level-1 trauma center of all single-digit replantations performed in adults from 2012 to 2021. Patient demographics, injury mechanism, level of injury, whether a vein was repaired, and replant survival were recorded. RESULTS: Sixty-seven single replanted digits were included. Patients were, on average, 38 years old, and 94% were men. The most common mechanism of injury was a sharp laceration (81%). The overall survival rates for all replantations were 68.7% (46/67) and 60% (12/20) for distal finger replantation. Patients with digital replantations at Tamai zone III or more proximal exhibited a 1.8 times increase in survival rates when one vein was repaired versus zero veins (84.4% vs 46.7%). Patients with digital replantations at Tamai zones I and II exhibited similar survival rates. CONCLUSIONS: Replantations at or proximal to the middle phalanx should be repaired with at least one artery and vein to maximize the chance for success. However, for distal finger replantations, artery-only replantation is a viable option when vein anastomosis is not achievable. TYPO OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Rethinking the Need for Nail Plate Removal: A Comparison of the Risks Between Standard Nail Bed Repair and Nonoperative Management.

PURPOSE: Nail bed injuries are commonly treated with nail plate removal and repair due to concern for future nail deformity. There is controversy whether this is necessary. We compared the outcomes for adult patients with simple nail bed lacerations who underwent either formal nail bed repair or nonoperative management. METHODS: A retrospective cohort study was performed of adult patients with nail bed lacerations from 2012 to 2019. Nail bed lacerations were diagnosed in patients with fingertip injuries resulting in subungual hematoma greater than 50% or in any subungual hematoma in the setting of a distal phalanx fracture. All patients included had an intact nail plate. Patients were treated with nail bed laceration repair or nonoperatively without nail plate removal. The primary outcome was the development of a nail deformity. Secondary outcomes included infection, fracture nonunion, and patient-reported functional outcomes using the quick Disabilities of the Arm, Shoulder and Hand score. RESULTS: Thirty-eight patients with nail bed lacerations were treated nonoperatively, and 40 patients were treated with nail bed repair. The average follow-up time was 4.5 weeks in the office. In addition, 1-year evaluation of patients was performed through telephone interview. The patients in the nonoperative group exhibited no statistically significant difference in the calculated risk for nail deformities compared with the nail bed repair group (13% vs 23%, relative risk = 0.58, P = 0.40, 95% confidence interval = 0.42-1.25). There were no significant differences in secondary outcomes or quick Disabilities of the Arm, Shoulder and Hand scores between groups. CONCLUSIONS: The authors observed no meaningful difference in the rate of nail deformities in adult patients who underwent nail bed repair compared with those managed nonoperatively.

Persistent Trigger Finger Due to Tendon Subluxation.

We report the case of an adult patient with persistence of triggering after A1 pulley division in the ring finger, which was caused by flexor digitorum superficialis tendon subluxation. This resolved after longitudinal flexor digitorum superficialis tendon separation.

Are You on the Right Platform? A Conjoint Analysis of Social Media Preferences in Aesthetic Surgery Patients.

BACKGROUND: Social media has become an indispensable tool for patients to learn about aesthetic surgery. Currently, procedure-specific patient preferences for social media platforms and content are unknown. OBJECTIVES: The authors sought to evaluate social media preferences of patients seeking aesthetic surgery. METHODS: We utilized a choice-based conjoint analysis survey to analyze the preferences of patients seeking 3 common aesthetic procedures: breast augmentation (BA), facial rejuvenation (FR), and combined breast/abdominal surgery (BAB). Participants were asked to choose among social media platforms (Facebook, Twitter, Instagram, Snapchat, Pinterest, Tumblr, YouTube), information extent (basic, moderate, comprehensive), delivery mechanism (prerecorded video, live video, photographs, text description), messenger (surgeon, nurse/clinic staff, patient), and option for interactivity (yes/no). The survey was administered using an Internet crowdsourcing service (Amazon Mechanical Turk). RESULTS: A total of 647 participants were recruited: 201 in BA, 255 in FR, and 191 in BAB. Among attributes surveyed, participants in all 3 groups (BA, FR, BAB) valued social media platform as the most important (30.9%, 33.1%, 31.4%), followed by information extent (23.1%, 22.9%, 21.6%), delivery mechanism (18.9%, 17.4%, 18%), messenger (16%, 17%, 17.2%), and interactivity (11.1%, 9.8%, 11.8%). Within these attributes, Facebook ranked as the preferred platform, with comprehensive information extent, live video as the delivery mechanism, and surgeon as the messenger as most preferred. CONCLUSIONS: The choice of social media platform is the most important factor for patients, and they indicated a preference for comprehensive information delivered by the surgeon via live video on Facebook. Our study elucidates social media usage in common aesthetic populations, which can help improve aesthetic patient outreach.

Use of a Purse-String Suture to Reduce Skin Graft Requirements.

BACKGROUND: When a wound cannot be closed in a linear fashion and either a local flap or skin graft is needed, a purse-string suture can be a useful adjunct to wound closure. Local tissue architecture is maintained in cases where clear surgical margins have not been achieved at the time of extirpative skin cancer surgery. We hypothesized that this technique could be applied to a range of wound sizes and locations to avoid or reduce the need for skin grafting. METHODS: We applied a non-absorbable purse-string suture to wounds in 18 patients over a 15-month period and measured the defect size before and after application of the suture intraoperatively. Residual defects were covered with full- or split-thickness skin grafts. Postoperative wound area, scar hypertrophy, partial graft loss and dehiscence following suture removal were additional outcomes. RESULTS: Ten patients achieved primary wound closure with the purse-string suture, while additional skin grafting was required in eight patients. Wounds closed primarily did not re-expand. Skin-grafted subjects had a 53.8% intraoperative wound area reduction but the skin grafts expanded during recovery, and ultimate reduction diminished to 11% on late follow-up. Wounds accounting for this late re-expansion were located on the extremities. CONCLUSIONS: Purse-string sutures are helpful for wound closure in wounds that cannot be closed primarily. They can decrease the size of a skin graft if the wound cannot be closed completely. Wound re-expansion, particularly in extremity defects, may occur following early removal of the tension-bearing purse string.

Sex Bias in Hand Surgery Research.

It has been long recognized that sex-based biases related to participant inclusion exist in research. To help address inequities in research participation, the National Institutes of Health Revitalization Act was passed into law in 1993. Although this act was primarily designed to increase inclusion of females and minorities in research funded by National Institutes of Health, it has also helped raise global awareness of the value of routinely including females and minority groups in research. Subsequent work has demonstrated a continued gap in inclusion of females in medical and surgical research and female animals and cell lines in basic science research. Hand surgeons have recognized that certain conditions have greater incidence in one sex over the other, but there has been no widespread discussion on whether, when, and how sex should be used as an outcomes variable. This review investigated the recent hand surgery literature to assess for equity in inclusion of both sexes in research as well as whether outcomes were analyzed based on sex.

The effect of an educational program on opioid prescription patterns in hand surgery: a quality improvement program.

PURPOSE: To assess the variability of opioid prescription patterns among hand surgeons in a single practice and to attempt to standardize postoperative prescription sizes based on the patient's surgical procedure. METHODS: We performed a preliminary chart review to assess the range of prescription sizes for 4 common hand surgery procedures. A group of hand surgeons agreed to write postoperative opioid prescriptions based on an evaluation of historical prescription patterns. An educational assist device (the pink card) was created to serve as a memory prompt and was given to physicians, midlevel practitioners, and trainees. Subsequent chart reviews of number of pills prescribed were done 3 and 15 months later. RESULTS: After implementation of the pink card, the average postoperative prescription size decreased for all 4 case types by 15% to 48%, reaching statistical significance for 2 of the procedures. Variability in prescription sizes decreased in all cases. There was a trend toward a decreasing number of prescription refills over the course of the study. There was no evidence that patients were obtaining refills from other sources within our multigroup practice. CONCLUSIONS: Although generalized opioid prescription guidelines exist, they lack specificity. Our multimodal approach using a simple educational-assist device and changes to postoperative order sets significantly affected surgeon behavior without evidence of inadequate treatment of pain. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.

The optimization of peripheral nerve recovery using cortical reorganization techniques: A retrospective study of wrist level nerve repairs.

STUDY DESIGN: Retrospective case series. INTRODUCTION: Outcomes following peripheral nerve repairs have not significantly improved over the past few decades. A new protocol using cortical reorganization techniques was developed with the goal of improving nerve recovery in the hand. PURPOSE OF THE STUDY: To determine if early sensory re-education using cortical reorganization techniques improved sensory outcomes in the hand after repair of wrist-level nerve injuries. METHODS: A retrospective study was completed of wrist-level peripheral nerve repairs in patients who underwent a sensory re-education protocol which included cutaneous anesthesia, tactile stimulation, and sensory and motor imagery. Data for static 2-point discrimination, Semmes Weinstein monofilament assessments and the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores were collected. RESULTS: At four months post-repair, three of seven of the median nerve lacerations had static 2-point discrimination of 7 mm or less in at least one digit. Using the Semmes Weinstein monofilaments, 9 of 11 nerve repairs felt the 4.31 filament (protective) or better by eleven months with five able to perceive the 2.83 filament (normal) in that time frame. CONCLUSIONS: This limited retrospective study suggests that early sensory re-education using cortical reorganization techniques may improve sensory outcomes. A larger scale study is indicated to confirm our findings. LEVEL OF EVIDENCE: IV.

Current uses of botulinum toxin A as an adjunct to hand therapy interventions of hand conditions.

STUDY DESIGN: Literature review. DISCUSSION: Botulinum toxin A, a neurotoxin causing temporary muscle paralysis at the neuromuscular junction, has been used to treat multiple acquired conditions of the hand and upper extremity. Initially approved for use in treating blepharospasm and strabismus in the 1980s, indications have expanded to include spasticity associated with cerebrovascular accidents, vasospastic disorders, focal dystonias, and pain conditions. This article reviews the current literature discussing the efficacy of botulinum toxin A in management of disorders of the hand and upper extremity relevant to hand therapists. LEVEL OF EVIDENCE: NA.

Common Peroneal Nerve and Tarsal Tunnel Release Surgery in an Adolescent Male with Hunter Syndrome: Illustrative Case.

BACKGROUND: Children with Hunter syndrome have a high prevalence of nerve compression syndromes given the buildup of glycosaminoglycans in the tendon sheaths and soft tissue structures. These are often comorbid with orthopedic conditions given joint and tendon contractures due to the same pathology. While carpal tunnel syndrome and surgical treatment has been well-reported in this population, the literature on lower extremity nerve compression syndromes and their treatment in Hunter syndrome is sparse. OBSERVATIONS: We report the case of a 13-year-old male with a history of Hunter syndrome who presented with toe-walking and tenderness over the peroneal and tarsal tunnel areas. He underwent bilateral common peroneal nerve and tarsal tunnel releases, with findings of severe nerve compression and hypertrophied soft tissue structures demonstrating fibromuscular scarring on pathology. Post-operatively, the patient's family reported subjective improvement in lower extremity mobility and plantar flexion. LESSONS: In this case, peroneal and tarsal nerve compression were diagnosed clinically and treated effectively with surgical release and postoperative ankle casting. Given the wide differential of common comorbid orthopedic conditions in Hunter syndrome and the lack of validated electrodiagnostic normative values in this population, the history and physical examination and consideration of nerve compression syndromes are tantamount for successful workup and treatment of gait abnormalities in the child with Hunter syndrome.

Characterizing the Timing of Surgical Repair of Congenital Hand Differences in the United States.

Background: Suggested timing of reconstruction of congenital hand differences varies widely. The goal of timely intervention is to achieve near-normal appearance and function. We evaluated national trends in surgical timing of congenital hand differences to determine whether interventions align with the literature. Methods: Recommended ages for surgical reconstruction were identified. The Pediatric National Surgical Quality Improvement Project database was queried from 2012 to 2020 for children who underwent surgery for simple syndactyly (SS), complex syndactyly (CS), polydactyly, or congenital trigger finger. Subgroup analysis was conducted to assess whether the surgeon's subspecialty (plastic surgery vs orthopedic surgery, pediatric vs generalist) influenced the timing of repair. Results: Congenital trigger finger and CS reconstructions occurred largely within the recommended age range (73.8% and 52.2%, respectively). Polydactyly repairs primarily occurred earlier than the recommendations (54.0%). Timing of SS reconstruction was split, either occurring before (44.3%) or after (41.4%) the recommendations. For children with polydactyly, plastic surgeons were more likely to perform polydactyly reconstruction at a younger age compared with orthopedic surgeons (P = .0001). Conclusions: Established expert recommendations for the treatment of congenital hand differences are largely not followed in practice in the United States. This suggests that practice patterns may not be determined by the surgical literature.

The Impact of a Centralized Plastic Surgery Research Infrastructure on Scholarly Productivity and Output.

Although research and innovation is a key within the field of plastic and reconstructive surgery, the impact of team structure, interpersonal dynamics, and/or standardized infrastructure on scholarly output has been infrequently studied. In this work, we present the formation and implementation of a novel plastic surgery research program that aims to unite previously disparate clinical and translational research efforts at our institution to facilitate critical inquiry. From July 2022 to June 2023, our department launched a pilot research program based on three pillars: (1) formalization of a research curriculum (monthly research meetings for agenda setting and discussion for project honing, formal research leadership for meeting facilitation and workflow regulation), (2) development of a centralized database to compile ongoing research (Google Drive repository to house all ongoing research documents, facilitate real-time editing, and provide resources/templates for assisting in the research process), and (3) bolstering of a core research identity built on mentorship and collaboration (more frequent interactions to shift previously siloed faculty-student mentorship into a robust milieu of intercollaboration). During the first year, we saw an increased number of publications and presentations, as well as robust participation and contribution from faculty, residents, and medical students. Future directions will focus on addressing resource limitation, such as project idea availability and funding, to sustain the success and growth of this novel research infrastructure.

Examining Racial and Gender Diversity in the Plastic Surgery Pipeline: Where is the Leak?

Background: There is limited information about minority representation throughout the plastic and reconstructive surgery (PRS) pipeline. The aim of this study was to examine trends in representation among minorities at different stages of the PRS training pathway, starting with potential candidates in high school through practicing physicians. Methods: The PRS pipeline was defined as high school; college; medical school applicants, matriculants, and graduates; PRS residency applicants, matriculants, and active residents; and PRS practicing physicians. Racial data for each stage were obtained from the US Census and Association of American Medical Colleges. The proportion of races at each stage were divided by their US population counterpart proportions to produce representation quotients (RQs). Medians and interquartile ranges (IQRs) are reported. Mann-Whitney U tests compared RQ values within identities between successive stages. Results: Black students had high representation in high school (RQ = 1.26 [IQR: 1.21-1.29]) but had significant, stepwise decreases in representation in subsequent stages. A similar trend was observed for Hispanic individuals, who had their highest representation in high school (1.43 [1.37-1.50]), followed by significant decreases in RQ at nearly every subsequent stage up to and including practicing physicians (0.30 [0.28-0.31). Asian individuals were overrepresented at every stage (high school RQ: 1.01 [1.00-1.03]; practicing physician RQ: 2.30 [2.27-2.32]). White individuals were underrepresented before residency but had an RQ that approximated 1 in subsequent stages. Conclusions: Racial minorities experienced decreases in representation at each successive stage in the PRS pipeline following high school. Ongoing diversity efforts should focus on premedical recruitment and professional support for minority students.

Refining Treatment Strategies in Patients With Fingertip Wounds and End-Stage Renal Disease.

BACKGROUND: Individuals with end-stage renal disease (ESRD) and fingertip wounds are at high risk of poor wound healing, ultimately requiring amputations. Optimal performance of upper extremity amputation (UEA) in patients with ESRD is important to decrease complications and minimize total operative procedures needed. This study evaluated outcomes of UEA in patients with ESRD and described risk factors predisposing patients to complications. METHODS: A retrospective analysis of patients receiving nontraumatic UEA for fingertip wounds was conducted, stratified by patients with and without ESRD. Demographics, comorbidities, complications, and hospital course were analyzed between groups for differences. Subanalysis of patients with ESRD was conducted to characterize operative course and predictors of complications. RESULTS: A total of 132 patients were included, 106 controls and 26 with ESRD. Compared with controls, patients with ESRD required more amputations (P < .001) and total operations (P < .001) to achieve wound healing. Patients with ESRD experienced higher rates of postoperative complications (P < .001). Predictors for complications in patients with ESRD were comorbid diabetes (odds ratio [OR]: 45; 95% confidence interval [CI], 1.7-1226.9), vascular disease (OR: 30; 95% CI, 2-441.8), arterial calcification (OR: 18; 95% CI, 1.56-207.5), and presence of a hemodialysis shunt in the affected arm (OR: 18; 95% CI, 1.56-207.5). Within patients with ESRD, initial amputation at, or proximal to, the metacarpophalangeal joint (MCPJ) led to fewer amputations (1.2 vs 2.19, P = .04) and fewer total operative procedures (4.1 vs 6.6, P = .03), compared with initial amputation distal to the MCPJ. CONCLUSION: In nontraumatic fingertip wounds, patients with ESRD had worse operative outcomes than patients without ESRD. More aggressive management of fingertip wounds using earlier and more proximal initial amputations may expedite wound healing in certain high-risk patients with ESRD.

An analysis of community-level socioeconomic status effects on pricing transparency and variability of hand surgery procedures.

BACKGROUND: The Hospital Price Transparency final rule requires hospitals to publish pricing information about provided items and services via two methods: a comprehensive machine-readable file (MRF), and a display tool of selected shoppable services. Using MRFs on hospital websites, we examined trends in pricing transparency and variation in association with community-level socioeconomic factors for three common hand surgery procedures among AAMC-affiliated hospitals. METHODS: Available discount cash prices and payer-specific negotiated prices for CPT codes 64721, 26615, and 25111 were recorded. Multivariate analysis was used to stratify hospitals into two groups based on their area's median household income, percent uninsured, and GPCI practice expense scores. Generalized linear mixed effects modeling was used to evaluate price variability against community-level financial characteristics of the patient population. RESULTS: Of hospitals that met selection criteria, a majority did not display discount cash prices and payer-specific negotiated prices for the three procedures. Hospitals in lower-income and higher percentage uninsured areas tended to charge a higher average payer-specific negotiated price for CPT code 25111. They also tended to have greater variation in payer-specific negotiated prices than hospitals found in higher-income and lower percentage uninsured areas. CONCLUSIONS: This study demonstrates that considerable pricing variation and incomplete transparency exists for CPT codes 64721, 26615, and 25111 among AAMC-affiliated hospitals. Patients in lower-income and higher-percentage uninsured areas are more exposed to a higher variability and average of negotiated prices than those in higher-income areas, which may translate to higher out-of-pocket costs for those with higher coinsurance and less socioeconomic prowess.

The Effect of Upper Extremity Slings (UESs) on Balance in Young Adults.

INTRODUCTION: Upper extremity slings (UESs) are frequently provided for patients with a hand or forearm injury. However, their effect on balance has not been well explored. We sought to characterize the effect of a UES on balance in young adults. METHODS: Healthy young adult participants with no injuries acting as a proxy for the general young adult patient population using UESs balanced on a BioDex Balance System platform: once while wearing a UES and once without wearing it, to serve as their own control. Participant weight, height, gender, hand dominance, overall stability index, anterior/posterior stability index, and medial/lateral stability index were recorded. Comparisons were analyzed with paired t-tests and linear regression analysis.  Results: No significant difference in the three stability index scores were found between UES and no UES usage. Height and weight were found to have positive significant relationships with the overall stability index during UES usage.  Conclusions: Our study demonstrates the feasibility of assessing balance discrepancies between the sling and nonsling usage in a broader patient population and suggests that height and weight may impact balance negatively during UES use.