Assessing the Influence of Intraoperative Core Body Temperature on Postoperative Venous Thromboembolism after Abdominal Wall Reconstruction.

Background: Venous thromboembolism (VTE) is a dangerous postoperative complication after abdominal wall reconstruction (AWR). Intraoperative core body temperature has been associated with thrombotic events in other surgical contexts. This study examines the effects of intraoperative temperature on VTE rate after AWR. Methods: A retrospective study was performed on AWR patients. Cohorts were defined by postoperative 30-day VTE. Intraoperative core body temperature was recorded as the minimum, maximum, and mean intraoperative temperatures. Study variables were analyzed with logistic regression and cutoff analysis to assess for association with VTE. Results: In total, 344 patients met inclusion criteria. Fourteen patients were diagnosed with 30-day VTE for an incidence of 4.1%. The VTE cohort had a longer median inpatient stay (8 days versus 5 days, P < 0.001) and greater intraoperative change in peak inspiratory pressure (3 mm H2O versus 1 mm H2O, P = 0.01) than the non-VTE cohort. Operative duration [odds ratio (OR) = 1.32, P = 0.01], length of stay (OR = 1.07, P = 0.001), and intraoperative PIP difference (OR = 1.18, P = 0.045) were significantly associated with 30-day VTE on univariable regression. Immunocompromised status (OR = 4.1, P = 0.023; OR = 4.0, P = 0.025) and length of stay (OR = 1.1, P < 0.001; OR = 1.1, P < 0.001) were significant predictors of 30-day VTE on two multivariable regression models. No significant associations were found between temperature metrics and 30-day VTE on cutoff point or regression analysis. Conclusions: Intraoperative core body temperature did not associate with 30-day VTE after AWR, though operative duration, length of stay, immunocompromised status, and intraoperative PIP difference did. Surgeons should remain mindful of VTE risk after AWR, and future research is warranted to elucidate all contributing factors.

Mesh Strip Repair for Midline Ventral Hernias: A Case Series.

Background: Polypropylene mesh strip repair is a novel method of hernia closure. Currently, there is limited representation in the literature regarding both the reproducibility of this method and its outcomes. The present study sought to analyze a second institution's experience with fascial closure using the mesh strip technique with long-term follow-up. Methods: A retrospective review of all patients undergoing abdominal wall reconstruction by the senior author was performed. Patients undergoing midline ventral hernia repair with mesh strip only fascial closure and greater than 1 year follow-up were including for analysis. Demographic data; operative details; and outcomes, specifically presence and timing of hernia recurrence, were recorded. Results: Eighteen patients met inclusion criteria. Average follow-up was 860 ±â€…307 days. Nine patients (50%) had recurrence of their hernia after repair. Average time to recurrence was 602 ±â€…406 days, with the earliest recurrence occurring at 126 days postoperatively. Seven patients (39%) underwent concurrent anterior component separation (four unilateral, three bilateral), of which there were three recurrences, all occurring in patients with bilateral anterior component separation. Conclusions: The mesh strip repair is a novel technique that shows uncertain reproducibility of outcomes, specifically with concurrent component separation techniques. With the recent Food and Drug Administration approval of a mesh suture, further multi-institutional analysis will allow for better characterization of the outcomes and indications for this technique.

The Plastic Surgery Central Application versus ERAS: Which is Preferred?

Background: The Plastic Surgery Central Application (PSCA), designed to provide an equitable and streamlined application for both applicants and programs, was first designed in 2019, piloted in the 2020-21 application cycle, and is now in its fourth cycle in 2023-24. It has included preference signaling since the 2022-23 cycle, a feature in which applicants can send five "signals" to programs to express interest. We surveyed both program directors (PDs) and applicants following the 2023 match on their perceptions of PSCA versus Electronic Residency Application Service (ERAS). Methods: Surveys were deployed to applicants from three integrated plastic surgery programs during the 2022-23 cycle and all PDs. Respondents were asked basic demographic information, which application system they preferred: PSCA or ERAS, how well they were able to highlight/evaluate different areas of the application, and about their experiences specifically with preference signaling. Results: Forty-two (48%) PDs and 93 (29%) applicants responded. Most PDs (72%) and applicants (59%) preferred PSCA, with only 18% and 27% preferring ERAS. The remainder had no preference. Ninety-three percent of applicants reported that the cost savings of the PSCA were important. Most applicants (78%) and PDs (80%) were in favor or strongly in favor of the preference signaling program. Conclusions: Most applicants and PDs prefer PSCA over ERAS. These data, in conjunction with the cost savings, suggest that the PSCA may be a better alternative for the integrated plastic surgery match. Future analyses of these application systems will help provide the best application for prospective residents.

Having Social Media among Integrated Plastic Surgery Applicants: Is It Needed to Match?

Background: Little information exists on the perceptions of integrated plastic and reconstructive surgery (PRS) residency applicants on the need for having social media (SoMe) during the application process. Methods: A cross-sectional survey study was conducted during the 2022 match cycle to assess integrated PRS residency applicants' perceptions on the role of SoMe during the match. Univariate and multivariate analyses were performed on variables of interest. Qualitative analysis was conducted on free-form responses. Results: Seventy-nine surveys were completed (response rate: 24%). The majority of respondents were educated in the United States (92%). Instagram was the most commonly used SoMe platform (92%). Of those surveyed, 18% thought that SoMe was beneficial to the application process. Twenty-nine percent of respondents agreed that a SoMe presence increases one's chances of matching into PRS residency (41% disagreed and 30% responded neutrally). Forty-four percent endorsed stress about maintaining a SoMe presence in PRS. Having mentors who recommended maintaining a SoMe presence was associated with the belief that SoMe increases one's chances of matching [odds ratio (OR) 8.1, 95% confidence interval (CI) 1.1-40.4, P = 0.011] and stress about maintaining a SoMe presence (OR 6.3, 95% CI 1.2-33.3, P = 0.030). Applicants who did research years had lower odds of experiencing stress (OR 0.16, 95% CI 0.04-0.70, P = 0.015). Conclusions: The growing role of SoMe in the residency selection process may be exacerbating applicants' stress and anxiety. PRS programs may consider establishing clear policies for how SoMe will be used in evaluating candidates.

Workplace Bias Affecting Applicants to Independent Plastic Surgery Residencies.

Background: This study explores factors that encourage residents to apply to independent plastic surgery residencies to gain insight into whether they faced bias as a result of this decision. Methods: Resident applicants who applied to two academic independent plastic surgery residencies in 2021 and 2022 were emailed a survey consisting of 25 questions. Responses were collected anonymously and analyzed. Descriptive statistics were performed, and subgroup analyses were conducted with Fisher exact and Pearson χ2 testing. Results: Thirty-nine complete responses were included for analysis (response rate 22.7%). Participants were asked what encouraged them to go into plastic surgery during residency. The most common reasons were scrubbing in on plastic surgery cases and interactions with plastic surgery faculty/residents, with each reason cited by 30 respondents (76.8%). Further, 20.5% of residents agreed or strongly agreed that they felt unsupported by their program director in their decision to apply into plastic surgery. Likewise, 64.1% of respondents agreed or strongly agreed to having experienced demeaning comments or jokes by faculty about their choice of plastic surgery. Consequently, 17.9% agreed or strongly agreed that they developed stress or anxiety due to how co-residents and/or faculty treated them regarding their decision to pursue plastic surgery. Conclusions: General surgery residents planning to apply to independent plastic surgery residency may experience workplace biases related to their career decision. An important opportunity exists to support independent applicants and to provide mentorship.

The Value of Case Reports in Plastic Surgery: An Analysis of 68,444 Articles across Six Major Plastic Surgery Journals.

Case reports provide a salient contribution to the field of plastic surgery through the timely dissemination of knowledge on previously underreported topics. Once a time-honored hallmark of the surgical literature, the perceived value of case reports has decreased with the ongoing prioritization of higher levels of evidence. In this study, we aimed to assess long-term trends in case report publication rates and discuss the continued merits of case reports in the modern-day landscape. Methods: A PubMed search was used to identify articles published in six prominent plastic surgery journals since 1980. Articles were separated as case reports versus all other publication types. The total number of articles published by group was tracked, and citation rates were compared across groups. Additionally, the most cited articles from each journal were identified for both groups. Results: A total of 68,444 articles were included for analysis. In 1980, there were 181 case reports published compared with 413 other articles across all six journals. In 2022, there were 188 case reports published compared with 3343 other articles. When comparing citations per year of case reports versus other article types across all journals since 1980, case reports were found to be cited significantly less frequently (P < 0.001). Conclusions: Case reports have been published and cited less frequently than other types of literature over the last 42 years. However, despite these trends, they have demonstrated significant historical contributions and provide continued value as an impactful forum for highlighting novel clinical entities.

Trends in Integrated Plastic Surgery Applicant, Resident, and Junior Attending Research Productivity.

INTRODUCTION: Research productivity is critical for matching into integrated plastic surgery residency. This study will identify how pre and intraresidency research productivity correlate with resident/junior attending productivity. MATERIALS AND METHODS: Retrospective review from 2006 to 2015 issues of the American Board of Plastic Surgery's Annual Newsletter to Diplomates was performed to identify newly board certified plastic surgeons. Only surgeons from US medical schools matching directly into integrated programs were included. Residency type/length, graduation year from medical school, and publication counts were recorded for each surgeon. Publications were categorized as preresidency, intraresidency, and junior attending (6 y post residency/fellowship training). RESULTS: Six hundred fifty-five integrated plastic surgery graduates were analyzed. The median number of total publications (preresidency, intraresidency, and junior attending) was 4 (interquartile range [IQR], 1 to 10). Linear regression revealed negligible correlation between preresidency and junior attending publications (r = 0.019, P = 0.002). Total publications and increasing graduation y had a significant correlation of 0.89 (P < 0.001). Graduates of fellowships had significantly increased median total publications compared to those without fellowships (7 IQR, 3 to 18 versus 3 IQR, 1 to 7, respectively, P < 0.001). Dedicated research years during residency were associated with significant (P < 0.001) increases in median total and junior attending publications. Total publications ranged from 3 (IQR, 1 to 6) to 8 (IQR, 7 to 18) for those who completed 5- and 8-y residencies, respectively. CONCLUSIONS: Increased preresidency research productivity is not strongly associated with increased junior attending productivity in integrated plastic surgery. Better markers are completing dedicated research years in residency or fellowship after residency.

Recommendations on Attaining Departmental Status: A Survey of Division Chiefs Turned Department Chairs.

In 2009, the Association of Academic Chairmen of Plastic Surgery, now known as the American Council of Academic Plastic Surgeons (ACAPS), published a white paper endorsing the conversion of plastic surgery divisions into autonomous departments, motioning for other national organizations to follow suit. ACAPS' rationale outlined 11 factors intended to promote the favorability of attaining departmental status within an institution. Through surveying division chiefs turned founding department chairs who successfully executed this transition, we evaluate the practicality and efficacy of these guidelines. A survey was distributed to founding chairs of plastic surgery departments that were established after ACAPS' 2009 white paper. Information pertaining to institutions' demographic information and respondents' utilization of the principles and suggestions espoused in the white paper was obtained. The survey achieved an 86% response rate. The average time needed for the transition was 22 ± 12 months. Four of seven chairs were familiar with the 2009 ACAPS white paper. Garnering support from hospital administrators and institutional stakeholders, having fiscal profitability within the institution, and coordinating an integrated plastic surgery training program were ranked as the top three most important factors, respectively. This study assesses ACAPS' recommendations on transitioning from a division to a department on the basis of perceived utility by academic leaders who recently navigated the process. The most frequently cited factors for a successful transition included rallying support from institutional stakeholders and ensuring profitability. Additionally, aligning the timing with a concurrent transition of leadership can expedite the process.

Plastic Surgery Residency Applicants' Perceptions of a Virtual Interview Cycle.

BACKGROUND: The 2020 to 2021 residency application cycle marked the first year of fully virtual integrated plastic surgery interviews. The virtual format was a double-edged sword for applicants with several advantages, such as reduced costs and time lost from travel, and disadvantages as the novel format introduced new stressors on top of an already demanding process. Concerns included unfair interview invitation distribution, interview "hoarding," and assessing "fit" virtually. In this study, the authors aimed to understand applicants' experiences of the 2020 to 2021 virtual plastic surgery interview cycle. METHODS: A survey was sent to 330 applicants in the 2020 to 2021 integrated plastic surgery application cycle. The survey included questions about participant demographics, preinterview preparation, virtual interview experiences, and postinterview process. Statistical comparisons were performed on responses using IBM SPSS Statistics version 25.0 (IBM, Armonk, N.Y.). RESULTS: Eighty-nine participants responded to the survey, representing a 27 percent response rate. Applicants received an average of 13.3 interview invitations (range, 0 to 45) and attended an average of 11.4 interviews (range, 0 to 30). Almost half (48.2 percent) did not feel interview invitations were distributed equitably, and more than half (68.2 percent) reported that there should be a limit on the number of interview invitations an applicant can accept. The majority of respondents (88.1 percent) reported spending $500 or less on virtual interviews. Half (50.6 percent) participated in virtual subinternships, of which 30.4 percent became significantly less interested in a program afterward. CONCLUSIONS: The inaugural virtual interview cycle had several advantages and disadvantages. Lessons learned from this year could be utilized toward building a more equitable, fair, and effective potential virtual cycle in years to come.

Matching into Plastic Surgery: Insights into the Data.

Matching into plastic and reconstructive surgery residency, whether integrated or independent, is a competitive process. This article serves to examine, review, and summarize data published on both residency application processes. Through the results summarized, applicants should carefully review the objective and subjective factors used in evaluation to strategize how to make themselves as competitive as possible. Specifically, though, early review of the data presented may allow applicants time to focus on what modifiable factors still remain before their respective application seasons.

A 5-Year Analysis of the Integrated Plastic Surgery Residency Match: The Most Competitive Specialty?

INTRODUCTION: The National Residency Matching Program is becoming more competitive across all medical specialties. The match rate for surgical specialties is considerably lower than the overall match rate each year. For those wishing to match into integrated plastic surgery, the magnitude of difficulty is in question. MATERIALS AND METHODS: Public data from 2016 to 2020 on the number of residency programs, number of residency positions, number of applicants, United States Medical Licensing Examination (USMLE) scores, and research experiences were collected for dermatology, categorical general surgery, neurological surgery, ophthalmology, orthopedic surgery, otolaryngology, integrated plastic surgery, integrated thoracic surgery, urology, and integrated vascular surgery. RESULTS: In the 2020 Match, integrated plastic surgery had only 82 programs and 180 positions, and over the 2016-2020 Matches, the growth of integrated plastic surgery was a mere 6.9 positions per year. For matched 2020 applicants, integrated plastic surgery had the highest USMLE Step 1 score (249), highest USMLE Step 2 score (tied at 256), and second highest number of abstracts/presentations/publications (19.1). CONCLUSIONS: The limited availability of residency spots in integrated plastic surgery, in conjunction with the quality of the applicant pool, makes it one of the most competitive matches. Candidates should understand this context before applying as to not risk going unmatched.

Analysis of Adverse Effects of Multimodal Gabapentin in Abdominal Wall Reconstruction.

BACKGROUND: Multimodal analgesia, a key component of enhanced recovery after surgery protocols, emphasizes the use of nonopioid analgesics. Preoperative and postoperative gabapentin is often included within multimodal analgesia because it has been shown to reduce postoperative opioid use. However, the role of gabapentin has been questioned because of concerns of adverse effects, particularly in the elderly. In an effort to better understand the specific role of gabapentin within the context of an established enhanced recovery after surgery protocol, the authors studied the prevalence of its adverse effects in patients undergoing abdominal wall reconstruction. METHODS: Following institutional review board approval, a retrospective review of a prospectively collected database of 267 consecutive patients who underwent abdominal wall reconstruction performed by a single surgeon was conducted. Demographic variables; operative details; postoperative analgesic use; the presence of dizziness, lightheadedness, or altered mental status; hypotension; negative Richmond Agitation Sedation Scale scores; and postoperative falls were recorded and analyzed according to postoperative gabapentin administration. RESULTS: Two hundred thirteen patients (80 percent) met inclusion criteria, of which 138 (65 percent) received postoperative gabapentin. Postoperative gabapentin use was not associated with dizziness, lightheadedness, or altered mental status; hypotension; negative Richmond Agitation Sedation Scale scores; or falls. Furthermore, even among those aged 65 years or older, postoperative gabapentin use was not significantly associated with these adverse events. CONCLUSIONS: In patients undergoing abdominal wall reconstruction, postoperative gabapentin administration was not associated with an increase in adverse effects. Further prospective analysis may better allow the characterization of the adverse effects of perioperative gabapentin. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Characteristics of Successful Integrated Plastic Surgery Applicants from US Allopathic Medical Schools without a Home Integrated Program.

OBJECTIVE: Integrated plastic surgery (PS) is one of the most competitive residency programs, but current literature lacks data specific to matched applicants from medical schools without home integrated PS residency programs (NHP). Therefore, there is a need to examine this specific demographic of applicants to identify key factors that led to a successful match. DESIGN: An anonymous survey was sent to PS residents who graduated from US allopathic medical schools with NHP. Survey questions focused on applicants' objective statistics (USMLE scores, research experiences, etc.), as well as various other factors, including access to resources and letters of recommendation. SETTING: All US-based integrated plastic surgery residency programs. PARTICIPANTS: PGY-1 through PGY-6 integrated PS residents who graduated from US allopathic medical schools with NHP. RESULTS: The survey was distributed to 178 NHP residents from May to June of 2021, achieving a 55.1% response rate. Thirty-seven percent attended an institution with an independent, but not integrated, residency program. Average USMLE Step 1 and 2 scores were 248 ± 10.1 and 256 ± 9.7, respectively. Respondents reported having 9.8 ± 9.5 abstracts, presentations, and publications listed on their residency applications. NHP applicants had an average of 1.5 letters of recommendation written by away rotation faculty. Forty-five percent reported accessing resources at institutions with home integrated residency programs (HP), 55.6% of whom "strongly agreed" or "agreed" that this significantly helped in matching. CONCLUSION: The USMLE Step scores and research experiences of NHP residents are similar to those which are reported among all matched applicants nationally. NHP respondents optimized their success by utilizing plastic surgery-related resources at their own institutions, while often seeking resources at other institutions.

Total Costs of Applying to Integrated Plastic Surgery: Geographic Considerations, Projections, and Future Implications.

In 2020, the American Council of Academic Plastic Surgeons and the Association of American Medical Colleges recommended residency programs suspend away rotations and in-person interviews. This study quantifies applicant costs and potential savings in the residency application process resulting from that change, while also evaluating differences in cost with respect to geographic region of the applicant. METHODS: A retrospective evaluation of the 2019-2020 Texas STAR (Seeking Transparency in Application to Residency) database was conducted. We queried responses from plastic surgery residency applicants, including expenses associated with the application, away rotations, interviews, and total costs for medical school seniors. Applicant characteristics were recorded. A Kruskal-Wallis H-test was used to evaluate differences in mean costs by medical school region. RESULTS: In total, 117 US allopathic applicants to plastic surgery residency were included. Total expenses for the application cycle were $10,845. This was made up of $1638 in application costs, $4074 in away rotation costs, and $5486 in interview costs. No significant differences were observed for mean total costs for applicants from schools in the Central ($11,045/applicant), Northeast ($9696/applicant), South ($11,332/applicant), and West ($11,205/applicant) (P = 0.209). CONCLUSION: Assuming relatively minimal expenditures related to a virtual interview cycle and lack of away rotations in 2021, the average cost savings for plastic surgery residency applicants during the COVID-19 pandemic was estimated to be over $9000.

Virtual Interviews for the Integrated Plastic Surgery Residency Match: The Program Director Perspective.

Interviews for the integrated plastic surgery residency match took place in a virtual format for the 2020-2021 application cycle. Current literature lacks the perspectives of program directors (PDs) on virtual interviews compared with traditional in-person interviews. METHODS: Following institutional review board approval, an anonymous 17-question survey was distributed by email to 82 program directors of integrated plastic surgery residency programs in the United States. Participants were asked baseline program information, the number of positions and interview invites offered, and their perspectives on various aspects of the virtual interview process. RESULTS: Sixty-two (75.6%) PDs completed the survey. Thirty-seven percent reported increasing the number of interview offers per available residency spot. On a five-point Likert scale (1, not well at all; 5, extremely well), PDs showed no significant differences in their ability judge an applicant's professionalism (3.1 ± 1.1), interpersonal and communication skills (3.2 ± 1.1), and "fit" with their program (2.9 ± 0.9) during virtual interviews (P = 0.360). Sixty-eight percent reported being satisfied (15.3% extremely satisfied, 52.5% somewhat satisfied) with the virtual interview process, though 76.3% preferred in-person interviews. CONCLUSIONS: This study is the first to provide insight into PDs' impressions of virtual residency interviews. Although most reported being satisfied with the virtual interview process, the majority still preferred in-person interviews. Further long-term studies evaluating the pros and cons of each interview modality may provide more information on whether virtual interviews could become a sustainable alternative to the traditional in-person residency interview.

Applicant Preferences for Virtual Interviews: Insights from the 2020-21 Integrated Plastic Surgery Application Cycle.

BACKGROUND: The COVID-19 pandemic created an unprecedented residency application cycle that required the use of virtual interviews. The inaugural class of applicants participating in virtual interviews were surveyed concerning their preferences and suggestions for future application cycles. METHODS: A survey was distributed to 349 individuals who applied for an integrated plastic surgery residency position at three institutions during the 2020-21 application cycle. Responses were analyzed to determine the most popular attributes of virtual interviews. RESULTS: Response rate was 44%. Eighty-six percent of applicants valued having time to consider their interview offers before scheduling; however, nearly one-third felt the instructions provided by programs lacked clarity and did not abide by the American Council of Academic Plastic Surgeons guidelines. Eighty-two percent of applicants valued having a preinterview social, and most preferred smaller breakout rooms organized by themes. A short interview day (less than three hours) was associated with less applicant familiarity with the program, its people, and its location when compared with medium (three to seven hours) and long (more than seven hours) interview days (P < 0.001 for all). Eighty percent of applicants preferred an interview day where they were placed into interview rooms by a program coordinator. CONCLUSIONS: The virtual interview format can be optimized in many ways to benefit both applicants and programs. The data presented in this article provide suggestions for future iterations of virtual interviews.