Article Factors Influencing Gender Disparities in Senior Authorship of Plastic Surgery Publications.

INTRODUCTION: Female plastic surgeons publish fewer and lower impact articles. To better understand how to address this gender gap, we explored the temporal trends in female senior authorship and evaluated predictive factors for female senior authorship. METHODS: A retrospective review of articles published in the 3 highest impact plastic surgery journals published from 2010 to 2020 was conducted. Trends with female senior authorship across time were analyzed with respect to study type, subspeciality, and geographical origin. RESULTS: Of the 5425 articles included, 13% (n = 720) had a female senior author, and female senior authorship increased across time ( R = 0.84, P = 0.033). Over the decade, an increased proportion of cohort studies ( R = 0.82, P = 0.045), systematic reviews ( R = 0.96, P = 0.003), breast-related articles ( R = 0.88, P = 0.022), and reconstruction-related articles ( R = 0.83, P = 0.039) were published by female senior authors. Subspecialty and geography predicted female senior authorship; articles focused on aesthetic (odds ratio [OR] = 1.3, P = 0.046) and breast (OR = 1.7, P < 0.001) subspecialties or those originating from Canada (OR = 1.7 P = 0.019), Europe (OR = 1.5, P < 0.001), and Latin America (OR = 3.0, P < 0.001) were more likely to have a female senior author. Articles from East Asia were less likely to have female senior authors (OR = 0.7, P = 0.005). CONCLUSION: Female senior authorship in plastic surgery has increased over the last decade, and the proportion of female plastic surgeons leading cohort studies and systematic reviews is increasing. Sex of the senior author is influenced by plastic surgery subspecialty and geographical origin, but article type did not impact the odds of female senior authorship.

Polyethylene Glycol Fusion Restores Axonal Continuity and Improves Return of Function in a Rat Median Nerve Denervation Model.

BACKGROUND: Polyethylene glycol (PEG) can fuse severed closely-apposed axolemmas and restore axonal continuity. We evaluated the effects of PEG-fusion on functional recovery in a rodent forelimb model of peripheral nerve injury. METHODS: The median nerves of male Lewis rats (n=5 per group) were transected and repaired with standard suture repair (SR), SR with PEG (PEG), or SR with PEG and 1% methylene blue (PEG+MB); a sham surgery group was also included. Proximal stimulation produced compound nerve (CAPS) and muscle (CMAPs) action potentials recorded distally. The contralateral limb of each animal acted as an internal control for grip strength measurements. RESULTS: CAPs and CMAPs immediately returned in all PEG and PEG+MB animals, but not in SR animals. PEG and PEG+MB groups demonstrated earlier return of function by post-operative day (POD) 7 (62.6 ±7.3% and 50.9 ±6.7% of contralateral limb grip strength, respectively) compared to SR group, in which minimal return of function was not measurable until POD 21. At POD 98, the PEG group grip strength recovered to 77.2 ±2.8% while the PEG+MB grip strength recovered to 79.9 ±4.4%, compared to 34.9 ±1.8% recovery in the SR group (p<0.05). The PEG and PEG+MB groups reached 50% of the Sham group grip strength on POD 3.8 and 6.3, respectively, whereas the SR group did not reach 50% grip strength recovery of the Sham group throughout the study period. CONCLUSION: PEG-fusion plus neurorrhaphy with or without methylene blue re-established axonal continuity, shortened recovery time, and augmented functional recovery compared to suture neurorrhaphy alone.

How Many Plastic Surgeons Does It Take to Write an Article? A 10-Year Bibliometric Analysis of Authorship Inflation.

BACKGROUND: Publications measure academic productivity; they can affect research funding and career trajectory. There is a trend of increased authors per publication in surgery journals. We sought to determine whether authorship inflation exists in the plastic surgery literature and identify independent predictors of the number of co-authors. METHODS: We performed a bibliometric analysis of articles published in 3 high impact plastic surgery journals at 2-year intervals between 2010 and 2020. For each publication, we collected details on year of publication, article type, plastic surgery topic, gender of senior author, geographical origin of study, and the number of authors. RESULTS: A total of 5593 articles were collected. The median number of authors per article increased over time (ρ = 0.20, P < 0.001). Cohort studies, basic science investigations, literature reviews, and systematic reviews experienced a significant increase in the number of authors per article from 2010 to 2020 (P < 0.001). The rise in the number of authors was consistent across all plastic surgery topics (P < 0.001). Both male and female senior authors had a significant increase in the number of co-authors (P < 0.001). The regression model demonstrated that article type (cohort studies, basic science investigations, and systematic reviews) predicted more co-authors, whereas geographical region (Africa, Middle East, South and Southeast Asia, and United Kingdom and Ireland) and plastic surgery topics (aesthetic and hand surgery) predicted fewer authors. CONCLUSIONS: The number of authors per publication is increasing in plastic surgery. Author proliferation was consistent across most article types and unaffected by gender. Possible reasons behind this trend include research complexity, increased collaboration, or gift authorship.

13-Year Analysis of Gender Disparity in Peer-reviewed Burn Literature.

Women are less likely to be senior authors, invited to write in scientific journals, and to be cited in high impact journals. The aim of this study was to investigate trends in authorship and gender differences in peer-reviewed burn literature over 13 years. We performed a retrospective analysis of original research articles published from January 2009 to September 2021 in three burn journals. A gender determination application was used to categorize the gender of the first and senior author. Of the 3908 articles analyzed, 42.5% had a woman first author and 27.6% had a woman senior author. We identified 2029 unique senior authors, 29.0% of whom were women. Woman senior authorship was associated with increased odds of woman first authorship [OR = 2.31 (95% CI: 2.00, 2.67); P < .001]. The percentage of papers with a woman senior author increased from 17.8% in 2009 to 35.7% in 2021. If this 1.0% (95% CI: 0.50-1.51%) linear trend increase per year in woman senior authorship continues, we will expect to see equal proportions of woman and man senior authors in the included journals starting in 2037. The field of burn care is far from reaching gender parity with respect to authorship of peer-reviewed publications. Supporting and encouraging gender-concordant and discordant first:last authorship dyads in mentorship as well as redistributing obligations that may detract from authorship opportunities are potential ways to improve parity in authorship and academia.

Association between patient-surgeon race and gender concordance and patient-reported outcomes following breast cancer surgery.

PURPOSE: Surgeon- and patient-related factors have been shown to influence patient experiences, quality of life (QoL), and surgical outcomes. We examined the association between patient-surgeon race and gender concordance with QoL after breast reconstruction. METHODS: We conducted a retrospective cross-sectional analysis of patients who underwent lumpectomy or mastectomy followed by breast reconstruction over a 3-year period. We created the following categories with respect to the race and gender of a patient-surgeon triad: no, intermediate, and perfect concordance. Multivariable regression was used to correlate postoperative global (SF-12) and condition-specific (BREAST-Q) QoL performance with patient-level covariates, gender and race concordance. RESULTS: We identified 375 patients with a mean (± SD) age of 57.6 ± 11.9 years, median (IQR) body mass index of 27.5 (24.0, 32.0), and median morbidity burden of 3 (2, 4). The majority of encounters were of intermediate concordance for gender (70%) and race (52%). Compared with gender-discordant triads, intermediate gender concordance was associated with higher SF-Mental scores (ß, 2.60; 95% CI, 0.21-4.99, p = 0.003). Perfect race concordance (35% of encounters) was associated with significantly higher adjusted SF-Physical scores (ß, 2.14; 95% CI, 0.50-4.22, p = 0.045) than the race-discordant group. There were no significant associations observed between race or gender concordance and BREAST-Q performance. CONCLUSION: Race-concordant relationships following breast cancer surgery were more likely to have improved global QoL. Perfect gender concordance was not associated with variation in QoL outcomes. Policy-level interventions are needed to facilitate personalized care and optimize breast cancer surgery outcomes.

Prostate Cancer in Male-to-Female Transgender Individuals: Histopathologic Findings and Association With Gender-affirming Hormonal Therapy.

Male-to-female (MtF) transgender individuals are at risk for prostate cancer, although guidelines for screening and management in this population are not well established. We describe a series of 9 MtF transgender patients who underwent prostate tissue sampling and highlight histopathologic features and challenges related to pathologic interpretation of prostate tissue in this patient population. Seven of 9 total patients were diagnosed with prostate cancer and all had elevated prostate-specific antigen at the time of diagnosis. Three of the 7 patients diagnosed with prostate cancer had received different types of hormone therapy for gender affirmation before the diagnosis of prostate cancer, and in all 3 of these patients, there was histologic evidence of hormone therapy effect in both benign prostate tissue and/or the adenocarcinoma. The 2 patients with benign prostate tissue underwent transurethral resection for lower urinary tract symptoms and were previously on hormone therapy for gender affirmation. Both of these specimens showed diffuse glandular atrophy and basal cell hyperplasia, indicative of hormone therapy effect on benign prostatic tissue. In the patients diagnosed with prostate cancer, a spectrum of grades was observed, ranging from Grade Group 1 to Grade Group 5. Four patients underwent radical prostatectomy, with 2 cases showing extraprostatic extension and Grade Group 5 prostatic adenocarcinoma, and 2 showing Grade Group 2 prostatic adenocarcinoma. Three of the 4 patients who underwent radical prostatectomy had received gender-affirming hormone therapy before surgery, and all 3 of these specimens showed hormone therapy effect in non-neoplastic prostate tissue and focal hormone therapy effect in prostatic adenocarcinoma. The presence of areas of viable carcinoma without hormone therapy effect enabled the assignment of a Gleason score and Grade Group in these 3 cases. Hormone therapy administered for gender identity affirmation induces histopathologic changes to both benign prostate tissue (nonkeratinizing squamous metaplasia, diffuse atrophy, basal cell hyperplasia, and stromal dominance with decreased numbers of glands) and prostatic adenocarcinoma (nuclear pyknosis, atrophy, cytoplasmic vacuolization, and architectural patterns that would qualify for Gleason 4 and 5 in the absence of hormone therapy effect) that have been traditionally seen in cis-male prostate cancer patients receiving hormone therapy. In the absence of hormone therapy, the morphology of prostatic adenocarcinoma in transgender patients shows classic morphologic features similar to those seen in cis-male patients not on hormone therapy. Prostate cancer with hormone therapy effect may not only be histologically quite subtle and may be overlooked if not suspected, but also should not be assigned a Gleason score because the Gleason score would substantially overstate its biologic potential. Therefore, similar to cis-male patients who have received androgen deprivation therapy for prostate cancer, transgender patients on hormone therapy for gender affirmation may be at risk for both underrecognition and over-grading of prostate cancer, particularly if the pathologist is not aware of the clinical history.

A systematic review of nerve grafting, end-to-end repair, and nerve transfer for obturator nerve injuries.

OBJECTIVE: Obturator nerve injury can occur as a complication of gynecologic surgeries, occurring most frequently in patients with endometriosis and genitourinary malignancies. The resulting injury causes paresthesia and major weakness in adduction and atrophy of the adductor group of lower extremity muscles. The objective of this study was to conduct a systematic review and meta-analysis of the effectiveness of end-to-end repair, nerve grafting, and nerve transfer in improving motor function in patients with obturator nerve injury. METHODS: PubMed, Cochrane, Medline, and Embase libraries were searched from May 1994 to August 2020 according to the PRISMA guidelines for articles that present functional outcomes after obturator nerve injury in patients treated with nerve grafting, end-to-end repair, or nerve transfer. RESULTS: A total of 25 patients from 22 studies were included in the study, 15 of whom were treated with end-to-end repair (60%), nine with nerve grafting (36%), and one with nerve transfer (4%). Of the 15 patients with transection data, two had incomplete (13%) and 13 had complete (87%) nerve transections. The patients underwent pelvic lymphadenectomy (n=24) and radical cystectomy (n=1) operations. The mean Medical Research Council (MRC) score was 2.95±1.7 immediately after treatment and 4.77±0.6 at the final follow-up. All patients achieved good outcomes (MRC ≥3) at the final follow-up. The mean MRC score for end-to-end repair (n=15), nerve grafting (n=9), and nerve transfer (n=1) was 4.8±0.6, 4.7±0.8, and 5, respectively. Patients with end-to-end repair had higher immediate post-operative strength than those treated with nerve grafting (p=0.03) and tended to achieve full functional recovery after shorter periods of time (rho=-0.65, p=0.049). Other parameters did not correlate with MRC. CONCLUSION: End-to-end repair, nerve grafting, and nerve transfer are equally effective in restoring function in patients with obturator nerve injury. However, patients treated with end-to-end repair had higher immediate post-operative strength than those treated with nerve grafting.

Representation of African American Patients in Social Media for Breast Reconstruction.

BACKGROUND: Social media use by plastic surgeons may contribute to the overall increase in breast reconstruction in the United States. However, recent data show a concerning decrease in breast reconstruction in African American women. The purpose of this study was to analyze the inclusion of African American women in social media posts for breast reconstruction, with the premise that this may be a possible contributing factor to decreasing rates of breast reconstruction in this population. METHODS: Data from several social media platforms were obtained manually on December 1, 2019. Each image was analyzed using the Fitzpatrick scale as a guide. RESULTS: A total of 2580 photographs were included that met the authors' criteria. Only 172 photographs (6.7 percent) were nonwhite. This study surveyed 543 surgeons, 5 percent of whom were nonwhite. The analysis of the results from the random sample of the top plastic surgery social media influencers showed that only 22 (5 percent) of the photographs uploaded were nonwhite patients. Furthermore, 30 percent of surgeons did not have any photographs of nonwhite patients uploaded. CONCLUSIONS: Numerous factors can contribute to the disparity between the growing trend of white patients seeking reconstructive surgery compared to the decreasing trend of African American patients, one of which may be the disparity in their representation in social media, particularly among common platforms and social media influencers. This study highlights the evolving factors that may impair African American breast cancer patients' access to safe, effective breast reconstruction, which must be identified and resolved.

Outcomes of Tibial Nerve Repair and Transfer: A Structured Evidence-Based Systematic Review and Meta-Analysis.

Although nerve transfer and repair are well-established for treatment of nerve injury in the upper extremity, there are no established parameters for when or which treatment modalities to utilize for tibial nerve injuries. The objective of our study is to conduct a systematic review of the effectiveness of end-to-end repair, neurolysis, nerve grafting, and nerve transfer in improving motor function after tibial nerve injury. PubMed, Cochrane, Medline, and Embase libraries were queried according to the PRISMA guidelines for articles that present functional outcomes after tibial nerve injury in humans treated with nerve transfer or repair. The final selection included Nineteen studies with 677 patients treated with neurolysis (373), grafting (178), end-to-end repair (90), and nerve transfer (30), from 1985 to 2018. The mean age of all patients was 27.0 ± 10.8 years, with a mean preoperative interval of 7.4 ± 10.5 months, and follow-up period of 82.9 ± 25.4 months. The mean graft repair length for nerve transfer and grafting patients was 10.0 ± 5.8 cm, and the most common donor nerve was the sural nerve. The most common mechanism of injury was gunshot wound, and the mean MRC of all patients was 3.7 ± 0.6. Good outcomes were defined as MRC ≥ 3. End-to-end repair treatment had the greatest number of good outcomes, followed by neurolysis. Patients with preoperative intervals less than 7 months were more likely to have good outcomes than those greater than 7 months. Patients with sport injuries had the highest percentage of good outcomes in contrast to patients with transections and who were in MVAs. We found no statistically significant difference in good outcomes between the use of sural and peroneal donor nerve grafts, nor between age, graft length, and MRC score.