Publications
We work hard to attract, retain, and support the most outstanding faculty, and are proud of their accomplishments, in areas ranging from clinical care to research, from systems improvement to medical education, and in locations that include our clinical sites in San Francisco and others around the globe. Since 2008, over 1600 articles have been published.
2014
909. Assessing the impact of nurse post-discharge telephone calls on 30-day hospital readmission rates.
2014
2014
2014
BACKGROUND
Understanding risk factors that increase readmission rates may help enhance patient education and set system-wide expectations. We aimed to provide benchmark data on causes and predictors of readmission following inpatient plastic surgery.
METHODS
The 2011 National Surgical Quality Improvement Program dataset was reviewed for patients with both "Plastics" as their recorded surgical specialty and inpatient status. Readmission was tracked through the "Unplanned Readmission" variable. Patient characteristics and outcomes were compared using chi-squared analysis and Student's t-tests for categorical and continuous variables, respectively. Multivariate regression analysis was used for identifying predictors of readmission.
RESULTS
A total of 3,671 inpatient plastic surgery patients were included. The unplanned readmission rate was 7.11%. Multivariate regression analysis revealed a history of chronic obstructive pulmonary disease (COPD) (odds ratio [OR], 2.01; confidence interval [CI], 1.12-3.60; P=0.020), previous percutaneous coronary intervention (PCI) (OR, 2.69; CI, 1.21-5.97; P=0.015), hypertension requiring medication (OR, 1.65; CI, 1.22-2.24; P<0.001), bleeding disorders (OR, 1.70; CI, 1.01-2.87; P=0.046), American Society of Anesthesiologists (ASA) class 3 or 4 (OR, 1.57; CI, 1.15-2.15; P=0.004), and obesity (body mass index ≥30) (OR, 1.43; CI, 1.09-1.88, P=0.011) to be significant predictors of readmission.
CONCLUSIONS
Inpatient plastic surgery has an associated 7.11% unplanned readmission rate. History of COPD, previous PCI, hypertension, ASA class 3 or 4, bleeding disorders, and obesity all proved to be significant risk factors for readmission. These findings will help to benchmark inpatient readmission rates and manage patient and hospital system expectations.
View on PubMed2014
BACKGROUND
The safety of single-stage augmentation-mastopexy remains controversial given the dual purpose of increasing breast volume and decreasing the skin envelope. Currently, the literature is relatively sparse and heterogeneous. This systematic review considered complication profiles and pooled summary estimates in an attempt to guide surgical decision-making.
METHODS
Multiple databases were queried for combined augmentation-mastopexy outcomes. Whenever possible, meta-analysis of complication rates was performed.
RESULTS
Twenty-three studies met inclusion criteria. Average follow-up varied from 16 to 173 weeks, with a majority under 1 year. The pooled total complication rate was 13.1 percent (95 percent CI, 6.7 to 21.3 percent). The most common individual complication was recurrent ptosis, with an incidence of 5.2 percent (95 percent CI, 3.1 to 7.8 percent), followed by poor scarring (3.7 percent; 95 percent CI, 1.9 to 6.1 percent). The pooled incidences of capsular contracture and tissue-related asymmetry were 3.0 percent (95 percent CI, 1.4 to 5.0 percent) and 2.9 percent (95 percent CI, 1.2 to 5.4 percent), respectively. Infection, hematoma, and seroma were rare, with pooled incidences of less than 2 percent each. Three published studies reported data on patient satisfaction. The reoperation rate obtained from 13 studies was 10.7 percent (95 percent CI, 6.7 to 15.4 percent).
CONCLUSIONS
This meta-analysis encompassed 4856 cases of simultaneous augmentation-mastopexy. Study heterogeneity was high because of differences in surgical techniques, outcome definitions, and follow-up durations. This review suggests that with careful patient selection, pooled complication and reoperation rates for single-stage augmentation-mastopexy are acceptably low.
View on PubMed2014
2014
PURPOSE
In addition to excellent patient care, the focus of academic medicine has traditionally been resident training. The changing landscape of health care has placed increased focus on objective outcomes. As a result, the surgical training process has come under scrutiny for its influence on patient care. We elucidated the effect of resident involvement on patient outcomes.
MATERIALS AND METHODS
We retrospectively analyzed data from the 2005 to 2011 NSQIP® participant use database. Patients were separated into 2 cohorts by resident participation vs no participation. The cohorts were compared based on preoperative comorbidities, demographic characteristics and intraoperative factors. Confounders were adjusted for by propensity score modification and complications were analyzed using perioperative variables as predictors.
RESULTS
A total of 40,001 patients met study inclusion criteria. Raw data analysis revealed that cases with resident participation had a higher rate of overall complications. However, after propensity score modification there was no significant difference in overall, medical or surgical complications in cases with resident participation. Resident participation was associated with decreased odds of overall complications (0.85). Operative time was significantly longer in cases with resident participation (159 vs 98 minutes).
CONCLUSIONS
Urology resident involvement is not associated with increased overall and surgical complications. It may even be protective when adjusted for appropriate factors such as case mix, complexity and operative time.
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