The latest medical research on Craniofacial Surgery

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about craniofacial surgery gathered by our medical AI research bot.

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Collaborative Approach toward Transplant Candidacy for Obese End-Stage Renal Disease Patients.

American College of Surgeons

An elevated Body Mass Index (BMI) is a major cause of transplant preclusion for patients with End Stage Renal Disease (ESRD). This phenomenon exacerbates existing socioeconomic and racial disparities and increases the economic burden of maintaining patients on dialysis. Metabolic Bariatric Surgery (MBS) in such patients is not widely available. Our center created a collaborative program to undergo weight loss surgery before obtaining a kidney transplant.

We studied the outcomes of these patients post MBS and transplant surgery. One hundred and eighty-three ESRD patients were referred to the bariatric team by the transplant team between Jan 2019 through June 2023. Of these, 36 underwent MBS (20 RYGB, 16 SG), and 10 underwent subsequent transplantation, with another 15 currently waitlisted. Both surgical teams shared resources, including dieticians, social workers, and a common database, for easy transition between teams.

The mean starting BMI for all referrals was 46.4 kg/m2 and was 33.9 kg/m2 at the time of transplant. The average number of hypertension medications decreased from 2.0 (range 2.0 to 4.0) pre-surgery to 1.0 (range 1.0 to 3.0) post-surgery. Similarly, HbA1C levels improved, with pre-operative averages at 6.2 (range 5.4 to 7.6) and postoperative levels at 5.2 (range 4.6 to 5.8) All transplants are currently functioning, with a median creatinine of 1.5 (1.2 - 1.6) mg/dl (GFR 46 (36.3 - 71.0)).

A collaborative approach between bariatric and transplant surgery teams offers a pathway toward transplant for obese ESRD patients, and potentially alleviates existing healthcare disparities. ESRD patients that undergo MBS have unique complications to be aware of. The improvement in comorbidities may lead to superior post-transplant outcomes.

Barriers to Black Medical Students and Residents Pursuing and Completing Surgical Residency in Canada: A Qualitative Analysis.

American College of Surgeons

The limited available data suggest that the Canadian surgical workforce does not reflect the racial diversity of the patient population it serves, despite the well-established benefits of patient-provider race concordance. There have been no studies to date that characterize the systemic and individual challenges faced by Black medical students in matching to and successfully finishing training in a surgical specialty within a Canadian context that can explain this underrepresentation.

Using critical qualitative inquiry and purposive sampling to ensure gender, geographical, and student/trainee year heterogeneity, we recruited self-identifying Black medical students and surgical residents across Canada. Online in-depth semi-structured interviews were conducted and transcribed verbatim. Transcripts were analyzed through an inductive reflexive narrative thematic process by four analysts.

27 participants including 18 medical students and 9 residents, were interviewed. The results showed three major themes that characterized their experiences: journey to and through medicine, perceptions of the surgical culture, and recommendations to improve the student experience. Medical students identified lack of mentorship and representation, as well as experiences with racism as the main barriers to pursuing surgical training. Surgical trainees cited systemic racism, lack of representation and insufficient safe spaces as the key deterrents to program completion. The intersection with gender exponentially increased these identified barriers.

Except for a few surgical programs, medical schools across Canada do not offer a safe space for Black students and trainees to access and complete surgical training. An urgent change is needed to provide diverse mentorship that is transparent, acknowledges the real challenges related to systemic racism and biases, and is inclusive of different racial and ethnic backgrounds.

Effect of Behavioral Health Disorders on Surgical Outcomes in Cancer Patients.

American College of Surgeons

Behavioral health disorders (BHD) can often be exacerbated in the setting of cancer. We sought to define the prevalence of BHD among cancer patients and characterize the association of BHD with surgical outcomes.

Patients diagnosed with lung, esophageal, gastric, liver, pancreatic, and colorectal cancer between 2018-2021 were identified within Medicare Standard Analytic Files. Data on BHD defined as substance abuse, eating disorder, or sleep disorder were obtained. Post-operative textbook outcome (TO)(i.e., no complications, prolonged length of stay, 90-day readmission, or 90-day mortality), as well as in-hospital expenditures and overall survival were assessed.

Among 694,836 cancer patients, 46,719 (6.7%) patients had at least one BHD. Patients with BHD were less likely to undergo resection (no BHD: 23.4% vs. BHD: 20.3%; p<0.001). Among surgical patients, individuals with BHD had higher odds of a complication (OR 1.32 [1.26-1.39]), prolonged length of stay (OR 1.36 [1.29-1.43]), and 90-day readmission (OR 1.57 [1.50-1.65]) independent of social vulnerability or hospital volume status, resulting in lower odds to achieve a TO (OR 0.66 [0.63-0.69]). Surgical patients with BHD also had higher in-hospital expenditures (no BHD: $16,159 vs. BHD: $17,432; p<0.001). Of note, patients with BHD had worse long-term post-operative survival (median, no BHD: 46.6 [45.9-46.7] vs. BHD: 37.1 [35.6-38.7] months) even after controlling for other clinical factors (HR 1.26 [1.22-1.31], p<0.001).

BHD was associated with lower likelihood to achieve a postoperative TO, higher expenditures, as well as worse prognosis. Initiatives to target BHD are needed to improve outcomes of cancer patients undergoing surgery.

Outcomes and Management of Re-Establishing Bariatric Patients.

American College of Surgeons

Lifelong follow-up after metabolic/bariatric surgery (MBS) is necessary to monitor for patient outcomes and nutritional status. However, many patients do not routinely follow up with their MBS team. We studied what prompted MBS patients to seek bariatric care after being lost to follow-up and the subsequent treatments they received.

A retrospective cohort study of patients after MBS who had discontinued regular MBS follow-up but represented to the MBS clinic between July 2018 and December 2022 to re-establish care. Patients with a history of a Sleeve Gastrectomy (SG), Roux-En-Y Gastric Bypass (RYGB), and Adjustable Gastric Banding (AGB) were included.

We identified 400 patients (83.5% female, mean age 50.3 ± 12.2 years at the time of RBC), of whom 177 (44.3%) had RYGB, 154 (38.5%) had SG, and 69 (17.2%) had AGB. Overall, recurrent weight gain (RWG) was the most common reason for presentation for all three procedures (81.2% in SG, 62.7% in RYGB, and 65.2% in AGB; p<.001). SG patients were more likely to undergo a revision MBS compared to RYGB patients (16.9% vs. 5.8%, p<.001), while RYGB patients were more likely to undergo an endoscopic intervention than SG patients (17.5% vs. 7.8%, p<.001). The response to AOM agents, specifically GLP-1 drugs, was better in RYGB patients, than SG patients.

This study highlights RWG as the most common reason for patients after MBS seeking to re-establish care with the MBS team. SG had a higher rate of revision MBS than RYGB, whereas endoscopic interventions were performed more frequently in the RYGB group. AOM, especially GLP-1 drugs, were more effective in RYGB patients.

Acute Intraoperative Conversion from Endovascular to Open vs Planned Open Operation for Abdominal Aortic Aneurysm: A Propensity-Score Matched Study from the American College of Surgeons NSQIP Targeted Database.

American College of Surgeons

Evaluating outcomes for acute intraoperative conversion to open surgery during endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) was difficult due to low incidence. This study aimed to compare 30-day outcomes between patients with acute intraoperative conversion during EVAR and planned open surgery, and to identify risk factors associated with acute conversion.

Patients underwent EVAR or planned open AAA repair were identified in ACS-NSQIP targeted databases 2012-2021. Patients with acute intraoperative conversion during EVAR were selected. A 1:3 propensity-score matching was used to match demographics, baseline characteristics, surgical indications, aneurysm size and extent, and emergency cases between the conversion open and planned open groups. Thirty-day postoperative outcomes were assessed.

Out of 20,566 EVAR, 177 (0.86%) had acute intraoperative conversion to open surgery. The conversion open group was matched to 504 out of 5,249 planned open patients. Conversion open and planned open groups had comparable 30-day mortality (23.43% vs 17.46%, p=0.09) and organ system complications including MACE (14.86% vs 10.71%, p=0.17), pulmonary complications (17.71% vs 24.01%, p=0.09), and renal complications (8.57% vs 11.11%, p=0.39). The conversion open group had lower bleeding requiring transfusion (48.57% vs 75.60%, p<0.01), shorter operation time (p<0.01), and shorter length of stay (p<0.01). Other postoperative outcomes did not differ. Risk factors associated with acute intraoperative conversion included ruptured aneurysm with or without hypotension. Protective factors included hypertension and aortic distal aneurysm extent.

While this study does not endorse a universal "EVAR first" strategy for all patients with AAA, EVAR can be attempted first in eligible AAA patients. Even when EVAR is unsuccessful, intraoperative conversion to open surgery still appears to be safe compared to planned open repair.

Remission of Obesity-Related Sleep Apnea and Its Effect on Mortality and Cardiovascular Events After Metabolic and Bariatric Surgery: A Propensity Matched Cohort Study.

American College of Surgeons

While obstructive sleep apnea (OSA) is common among patients with obesity and linked to cardiovascular disease, there is a lack of studies evaluating the effects of reaching remission from OSA after metabolic and bariatric surgery (MBS).

A registry-based nationwide study including patients operated with sleeve gastrectomy or Roux-en-Y gastric bypass from 2007 until 2019 in Sweden. Patients who reached remission of OSA were compared to those who did not reach remission, and a propensity score matched control group of patients without OSA at the time of operation. Main outcome was overall mortality, secondary outcome was major cardiovascular events (MACE).

In total, 5892 patients with OSA and 11,552 matched patients without OSA completed a 1-year follow-up and were followed for a median of 6.8 years. Remission of OSA was seen for 4334 patients (74%). Patients in remission had a lower risk for overall mortality (cumulative incidence 6.0% v. 9.1%;p<0.001) and MACE (cumulative incidence 3.4% vs 5.8%;p<0.001) at 10-years after operation compared to those who did not reach remission. The risk was similar to that of the control group without OSA at baseline (cumulative incidence for mortality 6.0%, p=0.493, for MACE 3.7%, p=0.251).

The remission rate of OSA was high after MBS. This was in turn associated with reduced risk for death and MACE compared to patients who did not achieve remission reaching a similar risk seen among patients without OSA at baseline. A diligent follow-up of patients who do not reach remission remains important.

Refractory and Recurrent Idiopathic Granulomatous Mastitis Treatment: Adaptive, Randomized Clinical Trial.

American College of Surgeons

Idiopathic Granulomatous Mastitis (IGM) is mostly described as an autoimmune disease with high prevalence among Middle Eastern childbearing-age women. The current study aimed to evaluate the best treatment of choice in patients with resistant or recurrent IGM.

Patients with established recurrent or resistant IGM who were referred to the breast cancer research center from 2017 to 2020 were randomly assigned to either one of the following treatment groups: A (Best supportive care), B (corticosteroids: prednisolone), and C (methotrexate and low dose corticosteroids). This adaptive clinical trial evaluated radiological and clinical responses, as well as the possible side effects, on a regular basis in each group, with patients followed up for a minimum of 2 years.

A total of 318 participants, with a mean age of 33.52 ± 6.77 years, were divided into groups A (10 patients), B (78 patients), and C (230 patients). In group A, no therapeutic response was observed; group B exhibited a mixed response, with 14.1% experiencing complete or partial responses, 7.7% maintaining stability, and 78.2% experiencing disease progression. Accordingly, groups A and B were terminated due to inadequate response. In group C, 94.3% achieved complete response, 3% partial remission, and 2.7% no response. Among the entire patient cohort, 11.6% tested positive for anti-nuclear antibodies (ANA), 3.5% for angiotensin-converting enzyme (ACE), and 12.3% for erythema nodosum (EN). Notably, hypothyroidism was a prevalent condition among the patients, affecting 7.2% of the cohort. Furthermore, the incidence of common side effects was consistent across all groups.

The most effective treatment option for patients with recurrent or resistant idiopathic granulomatous mastitis is a combination therapy involving steroids and disease-modifying antirheumatic drugs such as methotrexate.

Evaluating Outcomes of Non-Accidental Trauma in Military Children.

American College of Surgeons

Non-accidental trauma (NAT), or child abuse, is a leading cause of childhood injury and death in the United States. Studies demonstrate that military-affiliated individuals are at greater risk of mental health complications and family violence, including child maltreatment. There is limited information about the outcomes of military children who experience NAT. This study compares the outcomes between military-dependent and civilian children diagnosed with NAT.

A single institution, retrospective review was performed of children admitted with confirmed NAT at a Level I trauma center. Data was collected from the institutional trauma registry and the Child Abuse Team's database. Military affiliation was identified using insurance status and parental/caregiver self-reported active-duty status. Demographic and clinical data including hospital length of stay (LOS), morbidities, specialty consults, and mortality were compared.

Among 535 patients, 11.8% (n=63) were military-affiliated. The median age of military-associated patients, 3 months (IQR 1-7), was significantly younger than civilian patients, 7 months (IQR 3-18, p<.001). Military-affiliated patients had a longer LOS of 4 days (IQR 2-11) vs 2 days (IQR 1-7, p=0.041), increased morbidities/complications (3 vs 2 counts, p=0.002), and a higher mortality rate (10% vs 4%, p=0.048). There was no significant difference in number of consults or injuries, trauma activation, or need for surgery.

Military-affiliated children diagnosed with NAT experience more adverse outcomes than civilian patients. Increased LOS, morbidities/complications, and mortality suggest military-affiliated patients experience more life-threatening NAT at a younger age. Larger studies are required to further examine this population and better support at-risk families.

Abdominal Wall Tension and Early Outcomes after Posterior Component Separation with Transversus Abdominis Release: Does a "Tension-Free" Closure Really Matter?

American College of Surgeons

Ventral hernias result in fibrosis of the lateral abdominal wall muscles, increasing tension on fascial closure. Little is known about the effect of abdominal wall tension on outcomes after abdominal wall reconstruction. We aimed to identify an association between abdominal wall tension and early postoperative outcomes in patients who underwent posterior components separation (PCS) with transversus abdominis release (TAR).

Using a proprietary, sterilizable tensiometer, the tension needed to bring the anterior fascial elements to the midline of the abdominal wall during PCS with TAR were recorded. Tensiometer measurements, in pounds (lb), were calibrated by accounting for the acceleration of Earth's gravity. Baseline fascial tension, change in fascial tension, and fascial tension at closure were evaluated with respect to 30-day outcomes, including wound morbidity, hospital readmission, reoperation, ileus, bleeding, and pulmonary complications.

A total of 100 patients underwent bilateral abdominal wall tensiometry, for a total of 200 measurements (left and right side for each patient). Mean baseline anterior fascial tension was 6.78 lb (SD 4.55) on each side. At abdominal closure, the mean anterior fascial tension was 3.12 (SD 3.21) lb on each side. Baseline fascial tension and fascial tension after PCS with TAR at abdominal closure were not associated with surgical site infection, surgical site occurrence, readmission, ileus, and bleeding requiring transfusion. The event rates for all other complications were too infrequent for statistical analysis.

Baseline and residual fascial tension of the anterior abdominal wall do not correlate with early postoperative morbidity in patients undergoing PCS with TAR. Further work is needed to determine if abdominal wall tension in this context is associated with long-term outcomes, such as hernia recurrence.

Judgment Errors in Surgical Care.

American College of Surgeons

Human error is impossible to eliminate, particularly in systems as complex as health care. The extent to which judgment errors in particular impact surgical patient care or lead to harm is unclear.

American College of Surgeons National Surgery Quality Improvement Program (2018) procedures from a single institution with 30-day morbidity or mortality were examined. Medical records were reviewed and evaluated for judgment errors. Preoperative variables associated with judgment errors were examined using logistic regression.

Of the surgical patients who experienced a morbidity or mortality, 18% (31/170) experienced an error in judgment during their hospitalization. Patients with hepatobiliary procedure (Odds Ratio (OR) 5.4 (95% CI 1.23, 32.75), p = 0.002), insulin dependent diabetes (OR 4.8 (95% CI 1.2, 18.8), p=0.025), severe chronic obstructive pulmonary disease (OR 6.0 (95% Ci 1.6, 22.1), p=0.007), or with infected wounds (OR 8.2 (95% Ci 2.6, 25.8), p<0.001) were at increased risk for judgment errors.

Specific procedure types and patients with certain preoperative variables had higher risk for judgment errors during their hospitalization. Errors in judgment adversely impacted the outcomes of surgical patients who experienced morbidity or mortality in this cohort. Preventing or mitigating errors and closely monitoring patients after an error in judgment is prudent and may improve surgical safety.

Clinical Validation of Computer-Aided Diagnosis Software for Preventing Retained Surgical Sponges.

American College of Surgeons

We previously reported the successful development of a computer-aided diagnosis (CAD) system for preventing retained surgical sponges with deep learning using training data, including composite and simulated radiographs. In this study, we evaluated the efficacy of the CAD system in a clinical setting.

1,053 postoperative radiographs obtained from patients aged 20 years or older who underwent surgery were evaluated. We implemented a foreign object detection application software on the portable radiographic device used in the operating room to detect retained surgical sponges. The results of the CAD system diagnosis were prospectively collected.

Among the 1,053 images, the CAD system detected possible retained surgical items in 150 images. Specificity was 85.8%, which is similar to the data obtained during the development of the software.

The validation of a CAD system using deep learning in a clinical setting showed similar efficacy as during the development of the system. These results suggest that the CAD system can contribute to the establishment of a more effective protocol than the current standard practice for preventing the retention of surgical items.

Social Determinants of Outcomes Disparity among Pediatric Solid Tumor Patients.

American College of Surgeons

Socioeconomic factors have a significant impact on healthcare outcomes. Metrics such as the Area Deprivation Index (ADI) are used to quantify the anticipated influence of these factors. Here, we sought to assess the impact of socioeconomic factors on clinical outcomes among pediatric solid tumor patients in our region.

We identified 3863 pediatric patients who were diagnosed with a malignant solid tumor in the Texas Cancer Registry between 1995 and 2019. ADI was used to quantify socioeconomic determinants of health. These outcome variables were determined: stage of disease at diagnosis, time between diagnosis and treatment initiation, and overall mortality. Statistical analysis was performed using logistic regression, linear regression, Cox proportional hazards regression, and Kaplan-Meier survival curves.

53.5% of patients were male and the average age at diagnosis was 4.5 years. 47.0% of patients were white, 13.3% were Black, 36.2% were Hispanic, 1.7% were Asian, and other rare minority groups made up 1.8%. On multivariable analysis, increased risk of death was associated with Black race, rare minority race, residence in a border county, and increasing ADI score, with the risk of death at 5 years rising 4% with each increasing ADI point.

Social determinants of health are associated with disparate outcomes among pediatric solid tumor patients. Our results suggest that patients who are part of racial minority groups and those who reside in socioeconomically disadvantaged neighborhoods or regions near the Texas-Mexico border are at an increased risk of death. This information may be useful in strategizing outreach and expanding resources to improve outcomes in at-risk communities.