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Patil P, Nathani P, Bakker JM, van Duinen AJ, Bhushan P, Shukla M, Chalise S, Roy N, Gadgil A. Are LMICs Achieving the Lancet Commission Global Benchmark for Surgical Volumes? A Systematic Review. World J Surg 2023; 47:1930-1939. [PMID: 37191692 PMCID: PMC10310578 DOI: 10.1007/s00268-023-07029-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION The Lancet Commission on Global Surgery (LCoGS) set the benchmark of 5000 procedures per 100,000 population annually to meet surgical needs adequately. This systematic review provides an overview of the last ten years of surgical volumes in Low and Middle- Income-Countries (LMICs). METHODOLOGY We searched PubMed, Web of Science, Scopus, Cochrane, and EMBASE databases for studies from LMICs addressing surgical volume. The number of surgeries performed per 100,000 population was estimated. We used cesarean sections, hernia, and laparotomies as index cases for the surgical capacities of the country. Their proportions to total surgical volumes were estimated. The association of country-specific surgical volumes and the proportion of index cases with its Gross Domestic Product (GDP) per capita was analyzed. RESULTS A total of 26 articles were included in this review. In LMICs, on average, 877 surgeries were performed per 100,000 population. The proportion of cesarean sections was found to be high in all LMICs, with an average of 30.1% of the total surgeries, followed by hernia (16.4%) and laparotomy (5.1%). The overall surgical volumes increased as the GDP per capita increased. The proportions of cesarean section and hernia to total surgical volumes decreased with increased GDP per capita. Significant heterogeneity was found in the methodologies to assess surgical volumes, and inconsistent reporting hindered comparison between countries. CONCLUSION Most LMICs have surgical volumes below the LCoGS benchmark of 5000 procedures per 100,000 population, with an average of 877 surgeries. The surgical volume increased while the proportions of hernia and cesarean sections reduced with increased GDP per capita. In the future, it's essential to apply uniform and reproducible data collection methods for obtaining multinational data that can be more accurately compared.
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Affiliation(s)
- Priti Patil
- Department of Statistics, BARC Hospital, Mumbai, 400094, India
| | - Priyansh Nathani
- Department of Surgery, Hinduhridaysamrat Balasaheb Thackeray Medical College, Dr. Rustom Narsi Cooper Municipal General Hospital, Mumbai, India
| | - Juul M Bakker
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Alex J van Duinen
- Clinic of Surgery, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Pranav Bhushan
- Department of Public Health, Institute of Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Minal Shukla
- Department of Maternal Health, UNICEF, Bhopal, India
| | - Samir Chalise
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Nobhojit Roy
- Department of Global Public Health, Karolinska Institute, 171 77, Stockholm, Sweden.
- The George Institute for Global Health, New Delhi, India.
| | - Anita Gadgil
- The George Institute for Global Health, New Delhi, India
- Department of Surgery, BARC Hospital, Mumbai, 400094, India
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Heidari M, Haydar AA, Rajabi MT, Rafizadeh SM. Corneal biophysical changes after upper eyelid blepharoplasty and ptosis surgery: a review. BMC Ophthalmol 2023; 23:253. [PMID: 37280563 DOI: 10.1186/s12886-023-03010-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/31/2023] [Indexed: 06/08/2023] Open
Abstract
Upper eyelid surgeries, such as blepharoplasty and ptosis correction, are commonly performed procedures worldwide. This review examines the effects of these surgeries on ocular properties and visual function. A search of the PubMed and Google Scholar databases was conducted to identify relevant articles published after 2000. The results demonstrate that the ocular and adnexal organs function as a unified visual system, with changes in one component affecting the functions of others. Eyelid surgery can alter ocular properties and functions by modifying retinal lighting and ocular optics. These alterations can affect intraocular pressure estimation, corneal curvature, corneal epithelial thickness, refractive power of the cornea, and intraocular lens calculation. Additionally, eyelid surgery can exacerbate dry eye symptoms and impact contrast sensitivity, which is a significant factor in visual quality. Therefore, understanding these interactions is crucial before performing eyelid surgery and during follow-up. This review summarizes recent literature on the effects of upper eyelid surgery on corneal properties and visual function, emphasizing the importance of considering these factors when planning or undergoing such procedures.
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Affiliation(s)
- Mostafa Heidari
- Farabi Eye Research Center, Department of Oculofacial Plastic and Reconstructive Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, South Kargar Street, Qazvin Square, Tehran, 1336616351, Iran
| | - Ali A Haydar
- Farabi Eye Research Center, Department of Oculofacial Plastic and Reconstructive Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, South Kargar Street, Qazvin Square, Tehran, 1336616351, Iran
| | - Mohammad Taher Rajabi
- Farabi Eye Research Center, Department of Oculofacial Plastic and Reconstructive Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, South Kargar Street, Qazvin Square, Tehran, 1336616351, Iran
| | - Seyed Mohsen Rafizadeh
- Farabi Eye Research Center, Department of Oculofacial Plastic and Reconstructive Surgery, Farabi Eye Hospital, Tehran University of Medical Sciences, South Kargar Street, Qazvin Square, Tehran, 1336616351, Iran.
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Tuaño KR, Fisher MH, Woodall J, Iorio ML. Plastic Surgery Training: Trends in Hand Surgery Fellowship in the Setting of a Pandemic. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5066. [PMID: 37342304 PMCID: PMC10278718 DOI: 10.1097/gox.0000000000005066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/26/2023] [Indexed: 06/22/2023]
Abstract
Given the diminishing presence of hand surgeons trained in plastic surgery, we evaluated the associated trends in annual hand meeting educational content and postgraduate job offerings, and analyzed the effect of the coronavirus disease 2019 (COVID-19) pandemic on trainees in hand surgery. Methods Hand meeting registration and educational content were analyzed over the past 10 years. Current hand surgery job offerings were evaluated for training requirements, and the annual rates of subspecialty certificate in surgery of the hand board certifications were compared across training backgrounds. Results Top categories of annual meeting educational content were "bone/joint," "other," and "professional development." A majority of American Society for Surgery of the Hand presidents had training backgrounds in orthopedics (55%), followed by plastics (23%) and general surgery (22%). The job offerings on the American Society for Surgery of the Hand and Association for Surgery of the Hand websites specified more training requirements in orthopedics than in plastics. Additionally, there were two to three times as many examinees taking the surgery of the hand examination from orthopedic surgery compared with plastics, with an overall higher pass rate. Hand fellowship programs were also predominantly offered for orthopedic surgery (80.8%). Conclusions Optimization of training, society membership, and clinical practice profiles may increase the presence of plastic surgery-trained hand surgeons. The extent of the economic impact of the COVID-19 pandemic is yet to be fully determined, but our analysis suggests that a lucrative market for reconstructive/hand surgery may exist in the face of economic downturn.
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Affiliation(s)
- Krystle R. Tuaño
- From the Division of Plastic and Reconstructive Surgery, University of Colorado, Department of Surgery, Anschutz Medical Center, Aurora, Col
| | - Marlie H. Fisher
- From the Division of Plastic and Reconstructive Surgery, University of Colorado, Department of Surgery, Anschutz Medical Center, Aurora, Col
| | - Jhade Woodall
- From the Division of Plastic and Reconstructive Surgery, University of Colorado, Department of Surgery, Anschutz Medical Center, Aurora, Col
| | - Matthew L. Iorio
- From the Division of Plastic and Reconstructive Surgery, University of Colorado, Department of Surgery, Anschutz Medical Center, Aurora, Col
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Derakhshan A, Reny DC, Rathi VK, McCarty JC, Lindsay RW, Lee LN, Gadkaree SK. Otolaryngologists Trail Other Specialties in Industry Payments From Dermal Filler Companies. Laryngoscope 2021; 132:301-306. [PMID: 34236083 DOI: 10.1002/lary.29746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/13/2021] [Accepted: 06/29/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS Dermal filler (DF) is a widely used nonsurgical option for facial rejuvenation with a rapidly expanding market. Physician payments by DF industry leaders have yet to be characterized. We sought to investigate trends in physician-industry payments by DF companies over 6 years. Differences in payments based on physician specialty and time were characterized. STUDY DESIGN Database review. METHODS The Open Payments Database was queried from 2013 to 2018. Payments made by the three largest DF companies by market share to otolaryngologists, plastic surgeons, and dermatologists were analyzed. Total dollars paid, number of payments made, type of payments made, and total number of specialists paid were recorded. One-way ANOVA was used for statistical analysis. RESULTS Otolaryngologists, plastic surgeons, and dermatologists received average annual payments of $0.36 million, $6.3 million, and $6.6 million respectively (P < .001). An average of 330 otolaryngologists, 2,128 plastic surgeons, and 5,980 dermatologists were paid annually (P < .001). Accredited speaking arrangements, consulting fees, and royalty/licensing fees comprised the majority of dollars paid to physicians. CONCLUSIONS Average physician payment by DF companies exceeds $12 million annually, with otolaryngologists receiving significantly less compared to plastic surgeons and dermatologists. LEVEL OF EVIDENCE Not applicable Laryngoscope, 2021.
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Affiliation(s)
- Adeeb Derakhshan
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Danielle C Reny
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Vinay K Rathi
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Justin C McCarty
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.,Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Robin W Lindsay
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Linda N Lee
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Shekhar K Gadkaree
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
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Barbarite E, Occhiogrosso J, McCarty JC, Lee LN, Hadlock TA, Shaye DA, Gadkaree SK. Opioid Prescribing Patterns Among Facial Plastic and Reconstructive Surgeons in the Medicare Population. Facial Plast Surg Aesthet Med 2021; 23:401-404. [PMID: 33650887 DOI: 10.1089/fpsam.2020.0551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objective: To evaluate opioid prescribing patterns among American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) members in the Medicare population. Methods: Retrospective cohort study of AAFPRS members in the Medicare Part D Prescriber dataset. Results: From 2014 to 2016, there was a significant decrease in the number of days of opioids supplied per beneficiary (5.9 vs. 4.9 days, p < 0.005), as well as the opioid prescription cost per beneficiary ($14.52 vs. $11.79, p = 0.005). The highest prescription rate was found in the Midwest (20.5%) and lowest in the Northeast (14.0%), however, the difference between geographic regions was not significant (p = 0.11). There was a significant decrease in the number of total opioid days supplied per beneficiary in the South (p = 0.001), Midwest (p = 0.05), and West regions (p < 0.001). There was no significant difference in opioid prescription rate (p = 0.89) or total opioid days supplied per beneficiary (p = 0.26) when states were stratified by age-adjusted opioid-specific death rate. Conclusion: This study demonstrates a national trend toward fewer opioid days supplied and less opioid cost per Medicare beneficiary among AAFPRS members between 2014 and 2016.
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Affiliation(s)
- Eric Barbarite
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Jessica Occhiogrosso
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Justin C McCarty
- Center for Surgery and Public Health, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Linda N Lee
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Tessa A Hadlock
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - David A Shaye
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Shekhar K Gadkaree
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Center for Surgery and Public Health, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Gadkaree SK, Derakhshan A, Workman AD, Feng AL, Quesnel AM, Shaye DA. Quantifying Aerosolization of Facial Plastic Surgery Procedures in the COVID-19 Era: Safety and Particle Generation in Craniomaxillofacial Trauma and Rhinoplasty. Facial Plast Surg Aesthet Med 2020; 22:321-326. [PMID: 32628569 DOI: 10.1089/fpsam.2020.0322] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: COVID-19 poses a potentially significant infectious risk during procedures of the head and neck due to high viral loads in the nasal cavity and nasopharynx. Facial plastic surgery has significant exposure to these areas during craniomaxillofacial trauma procedures and rhinoplasty. Methods: Airborne particulate generation in the 1-10 μm range was quantified with an optical particle sizer in real time during cadaveric-simulated rhinoplasty and facial trauma conditions. Procedures tested included mandibular plate screw drilling, calvarial drilling, nasal bone osteotomy, nasal dorsal rasping, and piezoelectric saw use. Particulate generation was measured both adjacent to the surgical site and at surgeon mouth level (SML). Results: Mandibular plate screw drilling without irrigation generated significant particulate both adjacent to the surgical site and at SML (p < 0.01). Irrigation mitigated particulate generation at SML to nonsignificant levels. Calvarial drilling additionally produced substantial particulate above baseline adjacent to the surgical site (p < 0.01). Standard nasal osteotomies and dorsal rasping did not generate detectable airborne particulate, whereas piezoelectric saw use was associated with significant particulate generation both adjacent to the surgical site (p < 0.001) and at SML (p < 0.01). At SML, smaller particulate represented a significantly higher proportion of total particulate detected. Conclusions: The majority of craniomaxillofacial trauma procedures involve particle generation that may be limited in spread by the use of local irrigation. Most bony work involved in rhinoplasty can be safely performed without a high degree of particle formation. The use of piezoelectric instruments in rhinoplasty should be avoided when concerned for particulate generation.
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Affiliation(s)
- Shekhar K Gadkaree
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Adeeb Derakhshan
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Alan D Workman
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Allen L Feng
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Alicia M Quesnel
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - David A Shaye
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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