Effects of antihypertensive drugs on surgical outcomes of breast reconstruction: a nationwide population-based claim study

Disparities in Delays to Lower Extremity Free Flap Reconstructions

BACKGROUND

Lower extremity flap reconstructions are often due to traumatic injuries requiring emergency surgeries. Studies found that delays to operating increase morbidity, mortality, and length of hospital stay. There are limited studies assessing disparities in delays to reconstruction. This study investigates factories correlated to delays in surgery in lower extremity reconstructions.

METHODS

In a single center from January 2015 to January 2024, 80 patients who underwent a lower extremity flap reconstruction and remained inpatient until their reconstruction operation were identified. The time to surgery from admission, time to consult, and time from consult to surgery were collected. Delays to flap were defined as >14 days from admission to surgery. Demographics, substance use history, Charlson Comorbidity Index, and Trauma Severity Score were collected. A multiple analysis of variance for quantitative variables and a χ2 test for categorical variables were conducted. Variables with significant values on univariate analysis were further analyzed using a multivariate logistic regression to account for confounding variables.

RESULTS

In the delay to flap (DF) cohort (n = 40) and no delay to flap (ND) cohort (n = 40), minority patients were more likely to experience delays to flap (P < 0.001). Surprisingly, there were no correlations to Charlson Comorbidity Index, Trauma Severity Score, marijuana, or illegal drug use. ND patients were more likely to have a history of tobacco use (P = 0.012). DF patients correlated with a significantly longer time to consult (DF: 8.1 d, ND: 2.3 d, P < 0.001) and time to surgery from consult (18.3 d, 5.8 d, P < 0.001). There was a significant correlation between DF and preoperative infection (P = 0.012). DF patients were significantly associated with hypertension (P = 0.030) and less likely to have gastroesophageal reflux disease (P = 0.032). Of significant factors, hypertension was significantly associated with complications (P = 0.037).

CONCLUSIONS

Patients who experience delays to flap were more likely to be a minority, have preoperative infections, delayed time to consult, and hypertension. Although postoperative infection was correlated with ND, DF patients were associated with preoperative infections. This suggests that there may be a disparity of infection management, susceptibility to infection, and flap recognition that lead to delays to lower extremity reconstruction. Larger prospective studies may be helpful to further evaluate reasons for delays.

Surgical Management of Breast Capsular Contracture-A Multi-institutional Data Analysis of Risk Factors for Early Complications

BACKGROUND

Capsular contracture (CC) is a common complication following implant-based breast surgery, often requiring surgical intervention. Yet, little is known about risk factors and outcomes following CC surgery.

METHODS

We reviewed the American College of Surgeons National Surgical Quality Improvement Program database (2008-2021) to identify female patients diagnosed with CC and treated surgically. Outcomes of interest included the incidence of surgical and medical complications at 30-days, reoperations, and readmissions. Confounder-adjusted multivariable analyses were performed to establish risk factors.

RESULTS

5,057 patients with CC were identified (mean age: 55 ± 12 years and mean body mass index [BMI]: 26 ± 6 kg/m2). While 2,841 (65%) women underwent capsulectomy, capsulotomy was performed in 742 patients (15%). Implant removal and replacement were recorded in 1,160 (23%) and 315 (6.2%) cases, respectively. 319 (6.3%) patients experienced postoperative complications, with 155 (3.1%) reoperations and 99 (2.0%) readmissions. While surgical adverse events were recorded in 139 (2.7%) cases, 86 (1.7%) medical complications occurred during the 30 day follow-up. In multivariate analyses, increased BMI (OR: 1.04; p = 0.009), preoperative diagnosis of hypertension (OR: 1.48; p = 0.004), and inpatient setting (OR: 4.15; p < 0.001) were identified as risk factors of complication occurrence.

CONCLUSION

Based on 14 years of multi-institutional data, we calculated a net 30 day complication rate of 6.3% after the surgical treatment of CC. We identified higher BMI, hypertension, and inpatient setting as independent risk factors of postoperative complications. Plastic surgeons may wish to integrate these findings into their perioperative workflows, thus optimizing patient counseling and determining candidates' eligibility for CC surgery.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

One Molecule, Many Faces: Repositioning Cardiovascular Agents for Advanced Wound Healing

Chronic wound treatments pose a challenge for healthcare worldwide, particularly for the people in developed countries. Chronic wounds significantly impair quality of life, especially among the elderly. Current research is devoted to novel approaches to wound care by repositioning cardiovascular agents for topical wound treatment. The emerging field of medicinal products' repurposing, which involves redirecting existing pharmaceuticals to new therapeutic uses, is a promising strategy. Recent studies suggest that medicinal products such as sartans, beta-blockers, and statins have unexplored potential, exhibiting multifaceted pharmacological properties that extend beyond their primary indications. The purpose of this review is to analyze the current state of knowledge on the repositioning of cardiovascular agents' use and their molecular mechanisms in the context of wound healing.