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Hauc SC, Stögner VA, Ihnat JM, Hosseini H, Huelsboemer L, Kauke-Navarro M, Rivera JC, Williams M, Glahn JZ, Savetamal A, Pomahac B. Understanding the Drivers of Cost and Length of Stay in a Cohort of 21,875 Patients with Severe Burn. J Burn Care Res 2024; 45:425-431. [PMID: 37882472 DOI: 10.1093/jbcr/irad168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Indexed: 10/27/2023]
Abstract
Burn management has significantly advanced in the past 75 years, resulting in improved mortality rates. However, there are still over one million burn victims in the United States each year, with over 3,000 burn-related deaths annually. The impacts of individual patient, hospital, and regional demographics on length of stay (LOS) and total cost have yet to be fully explored in a large nationally representative cohort. Thus, this study aimed to examine various hospital and patient characteristics using a sample of over 20,000 patients. Inpatient data from the National Inpatient Sample from 2008 to 2015 were analyzed, and only patients with an ICD-9 code for second- or third-degree burns were included. In addition, a major operating room procedure must have been indicated on the discharge summary for patients to be included in the final dataset, ensuring that only severe burns requiring complex care were analyzed. Analysis of covariance models was used to evaluate the impact of various patient, hospital, and regional variables on both LOS and cost. The study found that skin grafts and fasciotomy significantly increased the cost of hospitalization. Having burns on the face, neck, and trunk significantly increased costs for patients with second-degree burns, while burns on the trunk resulted in the longest LOS for patients with third-degree burns. Infections in the hospital and additional procedures, such as flaps and skin grafts, also led to longer stays. The study also found that the prevalence of postoperative complications, such as electrolyte imbalance, was high among patients with burn surgery.
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Affiliation(s)
- Sacha C Hauc
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Viola Antonia Stögner
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Burn Center, Hannover Medical School, Hannover, Germany
| | - Jacqueline M Ihnat
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Helia Hosseini
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Lioba Huelsboemer
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Martin Kauke-Navarro
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Jean C Rivera
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Mica Williams
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Joshua Z Glahn
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Alisa Savetamal
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
| | - Bohdan Pomahac
- Department of Surgery, Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, 06511, CT, USA
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Alper DP, Almeida MN, De Baun HM, Glahn JZ, Rivera JC, Williams MCG, Collar JL, Mookerjee V, Persing JA, Alperovich M. Quality and Readability of Accessible Facial Feminization Literature: Where Can We Improve? Ann Plast Surg 2023; 90:533-537. [PMID: 37311308 DOI: 10.1097/sap.0000000000003569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Facial feminization surgery (FFS) consists of multiple, complex procedures. Well-informed patients have been shown to have better outcomes and expectations. However, there is limited data evaluating FFS patient-oriented material online. This study aims to evaluate the quality and readability of FFS literature online. METHODS Facial feminization surgery-related terms were queried in Google with location, cookies, and user account information disabled. Websites were analyzed for readability using Flesch Reading Ease and Flesch-Kincaid Reading Grade Level, suitability using the suitability assessment of materials (SAM), and quality using the DISCERN scale. Unpaired t tests and χ2 tests were used to compare the websites of community-based and academic or public institutions. RESULTS One hundred twenty websites met inclusion criteria (71 community-based and 49 academic). The average reading grade level was 11.68 ± 1.71. The average SAM score was 53.11 ± 11.75, denoting adequate readability. Only 16.67% of websites contained visual aids to assist in explaining procedures and benefits. Overall, 68.33% of websites' DISCERN score was rated very poor or poor, whereas only 8.33% were rated as good. The following DISCERN elements had the lowest scores across all graded websites: "clear source and date of information," "details of additional source of support," "refers to areas of uncertainty," and "describes risks of each treatment." Websites published by community-based institutions were significantly better in describing how FFS works and the benefits of each procedure. Academic sites overall were less biased (4.84 vs 4.62, P = 0.03) and provided additional sources of support (2.35 vs 1.32, P = <0.001). CONCLUSIONS Online FFS patient resources should be written at a more inclusive reading level and should increase the use of pictorial aids to improve patient comprehension. Facial feminization surgery patient resources were significantly above the recommended sixth grade reading level for health literature. Academic and community-based institutions should include more information about procedural risks and limitations in surgical outcomes to ensure a broader scope of understanding.
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Affiliation(s)
- David P Alper
- From the Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Mariana N Almeida
- From the Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Heloise M De Baun
- Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
| | - Joshua Z Glahn
- From the Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Jean Carlo Rivera
- From the Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Mica C G Williams
- From the Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - John L Collar
- From the Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Vikram Mookerjee
- From the Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - John A Persing
- From the Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Michael Alperovich
- From the Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
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Mateja KL, Long AS, Hauc SC, Glahn JZ, Weber CF, Junn AH, Juan HY, Bobba PS, Persing JA, Alperovich M. An Online Calculator for Estimating Breast Implant Volume from Imaging. Plast Reconstr Surg Glob Open 2022; 10:e4273. [PMID: 35450258 PMCID: PMC9015200 DOI: 10.1097/gox.0000000000004273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/24/2022] [Indexed: 11/27/2022]
Abstract
Breast implant surgery remains one of the most common surgical procedures performed in the United States. Implant exchange can be complicated by unavailability of medical records or implant identification cards. Using chest imaging of 154 breast implants, an algorithm for estimating breast implant volume was generated. Based on four simple measurements and patient body mass index, a free, online calculator was created with a mean error of volume estimate of less than 1 cm3 and a SD of 44 cm3. In instances where a surgeon does not have implant records available but has chest imaging, this online tool can be used to obtain a relatively accurate estimate of implant volume.
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Affiliation(s)
- Kirby L. Mateja
- From the Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, New Haven, Conn
| | - Aaron S. Long
- From the Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, New Haven, Conn
| | - Sacha C. Hauc
- From the Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, New Haven, Conn
| | - Joshua Z. Glahn
- From the Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, New Haven, Conn
| | - Clara F. Weber
- From the Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, New Haven, Conn
| | - Adam H. Junn
- From the Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, New Haven, Conn
| | - Hui Yu Juan
- From the Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, New Haven, Conn
| | - Pratheek S. Bobba
- From the Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, New Haven, Conn
| | - John A. Persing
- From the Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, New Haven, Conn
| | - Michael Alperovich
- From the Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, New Haven, Conn
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