Background The impact of the COVID-19 pandemic on physician relationships with industry and subsequent financial implications has not been previously assessed. The aim of this study is to compare pre-and post-COVID-19 payments between industry and medical providers for all plastic surgeons. Methods Payment information was collected for the 2019 and 2020 reporting periods from the Open Payments Program (OPP) database for plastic surgeons and plastic surgeon subspecialists. An analysis was performed of trends and comparison of payments for each year for all plastic surgeons and each subspecialty cohort. Results For all plastic surgeons, there was a decrease in industry payments between 2019 and 2020 (-30.5%). All plastic surgery subspecialties had a decrease in payments with general plastic and reconstructive surgery affected the most (-56%) and craniofacial surgery affected the least (-9%). Payments for almost all categories for plastic surgeons decreased along with compensation as faculty or as speakers. Total charitable contributions and grant payments increased by 61 and 273%, respectively.Conclusion Analysis of industry-physician payments available through the Sunshine Act shows that the COVID-19 pandemic has significantly impacted industry payments to plastic surgery and its subspecialties. While this study demonstrates the economic impact of the current pandemic, only time will tell whether these trends will persist in the coming years.
Summary: Chondrolaryngoplasty is a surgical procedure that reduces a prominent thyroid cartilage. Demand for chondrolaryngoplasty has significantly increased over recent years in transgender women and nonbinary individuals and has been shown to alleviate gender dysphoria and improve quality of life. When performing chondrolaryngoplasty, surgeons must carefully balance the desire for maximal cartilage reduction with the potential for damage to surrounding structures (ie, the vocal cords) that may result because of overaggressive or imprecise resection. Our institution has adopted the technique of direct vocal cord endoscopic visualization using a flexible laryngoscope for increased safety. Briefly, surgical steps include dissection and preparation for translaryngeal needle placement, endoscopic visualization of the needle placed above the level of the vocal cords, marking of the corresponding level, and resection of the thyroid cartilage. The following article and supplemental video provide further detailed descriptions of these surgical steps as a resource for training and technique refinement.
BACKGROUND Several unique clinical features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19) infection, have been identified and characterized. One such feature, mostly among patients with severe COVID-19 infection, has become known as COVID-19-induced coagulopathy. Surgical patients with a history of or active COVID-19 infection bear a significantly higher risk for postoperative thrombotic complications. These patients may require surgical intervention to treat severe thrombotic complications. Few studies have been carried out to better characterize this association. The purpose of this study was to perform a systematic review and meta-analysis of the literature on COVID-19 infections that led to thrombotic complications necessitating surgical intervention. We hypothesized that patients with recent or active COVID-19 infection would have high rates of thromboembolic complications both arterial and venous in origin. AIM To perform a systematic review and meta-analysis of the literature on COVID-19 infections that led to thrombotic complications necessitating surgical intervention. METHODS The current systematic review implemented an algorithmic approach to review all the currently available English medical literature on surgical interventions necessitated by COVID-19 thrombotic complications using the preferred reporting items for systematic reviews and meta-analysis principles. A comprehensive search of the medical literature in the “PubMed”, “Scopus”, “Google Scholar” top 100 results, and archives of Plastic and Reconstructive Surgery was performed using the key words “COVID-19” AND “surgery” AND “thromboembolism” AND “complication”. The search string was generated and the records which were not specific about surgical interventions or thrombotic complications due to COVID-19 infection were excluded. Titles and abstracts were screened by two authors and full-text articles were assessed for eligibility and inclusion. Finally, results were further refined to focus on articles that focused on surgical interventions that were necessitated by COVID-19 thrombotic complications. RESULTS The database search resulted in the final inclusion of 22 retrospective studies, after application of the inclusion/exclusion criteria. Of the included studies, 17 were single case reports, 3 were case series and 2 were cross sectional cohort studies. All studies were retrospective in nature. Twelve of the reported studies were conducted in the United States of America, with the remaining studies originating from Italy, Turkey, Pakistan, France, Serbia, and Germany. All cases reported in our study were laboratory confirmed SARS-CoV-2 positive. A total of 70 cases involving surgical intervention were isolated from the 22 studies included in this review. CONCLUSION There is paucity of data describing the relationship...
The healthcare system has been greatly affected by the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to compare pre-COVID-19 and post-COVID-19 payments between industry and medical providers for all surgeons and subspecialized surgeons. Payment information was obtained from the Open Payments Program database for the 2019 and 2020 reported periods for three physician groups: all physicians, all surgeons, and each surgical subspecialty. Comparison and analysis of payment amount and type between these years was performed for each cohort. Physicians experienced a 36% decrease in industry payments with surgeons experiencing a 30.4% decrease. All surgical subspecialties, including plastic surgery (−30.5%; P < 0.01), experienced a significant decrease in industry payments except for transplant surgery, trauma surgery, and neurological surgery. Charitable contributions and compensation for services other than consulting were the only payment types that increased from 2019 to 2020. The COVID-19 pandemic has significantly impacted industry physician payments across all medical and surgical fields with payment decreases across almost all surgical subspecialties.
This article aims to determine how quality of life (QoL) is defined and assessed in cases of severe craniofacial anomalies, as well as the impact such considerations may have on the treatment of a neonate with these conditions with respect to palliative neonatal care. Our literature review found insufficient evidence to suggest that craniofacial anomalies result in consistently poor QoL. Based on these findings and in line with the current acceptable standards for the ethical care of neonates, with the exception of rare cases, resuscitative efforts should always be performed on patients with isolated craniofacial anomalies, as demonstrated in the management of this reported patient.
INTRODUCTION:Urinary tract infection (UTI) is responsible for 15% of all community-prescribed antibiotics. The effects of the pandemic on UTI treatment are largely unknown. We evaluated the impact of COVID-19 and telemedicine on empiric UTI treatment in women, hypothesizing that increased telemedicine during the pandemic would increase empiric UTI treatment.METHODS:This is a retrospective cohort study of treatment patterns of female patients aged 18-65 using ICD-10 codes for acute cystitis with and without hematuria during the first 6 months of the pandemic versus the preceding 6 months. Our primary outcome was empiric antibiotic treatment, defined by treatment based on clinical picture with/without pending urine testing. To reach 80% power, we included 222 patients.RESULTS:The average age of participants was 42. Fifty-two percent were White, 23% Black, and 23% Hispanic. No demographic differences existed between cohorts. During the pandemic, 36.6% of UTI encounters were conducted via telemedicine, compared to 1.5% pre-pandemic (P<.0001). The rate of empiric treatment increased from 58.2% pre-pandemic to 70.5% pandemic (P=.055). The rate of treatment based on clinical picture with no pending urine testing was significantly higher during the pandemic (P<.0001). Nitrofurantoin or trimethoprim/sulfamethoxazole was used in 79% of patients prescribed an antibiotic. The treatment adjustment rate was 17.1%.CONCLUSION:COVID-19 dramatically increased telemedicine utilization by women with UTI symptoms. Empiric treatment approached significance and confirmatory urine testing was done significantly less during the pandemic. Given the importance of antibiotic stewardship, it is important to further characterize telemedicine’s impact on treatment of this common condition.
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