Hematomas represent one of the most common postoperative complications in patients undergoing aesthetic surgery. Depending on the type of procedure performed, hematoma incidence and presentation can vary greatly. Understanding the risk factors for hematoma formation and the preoperative considerations to mitigate the risk is critical to provide optimal care to the aesthetic patient. Various perioperative prevention measures may also be employed to minimize hematoma incidence. The surgeon's ability to adequately diagnose and treat hematomas after aesthetic surgery is not only crucial to patient care but also minimizes the risk of further complications or long-term sequelae. Understanding hematoma development and management enhances patient safety and will lead to overall increased patient satisfaction after aesthetic surgery.
A consensus on the optimal surgical approach for repair of a paraesophageal hernia has not been reached. The aim of this study was to examine the outcomes of open and laparoscopic paraesophageal hernia repairs (PHR), both with and without mesh. A review of the National Surgical Quality Improvement Program (NSQIP) database from 2007 to 2011 was conducted. Patients who underwent an open or laparoscopic PHR were included. The primary outcome was 30-day mortality. Secondary outcomes included infections, respiratory and cardiac complications, intraoperative or perioperative transfusions, sepsis, and septic shock. Statistical analyses using odds ratios were performed comparing the open and laparoscopic approaches. A total of 4470 patients were identified using NSQIP; 2834 patients had a laparoscopic repair and the remaining 1636 patients underwent an open PHR. Compared with the laparoscopic approach, the open repair group had significantly higher 30-day mortality (odds ratio, 4.75; 95% confidence interval, 2.67 to 8.47; P < 0.0001). The laparoscopic approach had a statistically significant decrease in infections, respiratory and cardiac events/complications, transfusion requirements, episodes of sepsis, and septic shock ( P < 0.05). Our data suggest increased perioperative morbidity associated with an open PHR compared with laparoscopic. There was no statistically significant difference in any of the primary or secondary outcomes in patients repaired with mesh compared with those without. The overall use of mesh in paraesophageal hernia repairs has increased. The NSQIP data show significantly increased 30-day mortality in open repair compared with laparoscopic as well as a significantly higher perioperative complication rate.
Surgical site infections represent one of the most common postoperative complications in patients undergoing aesthetic surgery. As with other postoperative complications, the incidence of these infections may be influenced by many factors and varies depending on the specific operation performed. Understanding the risk factors for infection development is critical because careful patient selection and appropriate perioperative counseling will set the right expectations and can ultimately improve patient outcomes and satisfaction. Various perioperative prevention measures may also be employed to minimize the incidence of these infections. Once the infection occurs, prompt diagnosis will allow management of the infection and any associated complications in a timely manner to ensure patient safety, optimize the postoperative course, and avoid long-term sequelae.
Volume 149, Number 4 • Viewpoints 837e Medicaid Services, relative value units dictate the exact dollar amount reimbursed to providers for any given medical service or procedure. We sought to identify and describe trends in Medicare reimbursement for microsurgery procedures from 2007 to 2020 in comparison to inflation. This study conformed to the Declaration of Helsinki's ethical principles for medical research.We identified Current Procedural Terminology (CPT) codes pertaining to procedures that utilize commonly performed microsurgical techniques (Table 1). Using the Physician Fee Schedule Look-Up Tool, available through the Centers for Medicare and Medicaid Services, we gathered relevant data around the relative value units for work, practice expense, and professional liability insurance as well as the conversion factors for each microsurgical CPT code from 2007 to 2020. Inflation data, as well as the general consumer price index, were obtained through the U.S. Department of Labor; these data are freely accessible through the Bureau of Labor Statistics. We utilized descriptive statistics as described in our previous publication. 2 We found that Medicare reimbursement for the 34 included codes increased, on average, by 2.28 percent from 2007 to 2020. The range of unadjusted difference in reimbursement was wide (−22 percent to +24 percent). The consumer price index changed by 27 percent from 2007 to 2020, according to the U.S. Department of Labor. After adjusting for changes in inflation rate, we found that Medicare reimbursement decreased by 1.74 percent annually, on average. Relative differences in overall reimbursement decreased for the included CPT codes from 2007 to 2020 by 19.97 percent, on average, when we adjusted for inflation (Table 2). In the included years, physician work, practice expense, and professional liability insurance relative value units increased (work, 0.59 percent; facility, 11.00 percent; malpractice, 96.13 percent). The change in conversion factor was −4.78 percent across the study period.Our results demonstrate that Medicare reimbursement rates for microsurgery are lagging behind consumer price index inflation. A recent study showed that microsurgical procedures are profitable for hospitals while reimbursement rates remain low for physicians by looking at projected Medicare payments to the surgeon and hospital for head and neck reconstructive microsurgery procedures 3 ; similar trends for low reimbursement for breast reconstruction have also been demonstrated. 4 The effects of inflation on Medicare reimbursement may also particularly affect microsurgical procedures, which have an added layer of complexity due to coding rules and bundling of the reimbursements for both the procedure and the use of the operating microscope. It is crucial for these data to be readily available to physicians given that Medicare may now include certain patients under age 65. Microsurgical procedures are performed on patients of all ages, so understanding these trends is particularly important in this con...
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