Abstract:
BACKGROUND:The Centers for Medicare and Medicaid Services has a list of 10 hospital-acquired conditions for which hospitals and physicians will not be reimbursed because it deems such conditions are preventable and should be considered "never events." To evaluate the validity of this premise, the authors conducted a real-life analysis of the incidence and categories of never events occurring in a breast reconstruction cohort of a multisurgeon plastic surgery practice. Cost analysis of estimated revenue loss and risk factors associated with the development of never events are enumerated. METHODS:A retrospective chart review of postmastectomy patients undergoing breast reconstruction from 2008 to August of 2010 was conducted. A total of 297 patients were identified and International Classification of Diseases, Ninth Revision codes corresponding to the never events of interest were applied to the study population. RESULTS:Of the 297 patients, 24 (8.08 percent) developed never events in two categories: surgical-site infections (7.74 percent) and catheter-related urinary tract infections (0.34 percent). There were no complications in the remaining eight categories. Overweight body mass index and diabetes were strong independent risk factors for the development of never events (p < 0.0001). Cost estimates of associated revenue loss and economic analysis reveal substantial financial burdens to physicians and hospitals as a result of nonreimbursement. CONCLUSIONS:The "one-size-fits-all" approach of the Centers for Medicare and Medicaid Services may be misplaced and misleading. Certain risk factors are independent predictors of developing a never event, making it impossible to classify certain outcomes as "never" occurrences. The never events pendulum may have swung immensely to the left, and it is time to attain a much-needed equilibrium. CLINICAL QUESTION/LEVEL OF EVIDENCE:Risk, II.
journal_name
Plast Reconstr Surgjournal_title
Plastic and reconstructive surgeryauthors
Adetayo OA,Salcedo SE,Biskup NI,Gupta SCdoi
10.1097/PRS.0b013e3182547b74subject
Has Abstractpub_date
2012-07-01 00:00:00pages
23-29issue
1eissn
0032-1052issn
1529-4242pii
00006534-201207000-00005journal_volume
130pub_type
杂志文章abstract:BACKGROUND:Congenital unilateral lower lip palsy or congenital hypoplasia of the depressor anguli oris muscle, also known as asymmetric crying facies, characterized by deformity of the lower lip, lacks aggressive surgical intervention methods. Although several dynamic and static reconstruction methods have been reporte...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/01.prs.0000264062.64251.10
更新日期:2007-07-01 00:00:00
abstract::A new use is described for the CO2 laser--that of deepithelialization. Deepithelialization is a technique used in a myriad of plastic surgical procedures. This paper introduces the use of the laser for deepithelialization and illustrates its advantages in 44 consecutive patients undergoing reduction mammaplasty. Advan...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198705000-00013
更新日期:1987-05-01 00:00:00
abstract::Free-flap failure is in the order of 4 to 10 percent. Heparin is more effective at preventing venous thrombosis than arterial thrombosis. This study was undertaken to investigate the efficacy of delivering heparin at a high dose locally but low dose systemically (heparin infusion via a catheter placed proximal to the ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-200003000-00024
更新日期:2000-03-01 00:00:00
abstract::A series of 22 patients with carpal tunnel syndrome secondary to chronic tenosynovitis was divided into two groups. The first group was treated by transverse carpal ligament release alone. The second group was treated by transverse carpal ligament release, external neurolysis of the median nerve, flexor synovectomy, ...
journal_title:Plastic and reconstructive surgery
pub_type: 临床试验,杂志文章
doi:10.1097/00006534-197801000-00016
更新日期:1978-01-01 00:00:00
abstract::We have studied the chemomigration activity of an epithelial carcinoma cell line using a modified 96-well Boyden chamber apparatus consisting of upper and lower wells separated by an 8-microns pore polycarbonate filter. Cells from the malignant squamous carcinoma cell line A-431 were plated in the upper wells over a c...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199512000-00024
更新日期:1995-12-01 00:00:00
abstract::The appropriate management of frontal sinus fractures is controversial. Experience with 78 frontal sinus fractures over a 9-year period was reviewed, and the fractures were classified into anterior wall, anterobasilar, and frontal skull fracture extensions. The presence of a concomitant CSF leak or an air-fluid level ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198710000-00003
更新日期:1987-10-01 00:00:00
abstract::Our procedure, in which the inverted nipple was suspended using autogenous tendon grafts, was easy to perform, and it was not necessary to cut the lactiferous ducts. There was no deformity of the nipple or areola after this procedure, and the surgical scars were inconspicuous. Three patients who were followed up for o...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199011000-00030
更新日期:1990-11-01 00:00:00
abstract::Thirty-seven domestic rabbits, 4 dogs, and 2 freshly amputated human limbs were divided into three groups as three different models of fasciosteal flaps that were taken from the distal radii or the tibiae. Through the methods of histology, fluorochrome bone labeling, and perfusing stain, it was confirmed that viabilit...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:
更新日期:1986-08-01 00:00:00
abstract::A description is presented of an anterior approach to the treatment of prominent ears with Kaye's method but with a few modifications to simplify it. Confirmation of the method's advantages is discussed. ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199702000-00042
更新日期:1997-02-01 00:00:00
abstract::Dorsal hump reduction can lead to significant aesthetic and functional deformities with distortion of the dorsal aesthetic lines without first preserving and subsequently restoring proper position of the upper lateral cartilages. The senior author (R.J.R.) previously described the component dorsal hump reduction to pr...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0b013e3182a01470
更新日期:2014-01-01 00:00:00
abstract::The authors present a cohort of 21 consecutive patients who had congenital pigmented nevi covering 15 to 65 percent of the forehead and adjacent scalp and who were treated at their institution within the last 12 years. All patients were treated with an expansion of the adjacent texture- and color-matched skin as the p...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-200103000-00004
更新日期:2001-03-01 00:00:00
abstract:BACKGROUND:The lumbar artery perforator flap is an excellent free flap for breast reconstruction whenever the deep inferior epigastric perforator (DIEP) flap is not an option. The main indication is a lack of abdominal bulk, often seen in young BRCA-positive women seeking prophylactic amputation and immediate reconstru...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000006681
更新日期:2020-04-01 00:00:00
abstract::Review of 46 consecutive patients undergoing immediate breast reconstruction with tissue expanders and subsequent implant placement was conducted to assess the potential liability of adjuvant chemotherapy. Twenty-three patients required chemotherapy, while 23 did not. Critical comparison of complications and outcome o...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199604001-00013
更新日期:1996-04-01 00:00:00
abstract::The midface of a full-term stillborn infant with a right complete unilateral cleft lip and palate was studied with plain-film radiography and tomography, xeroradiography, and computerized axial tomography. Gross skeletal and soft-tissue deficiencies on the cleft side were evident as compared to the noncleft side and i...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198608000-00018
更新日期:1986-08-01 00:00:00
abstract:BACKGROUND:Molecular mechanisms that direct the extent of the foreign body reaction to implanted biological meshes and their subsequent incorporation are poorly understood. The purpose of this study was to compare the influence of non-cross-linked human dermis (AlloDerm) with that of cross-linked porcine dermis (Permac...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0b013e3182818a3d
更新日期:2013-04-01 00:00:00
abstract::The purpose of this Special Topic article is to present the current state of scientific evidence related to the safety of silicone breast implants. There is presently overwhelming evidence to support the safety of silicone breast implants. Ultimately, the decision to obtain, keep, or remove breast implants is the choi...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章,评审
doi:10.1097/PRS.0000000000005710
更新日期:2019-07-01 00:00:00
abstract::Lateral ptosis of the eyebrow is a major part of the complex changes that patients are seeking to improve with an upper blepharoplasty. Two hundred and eight patients have undergone a browpexy procedure at the time of blepharoplasty. This operative maneuver, which is performed through the blepharoplasty incision, prev...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199710000-00029
更新日期:1997-10-01 00:00:00
abstract:BACKGROUND:Stable reduction of fractures of the zygomatic complex is essential to avoid long-term aesthetic, sensory, and ocular consequences. Delayed collapse or relapse after reduction of fractures of the zygomatic complex is attributed to muscle forces, when there has been no additional trauma. A number of studies h...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/01.prs.0000239565.82612.56
更新日期:2007-02-01 00:00:00
abstract::Rheumatoid arthritis affects approximately 1 percent of the adult population. Bilateral symmetric involvement of the wrist occurs in 85 percent of these patients, with recurrent flares and relentless progression. Anatomic changes consist of radiocarpal, intercarpal, and radioulnar subluxation and joint destruction. Fo...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199912000-00018
更新日期:1999-12-01 00:00:00
abstract::The role of craniofacial surgical techniques and immediate bone grafting in the management of complex craniofacial trauma has been reviewed. Four hundred and one patients with complex facial injuries have been treated. Two hundred and forty-one primary bone and cartilage grafts have been performed in 66 patients. Comp...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198501000-00005
更新日期:1985-01-01 00:00:00
abstract::Real-time ultrasonography in pregnancy can accurately detect gestational age, position of the fetus, position of the placenta, sex of the fetus, and many congenital anomalies before birth. To date, however, there has been no report of detection of a cleft lip-palate deformity by ultrasound. Two cases, in approximately...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198112000-00002
更新日期:1981-12-01 00:00:00
abstract::Traumatic amputation of the lip is a rare yet devastating event affecting both form and function. Considering the available methods for reconstruction, replantation may offer a reasonable solution. We sought to characterize the variables associated with lip replantation and to assess the outcome in a retrospective rev...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199808000-00009
更新日期:1998-08-01 00:00:00
abstract:BACKGROUND:Although studies have analyzed quality of life in children with nonsyndromic craniosynostosis, to date nobody has investigated long-term quality of life in adults with nonsyndromic craniosynostosis. The purpose of this study was to compare quality of life in adult nonsyndromic craniosynostosis patients with ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000004408
更新日期:2018-06-01 00:00:00
abstract::Closure of plantar defects with local rotation flaps was studied in 10 patients with 11 plantar defects. Ages ranged from 15 to 66 years, and the average defect was 3.0 X 3.6 cm. Two patients were diabetics. Etiology was variable and included trauma, tumors, and breakdown in patients with anesthetic plantar surfaces. ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198611000-00012
更新日期:1986-11-01 00:00:00
abstract::The Le Fort I osteotomy is a versatile operation for correction of developmental, congenital, and posttraumatic deformities of the lower midface. One of the challenges of the osteotomy is pterygomaxillary separation, with the potential for unfavorable fractures to the orbit/skull base or vascular injury. A modified te...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000006751
更新日期:2020-05-01 00:00:00
abstract::A successful replantation of an amputated penis-scrotum, by microneurovascular anastomoses, is presented. There were no significant postoperative complications. A satisfactory result was obtained with sensory reinnervation of the glans. Microsurgical replantation, with anastomoses, is the best procedure in these cases...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-197708000-00028
更新日期:1977-08-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to compare the local recurrence and distant metastasis of postmastectomy radiotherapy for breast cancer patients with and without immediate transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction. METHODS:Between March of 1997 and October of 2001, 191 breast can...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/01.prs.0000220527.35442.44
更新日期:2006-10-01 00:00:00
abstract::In a series of 708 parotidectomies (partial or total), we found 23 cystic lesions. Of these, 16 met the criteria for so-called "branchial cysts"; five were retention cysts of duct origin, and the remaining two were epidermal inclusion cysts. The principles of diagnosis and treatment of parotid cysts are presented. ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-197803000-00009
更新日期:1978-03-01 00:00:00
abstract::This study was undertaken to understand the control mechanisms differentiating circulation to normal skin and acute skin flaps. The approach was to compare the effects of systemic vasoactive drugs on skin blood flow in rats in acute skin flaps and identical areas of control skin. With this model it was felt that syste...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198303000-00018
更新日期:1983-03-01 00:00:00
abstract::Composite tissue defects may involve skin, mucosa, muscle, and bone together or in combinations of two or three of these tissues. Defects involving bone and skin are frequently encountered. Osteocutaneous flaps may be used to reconstruct these composite tissue defects. Sometimes, it is not possible to obtain a vascula...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/01.PRS.0000101062.00227.4F
更新日期:2004-02-01 00:00:00