Scientific Abstract Presentations: Practice Management Session 1 Thursday, October 15 Thu, Oct 15 1:30-3:00 p.m. CDT

Background Despite a growing presence of women plastic surgery trainees and faculty, compensation and advancement inequities persist. Prior literature suggests that increased representation alone may not eliminate structural pay disparities. The purpose of this study is to characterize gender differences in compensation, representation, and modeled lifetime earnings among academic plastic surgeons.

Methods The Association of American Medical Colleges (AAMC) Faculty Salary Reports from fiscal years 2022–2025 were analyzed for full-time plastic surgery faculty at accredited U.S. medical schools. Compensation was expressed as cents-on-the-dollar (CoD), defined as the ratio of female-to-male median compensation. Analyses examined overall gender-based compensation differences, rank-specific and public–private stratified differences, longitudinal trends, and modeled lifetime career earnings using a net present value approach with a 3% discount rate across 25-, 30-, and 35-year career horizons.

Results From 2022 to 2025, women earned an average of 89.27 CoD relative to men across all ranks and institutions. Compensation equity differed substantially by institution type, with women earning 92.72 CoD in public institutions compared with 85.55 CoD in private institutions. When pooled across years, mean compensation increased from public to private institutions for all ranks in men but decreased for all ranks for women. Women comprised approximately 27–32% of the academic plastic surgery workforce and were increasingly underrepresented with advancing rank, accounting for 41.18% of assistant professors, 29.45% of associate professors, and 15.85% of full professors. Gender pay disparities widened with rank, with assistant professors demonstrating the smallest gap (mean 92.61 CoD) and full professors the largest (range 72.28–84.09 CoD). Modeled career-earnings analyses demonstrated cumulative lifetime earnings losses for women exceeding $2.6 million at 35 years under standard promotion scenarios.

Conclusions Women in academic plastic surgery earn approximately 10.7% less than men overall, with disparities widening across academic rank and private institutions. Despite increasing representation at junior levels, compensation inequities persist and compound into multimillion-dollar lifetime earnings losses. These findings underscore that workforce diversification alone has not translated into financial equity and highlight persistent structural compensation disparities within academic plastic surgery.

PURPOSE: Safety-net healthcare facilities face significant financial pressure while serving socially vulnerable populations with complex social determinants of health (SDOH). We performed a cost-benefit analysis of the OASIS (Optimizing Access, Safety, and Integration Services) Clinic, a Federally Qualified Health Center (FQHC) Look-Alike at Zuckerberg San Francisco General Hospital, to evaluate operational efficiency, analyze SDOH impact on healthcare utilization and costs, and estimate return on investment (ROI) for targeted interventions. METHODS: We retrospectively analyzed 27,731 encounters (3,464 unique patients; 8.0±3.2 encounters/patient) over 12 months ending October 2025. Activity-Based Costing allocated direct and indirect costs at the encounter level. Revenue calculations used California Medi-Cal fee schedules (1) and FQHC Prospective Payment System rates ($285/encounter). Cost inputs incorporated San Francisco Department of Public Health financial reporting, University of California San Francisco Health statements, Health Resources and Services Administration (HRSA) benchmarks (2), and California Department of Health Care Access and Information cost data (3). SDOH analysis examined housing status, language barriers, and care complexity. Monte Carlo simulation (n=10,000) with sensitivity analysis (±30%) tested intervention projections through five-year net present value (NPV) modeling. RESULTS: Patients were 30.6% uninsured (Medicaid combined: 39.5%), 25.4% experiencing homelessness (7,049 encounters), and 29.4% required interpreter services; mean age was 53.9±14.6 years with peak utilization ages 55-64 (23.8%) and elderly ≥65 years comprising 27.0%. New patient visits comprised 81.0% of total encounters. Housing instability strongly correlated with adverse outcomes (r=0.94, p<0.001): street homeless patients demonstrated 5.9-fold higher no-show rates (12.4% vs 2.1%), 4-fold higher emergency department (ED) utilization (72 vs 18 visits/100 patients), and 2.3-fold higher per-visit costs. Homeless patients aged 55-64 showed highest complexity (31.2 Charlson-weighted conditions), 4.6-fold greater than housed peers. Annual revenue was $9.76M versus costs $9.46M (3.1% margin; $298K net). Cost/encounter was $341 (benchmark: $310) and revenue/encounter $352 (benchmark: $285) (2). Clinical staffing represented largest expense (41.2%). Top five providers managed 73% of encounters averaging 20-25 patients/day, exceeding Medical Group Management Association benchmarks (4). No-show rate was 3.0% versus 8.5% benchmark. Preventable costs totaled $1.97M annually with $1.42M addressable. Four interventions-reminders ($125K/$185K), network optimization ($95K/$253K, 166% ROI), telehealth ($78K/$63K), complex care ($385K/$573K)-yielded $683K investment with $1.07M annual benefit. Five-year NPV was $4.23M (95% confidence interval: $2.97M-$5.49M), internal rate of return 28.4%, 17-month payback; Monte Carlo showed 94.7% probability of positive NPV. CONCLUSIONS: Safety-net primary care achieves financial sustainability serving vulnerable populations. Housing instability and language barriers increase costs, with $1.42M in preventable expenditures. Network optimization demonstrated highest ROI (166%); complex care management yielded largest benefit ($573K annually). This methodology provides a replicable framework for resource allocation across safety-net systems (5). REFERENCES: 1. California Department of Health Care Services. Medi-Cal Rates. Sacramento, CA: DHCS; 2024. 2. Health Resources and Services Administration. 2023 Uniform Data System Manual. Rockville, MD: HRSA; 2023. 3. California Department of Health Care Access and Information. Healthcare Payments Database. Sacramento, CA: HCAI; 2024. 4. Medical Group Management Association. Provider Compensation and Production Report. Englewood, CO: MGMA; 2024. 5. Gaskin DJ, Hadley J. Population characteristics of markets of safety-net and non-safety-net hospitals. J Urban Health. 1999;76(3):351-370.

PURPOSE: Breast reconstruction after mastectomy supports physical and psychosocial recovery. Autologous breast reconstruction (ABR) may offer higher patient satisfaction and more favorable long-term outcomes than implant-based reconstruction (IBBR), but its greater technical requirements and upfront resource utilization limits adoption. The Centers for Medicare and Medicaid Services (CMS) plays a critical role in shaping reimbursement, potentially impacting decision-making and ABR access. This study quantitatively evaluates regional and procedural trends in breast reconstruction billing and payment to inform policy.

METHODS: Using 2024 CMS Physician/Supplier Procedure Summary data, Current Procedural Terminology (CPT) codes for ABR (19361, 19364, 19367–19369) and IBBR (19340, 19342, 19357) were analyzed for reimbursement, provider billing, and work relative value units (wRVU). Census regions were assigned from locality and carrier codes. Rurality was approximated by the percentage of the state's population living in urban areas per the 2020 Census Continuous variables were compared with Mann-Whitney U tests and categorical with Fisher's exact or chi-square tests in Python (v3.9.1) and visualized with plotly (v2.35.3).

RESULTS: Median absolute reimbursement was higher for ABR than IBBR ($1,484.36 vs $805.32, p = 0.008), reflecting greater procedural complexity. However, payment relative to submitted charges (reimbursement rate) was higher for IBBR (13.3% vs 2.9%, p < 0.001). This discrepancy is partly influenced by institutional billing practices and denied claims. IBBR also received more than twice the payment per unit of work ($69.00 vs $31.94, p < 0.001). Payment-to-allowance ratios did not differ by reconstruction type or by state, suggesting that undervaluation of ABR may stem from CMS-assigned value rather than inconsistent adherence to those allowances. State-level reimbursement per wRVU was heterogeneous, suggesting that Medicare payments do not consistently scale with their own CMS-assigned procedural value, which may disproportionately affect states with higher ABR utilization. Although only a minority of states had sufficient ABR volume for comparison, relative reimbursement consistently favored IBBR, consistent with policy-level discordance in cost-value weighting. Cautious interpretation is needed, as only provider-level wRVU was incorporated, potentially overlooking regional practice expenses, though no clear geographic patterns were observed.

CONCLUSIONS: ABR payment is lower relative to its work intensity, which may contribute to disincentives for ABR adoption, especially in settings with constrained resources. These findings provide objective metrics to inform advocacy aimed at aligning reimbursement with the true procedural value of reconstruction. Future research should assess how current reimbursement patterns influence patient choice and whether they amplify inequities in reconstructive care. Additionally, evaluating long-term costs of ABR versus IBBR could clarify the economic impact of existing reimbursement structures and further guide policy reform.

Background: Device usage in operating rooms (ORs) consumes significant electricity, resulting in high hospital expenditure and emissions. Prior studies have evaluated institutional policy approaches toward this problem (1,2), but there is limited analysis of individual devices' energy consumption in United States ORs. This study's objective was to quantify the energy expenditure of equipment commonly used in the OR, serving as a foundation for future sustainability efforts.

Methods: The 29 most commonly identified OR devices at a tertiary academic medical center were categorized as structural (built into ORs) or procedural (brought in for procedures). Each device's electrical utilization was quantified in kilowatt-hours using standard technical ratings and estimated use times. Cost calculations using 2024 electrical prices were scaled to estimate those in average (7 ORs, as per literature) and large (69 ORs, the setting of this study) size hospitals.

Results: An average size hospital spends $19,207 annually on OR equipment electricity; larger institutions spend around $189,327 annually. Stand-alone suction devices, x-ray generators of C-arm x-ray machines, and heated air devices were the highest energy consumers. Procedural devices accounted for 64% of total annual electrical costs.

Conclusions: Annual electricity costs for OR equipment at a large hospital equal that of five school buildings; an average size hospital equates to a warehouse. Stand-alone suction devices at a large hospital draws the equivalent as 5,120 electrical cars; even turning them off for one hour per day can save $4,650.56 per year. Incremental reforms in OR equipment utilization can substantially reduce hospital expenses and carbon footprint.

1. Parilli-Johnson C, Pitman JS, Barbee K, et al. Implementation of a Power Down Initiative in 34 Operating Rooms. AANA J. 2024;92(4):257-268. https://pubmed.ncbi.nlm.nih.gov/39056495/
2. Lodhia S, Pegna V, Rockall T. Evaluating cost savings through equipment shutdown: A practical step toward sustainable surgery. Surgery. Published online June 23, 2025:109484. doi:10.1016/J.SURG.2025.109484

Purpose: Vascularized Composite Allotransplantation (VCA) involves the transplantation of entire interconnected units of soft tissues such as the face, upper extremity, abdominal wall, and reproductive organs. Unlike solid organ transplantation, which is generally classified as life-saving, VCA procedures are often considered life-enhancing and experimental, contributing to limited insurance coverage. As a result, patients assume substantial post-operative financial burdens, including immunosuppression, long-term rehabilitation, and supportive care, prompting many to rely on medical crowdfunding. Prior research in solid organ transplantation suggests that crowdfunding success is influenced by factors such as digital literacy, social network reach, and media visibility. This study evaluates how United States VCA crowdfunding campaigns describe financial need and examines whether media exposure influences fundraising outcomes.

Methods: We systematically searched GoFundMe for U.S. campaigns related to face, upper extremity, uterus, lower extremity, and penile transplantation (August 3rd to August 6th, 2025). Searches used terms such as "face transplant," "uterus transplant," and "VCA." Eligible campaigns sought funds for direct or indirect VCA-related expenses. Extracted variables included amount requested, amount raised, number of donors, and media exposure if referenced in local, national, or healthcare outlets. Campaigns were stratified by absence or presence of referenced media coverage.

Results: Twenty-four campaigns met inclusion criteria. The most frequent expense categories were surgery-related costs (40%), medical aftercare (24%), transportation (16%), and general expenses (16%). Media exposure was associated with greater campaign engagement. Campaigns without media coverage (n=14) averaged 15 donors, raised a mean of $1,690, and reached 24.5% of goals. Campaigns with media coverage (n=10) averaged 778 donors, raised $62,040 on average, and reached 63.5% of goals. Donor count was the only statistically significant metric (p=0.006), indicating a significant association between media exposure and donor count.

Conclusions: As reconstructive transplantation increasingly falls within plastic surgery practice, understanding financial access barriers is critical to equitable clinical adoption. Crowdfunding for VCA reveals financial vulnerabilities similar to those observed in solid organ transplantation while introducing distinct ethical and equity concerns. Media exposure was associated with greater donor participation and fundraising success, suggesting that visibility may influence access to care. Reliance on media visibility may pressure patients to publicly disclose highly personal medical experiences, raising privacy concerns that may differentially affect certain VCA procedures (e.g., penile transplantation). As clinical adoption expands, these findings highlight ongoing challenges related to access, patient burden, and dependence on crowdfunding for long-term care costs. Ongoing VCA initiatives such as the Clinical Organization Network for Standardization of Reconstructive Transplantation (CONSORT) aim to standardize cost and outcomes data, supporting broader insurance coverage and reducing reliance on publicity-driven fundraising.1

1. National Academies of Sciences, Engineering, and Medicine. Advancing Face and Hand Transplantation: Principles and Framework for Developing Standardized Protocols. National Academies Press; 2025. doi:10.17226/28580

Background Optimal timing of operative intervention in burn patients remains an area of active debate in burn and reconstructive surgery. While early excision and coverage may improve wound control and resource utilization, concerns persist regarding perioperative risk in medically complex patients. We evaluated whether early operative intervention is associated with improved outcomes compared with delayed surgery and whether these associations vary by age. Methods We conducted a retrospective cohort study of hospitalized burn patients undergoing operative management at an American Burn Association-verified burn center within a regional network at a large suburban hospital from 2021-2025. Early surgery was defined as initial operative intervention within 7 days of admission. Outcomes included hospital length of stay, hospital-acquired cellulitis, and major adverse events. Continuous variables were analyzed using the Wilcoxon rank-sum test, and categorical variables were compared using Fisher's exact test. Logistic regression was used to predict adverse outcomes using multivariable modeling. Age-stratified analyses were performed to assess effect modification of surgery timing. Results Among the complete cohort (N = 541), baseline demographic and injury characteristics, including sex and percent total body surface area, were comparable between early and delayed surgery groups (Table 1, all p > 0.05). Pediatric and patients ages 18-39 underwent earlier operative management at higher rates compared to older sub-groups (p = 0.003). Patients with delayed presentation were also more likely to undergo early operative intervention (p < 0.001). Early operative intervention was associated with a significantly shorter hospital length of stay compared with delayed surgery (p < 0.05). Rates of major in-hospital adverse events did not differ significantly between groups (p > 0.05). Cellulitis occurred more frequently among patients undergoing delayed surgery, although this association did not reach statistical significance. Age-stratified analyses did not demonstrate a statistically significant interaction between age group and timing of surgery. Pediatric subgroup analyses were limited by small sample size and low event rates. In contrast, burn severity emerged as a strong predictor of wound infection (OR = 67.5, 95% CI: 10.8, 1310, p < 0.001) and trended toward significance when predicting cellulitis (OR = 2.68, 95% CI: 0.84, 7.30, p = 0.07), while controlling for age and surgical timing. Conclusions Among hospitalized burn patients, early operative intervention was associated with reduced hospital length of stay without an increase in major complications. These findings support the safety of earlier surgical management from a reconstructive standpoint and suggest potential benefits in wound control and efficiency of care. Burn severity, rather than patient age, appears to be a more important determinant of adverse outcomes. Prospective studies are needed to further define patient selection and infectious risk in timing-based reconstructive strategies.

Background: Facial appearance strongly influences professional and social outcomes, with individuals perceived as more attractive often receiving increased job opportunities-a phenomenon known as "attractiveness bias." As facial plastic surgery becomes increasingly common, its potential impact on workplace dynamics and ethics warrants evaluation.

Methods: A comprehensive search of MEDLINE via PubMed, Cochrane Library, SCOPUS, and PsycINFO was conducted (inception to September 10, 2025) according to PRISMA-ScR guidelines. Controlled vocabulary (MeSH) and free-text terms related to facial aesthetic surgery, career outcomes, and attractiveness bias were combined. Studies were included if they examined surgical facial aesthetic or reconstructive procedures and assessed self-perception, attractiveness bias, professional or socioeconomic outcomes, or appearance-related psychological distress. Two independent reviewers screened titles/abstracts and full texts using Covidence, with discrepancies resolved by consensus. Inter-rater reliability was assessed using Cohen's kappa. Due to substantial methodological heterogeneity, a qualitative thematic synthesis was performed.

Results: Of the 2,240 records identified, sixty-one studies met inclusion criteria (κ=0.862 for title/abstract; κ=0.850 for full text) and were synthesized qualitatively into three conceptual domains. In the "External Perception and Attractiveness Bias" domain (n=19), postoperative images were rated as more attractive, trustworthy, competent, and intelligent than preoperative images. In contrast, individuals with facial trauma, congenital malformations, or features diverging from cultural beauty norms reported discrimination and lower levels of overall satisfaction. One study demonstrated that provider facial appearance alone influenced expectations of pain and treatment decisions, underscoring the breadth of appearance-based bias. The "Self-Perception and Psychosocial Outcomes" domain (n=29) demonstrated consistent postoperative improvements in self-esteem, body image, and quality-of life instruments, including FACE-Q and Rhinoplasty Outcome Evaluation scores. Career-related motivations were reported as a key motivator in 28-37% of patients in seven studies. Sociocultural pressures, particularly social media exposure, were variably associated with lower baseline self-esteem and increased desire for surgery. These trends were observed across diverse cultural contexts, suggesting a globalization of aesthetic norms. The "Mental Health and Appearance-Related Distress" domain (n=13) identified elevated rates of psychiatric comorbidity among patients seeking facial procedures, including a prevalence of body dysmorphic disorder (BDD) ranging from 2.5% to 32% depending on screening methodology and patient population. Patients with craniofacial differences reported high rates of social difficulty and increased odds of BDD. Personality traits such as neuroticism were associated with pursuit of specific procedures. Despite some influence by concurrent life stressors or baseline mental health, most patients experienced psychological benefit postoperatively.

Conclusions: The intersection of facial aesthetics, workplace bias, and career success represents an evolving and ethically complex field. While cosmetic surgery may enhance personal confidence and professional engagement, it also raises critical questions about fairness, implicit bias, and social pressures in the workplace. Future research should explore whether societal trends are shifting toward the professionalization of facial aesthetics, and what role plastic surgeons should play in that discussion. While improved confidence and self-perception are valid motivations, surgeons should be mindful of patients seeking surgery primarily for professional advantage, engaging in nuanced preoperative counseling to ensure realistic expectations in order to optimize patient outcomes.

Background: The Merit-Based Incentive Payment System (MIPS) adjusts Medicare reimbursement based on performance scores. National analyses of early MIPS implementation suggested that physicians caring for socially vulnerable, dually eligible patients received lower scores independent of clinical complexity, raising concerns about equity. Whether similar patterns exist in plastic surgery-where practice structures range from small private practices to large safety-net hospital systems-remains unknown. This study examines the association between patient social risk, surgeon and practice characteristics, and MIPS performance in 2017 and 2023.

Methods: In this retrospective cross-sectional study, publicly available CMS Quality Payment Program, Medicare Physician & Other Practitioners, Physician Compare/NPPES, Distressed Communities Index, and U.S. Census data were linked. Plastic surgeons with reported MIPS scores were stratified into quintiles based on the percentage of dually eligible Medicare–Medicaid beneficiaries, a validated proxy for social risk. Surgeon and practice characteristics were compared between lowest-risk (Q1) and highest-risk (Q5) quintiles. Multivariable linear and logistic regression assessed whether social-risk quintile independently predicted MIPS performance after adjustment for demographics, beneficiary volume, community distress, and reporting type (individual, group, or alternative payment model [APM]).

Results: The analysis included 1,554 plastic surgeons in 2017 and 1,229 in 2023. Surgeons in the highest social-risk quintile practiced more frequently in safety-net and hospital-based systems and reported substantially larger group sizes. Unadjusted analyses showed higher mean MIPS scores in Q5 versus Q1 in both 2017 (76.8 vs 63.0, p<0.001) and 2023 (84.0 vs 76.5, p<0.001). However, reporting structure was the dominant driver of score differences. Q5 surgeons were far more likely to report as groups or through APMs, whereas Q1 surgeons more often reported individually. In 2023, APM reporters averaged 94.7 points, group reporters 81.8, and individual reporters 63.9 (p<0.001). Within the same reporting type, MIPS scores were largely similar across social-risk quintiles. Filing type increased the variance explained in MIPS scores by 20–28% (R² 0.12→0.33 in 2017; 0.07→0.34 in 2023), and social-risk quintile was no longer independently associated with performance. By 2023, only four Q5 surgeons reported individually, suggesting migration of high-social-risk surgeons into group and APM structures. No independent association was observed between social-risk quintile and negative payment adjustments or exceptional performance bonuses.

Conclusions: Among plastic surgeons, higher MIPS scores in practices serving socially vulnerable patients are attributable to reporting infrastructure rather than patient social risk. After accounting for reporting type, social risk has no measurable independent effect on MIPS performance. These findings suggest that MIPS payment adjustments in plastic surgery reflect organizational structure more than intrinsic quality or patient vulnerability, with implications as value-based payment models expand.

PURPOSE: Hand surgery procedures are performed by surgeons with training in plastic surgery, orthopedic surgery, general surgery, and more. The objective of this study is to analyze trends in the proportion and types of hand surgery procedures performed by surgeons with different training backgrounds for the Medicare part B population. METHODS: The top 30 procedure codes billed by hand surgeons were queried from the CMS Medicare Physician and Other Practitioners database for 2013 to 2023. These codes were used to extract all other providers that performed those same procedures within the original database. Only surgeons were included for analysis, and were stratified by training background (plastic, general, orthopedic, or other surgery) using the NPPES NPI registry. Negative binomial regression was used to model differences in procedure volume over time by training background. Procedure volume was normalized to per million Medicare beneficiaries. RESULTS: 36,547,760 procedures billed by 22,856 surgeons were analyzed. The majority of surgeons were general orthopedic surgeons (70.5%), followed by subspecialty orthopedic surgeons (17.6%). Plastic surgery-trained hand surgeons made up 0.5% of the sample. Most providers practiced in the South (36.2%), in an urban setting (88.5%), and in a non-facility office (85.5%). The number of yearly procedures decreased 25%, from 68,118 to 50,882 per million Medicare beneficiaries. When comparing rates of change in procedure volume for plastic surgery-trained hand surgeons compared to other training backgrounds, general surgery and orthopedic surgery both grew at a faster rate, while neurological surgery grew at a slower rate (p < 0.001). CONCLUSIONS: Hand surgery procedures for Medicare patients are performed by surgeons from a variety of different backgrounds. Over the past decade, the number of common hand procedures performed by orthopedic and general surgery-trained surgeons have increased at a faster rate than the number performed by plastic surgery-trained hand surgeons.

Background: Recommendations for long-term surveillance following silicone breast implant placement continue to evolve. The U.S. Food and Drug Administration (FDA) recommends MRI or ultrasound screening beginning 5–6 years after implantation and periodically thereafter to detect silent implant rupture. Despite these recommendations, real-world adherence to surveillance imaging remains unclear. We evaluated compliance with MRI surveillance among patients undergoing silicone implant-based breast reconstruction at a single institution and reviewed institutional strategies to improve follow-up.

Methods: A retrospective manual review was performed of patients undergoing mastectomy with silicone implant-based reconstruction between January 2018 and December 2019 at Sanford Health Department of Plastic and Reconstructive Surgery. Patients were assessed for completion of recommended postoperative MRI surveillance as of February 14, 2026. Patients who were deceased, had implant removal, implant replacement with reset surveillance timelines, relocation, or alternative oncology-directed imaging were excluded from compliance calculations. Institutional recall practices implemented beginning in 2021 were also reviewed.

Results: A total of 110 patients met initial inclusion criteria. After exclusions for implant replacement (n=5), implant removal (n=3), death (n=4), relocation (n=4), insurance denial requiring alternative imaging (n=3), and oncology-directed imaging (n=2), 98 patients remained eligible for MRI surveillance. Among eligible patients, 62 completed MRI surveillance, yielding a compliance rate of 63.3%. Prior to 2021, surveillance relied on manual chart review and placement of recall notices for a 3-year office visit and 6-year MRI, often communicated through general reminder letters. Informal institutional experience suggested many patients missed early follow-up visits and therefore were not informed of subsequent MRI recommendations. Following FDA implementation of the Patient Decision Checklist requirement in 2021, institutional workflow was modified to include surveillance counseling at initial consultation, structured documentation, and manual placement of both 3-year clinic and 6-year MRI recalls reinforced at postoperative visits.

Conclusions: In this retrospective single-institution compliance review spanning both the pre-2021 surveillance approach and the period following implementation of structured counseling and standardized recall workflows, adherence to FDA-recommended MRI surveillance after silicone implant-based reconstruction was moderate, with approximately two-thirds of eligible patients completing imaging. Missed early follow-up visits may represent an important barrier to long-term surveillance adherence. Institutional workflow changes introduced after 2021 may improve future compliance. Ongoing monitoring will be necessary to determine the sustained impact of these interventions and optimize long-term implant safety surveillance.

Introduction: Career decision-making among plastic surgery trainees is shaped by a complex interaction of personal, institutional, and socioeconomic influences. Although numerous studies have explored program-specific outcomes, the factors guiding trainees toward academic, private, or fellowship-based career paths have not been fully characterized in a comprehensive synthesis. Identifying these determinants is essential for optimizing mentorship, research opportunities, and training structures to meet the evolving needs of the specialty. This systematic review aimed to examine and categorize the factors most consistently associated with post-training career trajectories in plastic surgery.

Methods: Pubmed, Embase, and Wed of Science databases were queried for studies from 2005 to 2025 evaluating predictors of career choice among plastic surgery residents and fellows. Eligible studies included quantitative or mixed-method analyses linking trainee-level, program-level, or structural characteristics to post-training practice type or fellowship pursuit. Extracted variables were harmonized into conceptual domains, including academic orientation, research productivity, mentorship quality, training pathway structure, institutional prestige, financial burden, and family or demographic factors. This study utilized PRISMA guidelines.

Results: Twenty-five studies encompassing 4,286 individuals from the U.S., Canada, France, and Germany met inclusion criteria, with possible cohort overlap. Academic practice was consistently associated with strong research engagement, including dedicated research time in residency and higher bibliometric indices. Graduates of integrated residency pathways were more likely to pursue academic careers and fellowship training compared with independent trainees. Mentorship quality, presence of a formal academic track, institutional research culture, and training at highly ranked or fellowship-affiliated programs were also significant predictors of academic placement.

Conversely, private practice was associated with greater emphasis on compensation structure, higher educational debt, reduced research exposure, independent training pathways, and geographic preferences favoring smaller communities. Greater emphasis on autonomy and incentive-based compensation further distinguished private practice trajectories.

Fellowship pursuit was influenced by integrated residency training, higher research productivity, institutional prestige, and intention to pursue an academic career. Conversely, older age, greater family responsibilities, higher debt burden, and reduced research exposure were associated with forgoing additional subspecialty training.

Conclusion: Plastic surgery career trajectories reflect interdependent academic, financial, structural, and personal determinants. Research engagement and mentorship emerged as the most consistently associated and potentially modifiable factors of academic and fellowship pathways, whereas debt burden and financial prioritization influence private practice entry. Optimizing structured mentorship, protected research time, and transparent career guidance may help training programs better support diverse career pathways. Prospective, longitudinal studies are needed to clarify how evolving training paradigms shape long-term academic participation and practice diversity within the specialty.

Introduction Medical scribes have become increasingly common across primary care and emergency medicine departments, valued for economic advantages and the opportunity to redirect physician attention from documentation toward the patient. (1) Yet, their role in surgical subspecialties remains sparse and understudied. Plastic surgery presents a compelling context where conversations are deeply personal, examinations can feel vulnerable, and any third party carries meaningful implications for patient comfort. Whether scribe presence helps or hinders these interactions has not been formally evaluated. This study was further motivated by gender dynamics in such encounters and the perspective of scribes navigating integration within specialized surgical teams. We hypothesized that in-person scribes would preserve and enhance communication quality, patient comfort, and privacy, establishing a foundation for comparison as healthcare systems increasingly push for AI-based alternatives.

Methods We conducted a prospective survey study at Dartmouth Hitchcock Medical Center Plastic Surgery outpatient clinics. Adult patients (age ≥ 18) seen during in-person scribe-assisted clinics between October 2025 and February 2026 were invited to participate. Consenting patients completed a modified CG-CAHPS adapted to include a dedicated scribe subsection, resulting in a 14-item tool. (2) A subset also completed the validated Communication Assessment Tool (CAT). (3) Surveys spanned four attending physicians (001 – 004). Descriptive statistics, top-box rates, and Cronbach's alpha were calculated.

Results 113 patients completed the modified CG-CAHPS (Attending 001: n = 43, 002: n = 41, 003: n = 17, 004: n = 12); mean age 52.6 ± 15.9 years (median = 52, range = 20–93). By sex assigned at birth, 73.5% were female; by gender identity, 71.7% identified as female, 23.0% male, 3.5% transgender female, and 1.8% transgender male (5.3% total). Provider top-box rates ("Always") were 92.0% for clarity of explanation (Q1), 89.4% for attentive listening (Q2), and 92.0% for respect (Q3); 97.3% reported adequate time with their provider. Notably, 54.9% were encountering their provider alongside a scribe for the first time, of which 89.4% felt comfortable or very comfortable with the scribe's presence, 97.3% reported no negative effect on sensitive topic discussions, 100% noted no decrease in physician attention (13.6% felt it increased), and 98.1% expressed minimal or no privacy concerns. 91.7% favored in-person scribes over AI or remote alternatives. Mean provider rating was 9.46/10 (median = 10) and 91.1% recommend their provider. Provider communication internal consistency was high (α = 0.886). Among 21 CAT completers, with a composite mean of 4.64/5.00 (SD = 0.78; α = 0.990).

Discussion/Conclusion These findings support our central hypothesis that in-person scribes preserve and enhance the physician-patient dynamic in plastic surgery. Results were consistently favorable across communication, comfort, and privacy, which is particularly meaningful since over half of participants were experiencing this for the first time. The strong patient preference for in-person scribes over AI alternatives is relevant as institutions face growing pressure toward AI-based documentation. As future AI-scribe comparison arms are incorporated, these results provide a patient-centered foundation for evaluating the role of scribes in plastic surgery.

References (1) Misra-Hebert AD, Kay R, Stoller JK. A review of physician burnout: personal, professional, and organizational solutions. Cleve Clin J Med. 2004;71(10):788-795. (2) Agency for Healthcare Research and Quality. CAHPS Clinician & Group Survey, Version 3.0. Rockville, MD: AHRQ; 2012. https://www.ahrq.gov/cahps (3) Makoul G, Krupat E, Chang CH. Measuring patient views of physician communication skills: development and testing of the Communication Assessment Tool. Patient Educ Couns. 2007;67(3):333-342. doi:10.1016/j.pec.2007.05.005

Introduction Day-of-surgery cancellations (DoSCs) of elective pediatric plastic surgery represent a significant and largely preventable disruption in care delivery. In pediatric plastic surgery, cancellations carry compounding clinical stakes - established timing windows exist for procedures such as cleft lip and palate repair and craniosynostosis correction, where delays adversely affect speech development, craniofacial growth, and neurodevelopmental outcomes. Despite reported DoSC rates of 4.1–12% and evidence that 70–85% of cancellations are potentially preventable, the influence of social determinants of health (SDOH) on cancellation patterns in this population remains poorly characterized. We sought to evaluate the relationship between neighborhood-level social vulnerability, race, and DoSC risk, hypothesizing that socially disadvantaged and racial minority children would face disproportionately elevated cancellation rates.

Methods We performed a retrospective cohort study of elective plastic surgery encounters at a free-standing tertiary pediatric hospital from 2020–2025. Encounters were classified as completed, non-same-day cancellation (>24 hours), or DoSC (≤24 hours before scheduled start). Residential addresses were geocoded and linked to 2020 CDC Social Vulnerability Index (SVI) data, analyzed at composite, thematic domain, and individual census-variable levels. Multivariable logistic regression identified independent predictors of DoSC compared to non-same-day cancellations (Model 1) and all other outcomes (Model 2).

Results Among 4,590 elective encounters, the DoSC rate was 4.9% (n=227). Black or African American patients were markedly overrepresented among DoSC cases, comprising 34% of same-day cancellations versus 15% of completed cases (p<0.001). At the neighborhood level, mean composite SVI was significantly higher among DoSC patients (0.51 vs. 0.41, p<0.001), and 41% of DoSC cases resided in the highest SVI tertile compared to 25% of completed cases. Three of four SVI thematic domains were significantly elevated among DoSC patients: socioeconomic status, household composition, and minority status/language (all p≤0.001). At the granular variable level, DoSC cases had significantly higher rates of neighborhood poverty, minority concentration, lack of vehicle access, housing cost burden, and single-parent households compared to completed cases (all p<0.001). In adjusted models, Black race remained the strongest independent predictor of DoSC in both models (Model 1: OR 2.17, 95% CI 1.42–3.34; Model 2: OR 2.34, 95% CI 1.65–3.31; both p<0.001), while composite SVI was attenuated after adjustment.

Conclusions DoSCs in pediatric plastic surgery are patterned by race and multidimensional neighborhood-level vulnerability, reflecting structural inequities that extend beyond any single socioeconomic factor. Black or African American children faced more than twice the odds of same-day cancellation compared to White peers after adjustment for neighborhood disadvantage. These findings highlight an opportunity for pediatric surgical programs to implement equity-centered perioperative systems - including early social risk stratification, nurse navigator programs, and targeted preoperative outreach - to address preventable disparities in surgical access.

Background: Patients with prior gastric bypass are frequently advised to avoid nonsteroidal anti-inflammatory drugs (NSAIDs) because of the perceived increased risk of ulceration and gastrointestinal (GI) bleeding. As a result, plastic surgeons often rely heavily on opioid-based regimens for postoperative analgesia following body contouring procedures. However, multimodal pain control strategies that include NSAIDs may reduce opioid exposure while maintaining adequate analgesia. The safety of short-term NSAID use in this population remains unclear, with short term use defined as less than 30 days. This study evaluated whether postoperative NSAID use in patients with a history of gastric bypass is associated with decreased opioid utilization and whether short term NSAID use had increased GI complications. Methods: A retrospective cohort study was performed using a federated electronic health record database called TrinetX. Patients with prior gastric bypass who subsequently underwent abdominal body contouring were identified and divided into cohorts based on postoperative NSAID use. Primary outcomes included opioid prescription utilization and GI complications (gastrojejunal ulcer, duodenal ulcer, peptic ulcer disease, and GI hemorrhage) within the postoperative period. Comparisons between cohorts were performed using appropriate statistical testing. Results: 1,315 patients were included in the NSAID cohort and 1,337 in the non-NSAID cohort for the opioid analysis. The proportion of patients requiring opioids was similar in both groups (n = 743 in each). The mean number of opioid prescription instances was slightly higher in the NSAID cohort (2.07 ± 1.78) compared with the non-NSAID cohort (1.95 ± 1.70), though this difference was not statistically significant (p = 0.179). For GI complications, 1,225 patients in the NSAID cohort and 1,271 in the non-NSAID cohort were analyzed. GI events occurred in 11 patients in the NSAID group and 14 patients in the non-NSAID group, with no significant difference in the mean number of complication instances between cohorts (1.36 ± 0.67 vs 1.21 ± 0.80; p = 0.625). Overall event rates were low in both groups. Conclusions: Short-term postoperative NSAID use in patients with prior gastric bypass was not associated with a significantly increased rate of GI complications following abdominal body contouring procedures. Additionally, NSAID use did not significantly reduce opioid prescription utilization in this cohort. These findings suggest that limited postoperative NSAID exposure may be safe from a gastrointestinal standpoint in carefully selected patients, though its opioid-sparing benefit was not demonstrated. Further studies are needed to better define multimodal analgesic strategies in this patient population.