New approach to breast reconstruction surgery reduces opioid painkiller use, hospital stays

A new approach to breast reconstruction surgery aimed at helping patients’ bodies get back to normal more quickly cut their postoperative opioid painkiller use in half and meant a day less in the hospital on average, a Mayo Clinic study found. The method includes new pain control techniques, preventive anti-nausea treatment and getting women eating and walking soon after free flap breast reconstruction surgery. It has proved so effective, it is now being used across plastic surgery at Mayo Clinic. The findings were being presented at the Plastic Surgery Research Council annual meeting March 7-9 in New York.Breast reconstruction surgery is common after breast tissue is removed to prevent or treat breast cancer; in free flap breast reconstruction, the plastic surgeon transfers a section of tissue from one part of the body to the chest. Using traditional care, the hospital stay averaged roughly four and a half days after that procedure. Using a new approach known as an “enhanced recovery pathway,” patients spent an average of three days in the hospital, the researchers found.Opioid painkiller use by patients in the hospital after surgery also declined with the new method, and those patients reported less pain at 24 hours after surgery than those who received the traditional approach. Calculated in oral morphine equivalents, opioid use averaged 142.3 milligrams over the first three days in the hospital, compared with an average of 321.3 milligrams over the same period with traditional care.Patients are giving the changes positive reviews, says senior author Michel Saint-Cyr, M.D., a plastic surgeon in the Breast Diagnostic Clinic at Mayo Clinic in Rochester, Minn.”I think it minimizes their apprehension and anxiety preoperatively and they go into surgery with a better mindset. The majority do not think it was as painful as they thought it would be after surgery,” Dr. Saint-Cyr says. “We’re seeing pain scales ranging from 0 to 4 out of 10, compared to 6 to 8 out of 10 before the pathway. …

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When cats bite: One in three patients bitten in hand hospitalized, infections common

Dogs aren’t the only pets who sometimes bite the hands that feed them. Cats do too, and when they strike a hand, can inject bacteria deep into joints and tissue, perfect breeding grounds for infection. Cat bites to the hand are so dangerous, 1 in 3 patients with such wounds had to be hospitalized, a Mayo Clinic study covering three years showed. Two-third of those hospitalized needed surgery. Middle-aged women were the most common bite victims, according to the research, published in the Journal of Hand Surgery.Why are cat bites to the hand so dangerous? It’s not that their mouths have more germs than dogs’ mouths — or people’s, for that matter. Actually, it’s all in the fangs.”The dogs’ teeth are blunter, so they don’t tend to penetrate as deeply and they tend to leave a larger wound after they bite. The cats’ teeth are sharp and they can penetrate very deeply, they can seed bacteria in the joint and tendon sheaths,” says senior author Brian Carlsen, M.D., a Mayo Clinic plastic surgeon and orthopedic hand surgeon.”It can be just a pinpoint bite mark that can cause a real problem, because the bacteria get into the tendon sheath or into the joint where they can grow with relative protection from the blood and immune system,” Dr. Carlsen adds.The bacteria injected by a cat bite can include a strain common in animals and particularly hard to fight with antibiotics, he says.In the study, researchers identified 193 Mayo Clinic patients with cat bites to the hand from January 1, 2009, through 2011. Of those, 57 were hospitalized; on average, they were in the hospital three days. …

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Diaphragm pacing in spinal cord injury successful in weaning patients from ventilators

A new study published in the Journal of Trauma Acute Care Surgery finds that diaphragm pacing (DP) stimulation in spinal cord-injured patients is successful not only in weaning patients from mechanical ventilators but also in bridging patients to independent respiration, where they could breathe on their own without the aid of a ventilator or stimulation.The stimulation is provided by the Diaphragm Pacing System (DPS), a technology providing electrical stimulation to nerves running through the diaphragm, the major muscle involved in breathing. When stimulated, the diaphragm contracts, allowing patients to breathe more naturally than having air forced into their lungs as a mechanical ventilator would do. The system is implanted through minimally invasive laparoscopic surgery.One of the inventors of DPS and an author of the new study is Raymond Onders, MD, of University Hospitals (UH) Case Medical Center. DPS gained national attention in 2003 when Dr. Onders, Director of Minimally Invasive Surgery at UH, implanted the system in the late actor Christopher Reeve, who had a traumatic spinal cord injury (SCI) from a horse-riding accident.The new study examined the records of 29 patients, average age 31, at 16 hospitals in the United States where DP implantation is approved. SCIs were caused by a variety of accidents, including car accidents, diving, gunshot wounds, falls, and athletic injuries. Elapsed time from injury to surgery was 40 days, which was considerably shorter than an initial FDA trial in which patients did not have DP testing and surgery for more than a year after injury. All but two patients were men. A goal of this study was to determine if earlier testing and DP implants provided benefit.Of the patients whose diaphragm muscles responded to stimulation, 16 of 22 patients (72 percent) were completely free of ventilator support in an average of 10 days. Of the remaining six patients, two had a delayed weaning of six months, three had partial weans using DP at times during the day (One patient successfully implanted went to a long-term acute care hospital and subsequently had life-prolonging measures withdrawn.) Seven of the 29 patients were found to have non-stimulatable diaphragms from nerve damage.Eight patients (36 percent) had complete recovery of respiration, and DP wires were removed.”This study provides several important observations,” said Dr. …

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Abdominal-Peritoneal Mesothelioma Info

Mesothelioma tumors of the peritoneum include benign, malignant and cystic.Although peritoneal mesothelioma is the most common of these, it is very rare with an annual incidence of 1-2 cases per million persons. Only 10-20 percent of all mesotheliomas arise in the peritoneum. Peritoneal malignant mesothelioma occurs more commonly in adult males but also occurs rarely in children with equal sex incidence.Malignant mesothelioma occurs mainly late in the fifth decade of life, the benign type in the fourth decade and the cystic type in the third decade. The non malignant type are common in women.Cause:The link with asbestos exposure which is well established for pleural mesothelioma is not clear for peritoneal mesothelioma.Symptoms and Signs-Abdominal pain which may not be limited to any specific region …

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Advantages of minimally invasive surgery to treat hyperparathyroidism

Oct. 16, 2013 — An open surgical procedure called bilateral neck exploration (BNE) has been the gold standard operation for treating patients with primary hyperparathyroidism. But the development of a minimally invasive procedure to remove the parathyroid gland now offers a new option. A study designed to compare cure rates, postoperative pain, cosmetic satisfaction, and length of the procedure and of the hospital stay for patients with hyperparathyroidism who underwent BNE versus minimally invasive video-assisted (MIVAP) parathyroidectomy will be presented in a poster at the 83rd Annual Meeting of the American Thyroid Association, October 16-20, 2013, in San Juan, Puerto Rico.Share This:Youben Fan, from Affiliated Sixth People’s Hospital, Shanghai, China, reports no difference in cure rates between the two approaches, or in the frequency with which treated patients have persistent or recurrent hyperparathyroidism. MIVAP demonstrated several advantages compared to BNE, including a lower incidence of early severe hypocalcemia, a higher cosmetic satisfaction rate, shorter operations, less postoperative pain, and shorter hospital stays. These findings are presented in the poster entitled “Minimally Invasive Video-assisted Parathyroidectomy Compared with the Conventional Open Operation for Primary Hyperparathyroidism: A Randomized Controlled Trial.””Primary hyperparathyroidism is a common condition for which parathyroidectomy is curative,” says Julie Ann Sosa, MD, Program Committee Co-Chair; Professor of Surgery and Medicine, Chief, Section of Endocrine Surgery, and Director of Health Services Research, Department of Surgery, Duke University School of Medicine; and Leader, Endocrine Neoplasia Diseases Group, Duke Cancer Institute and Duke Clinical Research Institute, Durham, NC.”While bilateral neck exploration has been the traditional approach, minimally invasive parathyroidectomy has emerged as an alternative technique associated with improved patient outcomes, largely based on retrospective, single institution or surgeon clinical series. This report is potentially exciting because it represents a randomized controlled trial and specifically looks at minimally invasive, video-assisted parathyroidectomy as compared to traditional open parathyroidectomy.Share this story on Facebook, Twitter, and Google:Other social bookmarking and sharing tools:|Story Source: The above story is based on materials provided by American Thyroid Association. Note: Materials may be edited for content and length. For further information, please contact the source cited above. Need to cite this story in your essay, paper, or report? …

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Mesothelioma Surgery- What Are Your Options?

There are three main types of surgeries used in the treatment of mesothelioma.A-Diagnostic surgery: This is used to confirm the diagnosis and locate the tumor. It is usually non invasive {it does not require cutting up the patient surgically}B-Curative surgery: This involves the removal of as much tumor as possible with the hope of curing the patient. Radiotherapy and or chemotherapy is often used in combination with this type of surgery.C-Palliative surgery: This form of surgery offers only symptomatic relief. It involves removal of cancer tissue but it does not offer a cure.These are the different types of surgical procedures available for treatment:1-BiopsyThis is a diagnostic form of surgery in which the suspected cancer tissue is partially removed and sent …

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Mesothelioma Treatment Options

Mesothelioma Treatment OptionsBy Garry NealeMesothelioma is a cancer caused by contact with asbestos, a carcinogen. The disease attacks the lining of the lung or the lining of the abdominal cavity. It can be difficult to deal with this type of cancer and find decent mesothelioma info online. This article will outline some of the main treatment options available to deal with the disease. The more knowledge you have about this disease, the better.Most people searching for mesothelioma info are looking for information regarding the different treatments currently available to those affected by the cancer. The type of treatment you receive for it depends on many factors, including cancer stage, location of the disease, and how far it has spread. It also depends on how the cancer …

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Children and magnets have a dangerous attraction, end up in the ER

Aug. 7, 2013 — Cases involving children ingesting magnets quintupled between 2002 and 2011, with ingestion of multiple magnets generally resulting in more serious outcomes, including emergency surgery. The results of a study documenting a rapid rise in pediatric injuries was published online yesterday in Annals of Emergency Medicine.”It is common for children to put things in their mouth and nose, but the risk of intestinal damage increases dramatically when multiple magnets are swallowed,” said lead study author Jonathan Silverman, MD, of the Department of Pediatrics at the University of Washington in Seattle, Wash. “The ingestion of multiple magnets can severely damage intestinal walls to the point that some kids need surgery. The magnets in question were typically those found in kitchen gadgets or desk toys marketed to adults but irresistible to children.”Over a 10-year period, 22,581 magnetic foreign body injuries were reported among children. Between 2002 and 2003, incidence of injury was 0.57 cases per 100,000 children; between 2010 and 2011, that jumped to 3.06 cases per year out of 100,000 children. The majority of the cases occurred in 2007 or later.In cases where children ingested multiple magnets, 15.7 percent were admitted to the hospital (versus 2.3 percent of single magnet ingestions). Nearly three-quarters (74 percent) of magnets were swallowed; twenty-one percent were ingested through the nose. Nearly one-quarter (23.4 percent) of the case reports described the magnets as “tiny,” or other variants on the word “small.””The injuries were not restricted to small children either,” said Dr. Silverman. …

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Lunar cycle affects cardiac patients undergoing acute aortic dissection: Waning and full moon cycles impact length of stay, mortality

July 15, 2013 — If you need cardiac surgery in the future, aortic dissection in particular, reach for the moon. Or at least try to schedule your surgery around its cycle. According to a study at Rhode Island Hospital, acute aortic dissection (AAD) repair performed in the waning full moon appears to reduce the odds of death, and a full moon was associated with shorter length of stay (LOS).Share This:The study is published online in advance of print in the journal Interactive Cardiovascular and Thoracic Surgery.The purpose of the study was to assess the effect of natural time variations of both the season and the lunar cycle phase on hospital survival and length of stay (number of days a patient is in the hospital) following acute aortic dissection repair.”While there has been previous research of seasonal impacts on cardiovascular disease, there has not been any data about the effect of the lunar cycles on cardiac cases, until now,” said senior author Frank Sellke, M.D., chief of cardiothoracic surgery and co-director of the Cardiovascular Institute at Rhode Island, The Miriam and Newport hospitals. “We focused the study on patients having aortic dissection and found that the odds of dying following this procedure were greatly reduced during the waning full moon, and that length of stay was also reduced during the full moon.”Researchers studied the relationship of lunar cycles and seasonal variation on two surgical groups: Group A: Patients having repair of ascending aortic dissection, and Group B: Patients having aortic dissection and either aortic valve surgery, coronary bypass surgery, or both. They also studied the relationship of the lunar cycle on patients’ length of stay. The study indicates that aortic dissection performed during the full moon phase had a significantly shorter length of stay than two other moon phases — 10 days for the full moon cycle vs. 14 days for the other phases.”Can we always plan for such procedures to be performed around lunar cycles? Of course not,” Sellke said. “But better understanding the effects of the environment — including seasonal and lunar cycles — on our health can help us to better understand these rhythms, and ultimately provide better care for our patients.”Share this story on Facebook, Twitter, and Google:Other social bookmarking and sharing tools:|Story Source: The above story is reprinted from materials provided by Lifespan, via EurekAlert!, a service of AAAS. Note: Materials may be edited for content and length. …

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Emergency helicopter airlifts help the seriously injured

June 20, 2013 — Patients transferred to hospital via helicopter ambulance tend to have a higher survival rate than those who take the more traditional road route, despite having more severe injuries. The research, published in BioMed Central’s open access journal Critical Care suggests that air ambulances are both effective and worthy of investment.Share This:Helicopters have been used as emergency ambulances for the past 40 years. For much of that time there has been ongoing debate about the cost of the service compared to the benefit in saving lives.The TraumaRegister DGU® of the German Society for Trauma Surgery collects anonymous data from more than 300 European medical centres. Researchers from hospitals across Germany used information from this register to evaluate the effectiveness of helicopter ambulances.Of 13,000 patients included in the study, a third were transported to hospital by helicopter. These patients tended to be more seriously injured, with chest and abdominal injuries requiring more extensive on-scene treatment. While in the ICU they were more likely to suffer complications, such as sepsis and multiple organ failure, and consequently require more time in hospital before being released home. But these patients had a survival benefit compared to the ones transported by road.Patient diagnosis and quality of in-hospital care seemed to be the same regardless of methods of being transported to hospital so the reason behind this benefit must lie elsewhere. Dr Hagen Andruszkow from the University Hospital Aachen, Department of Trauma and Reconstructive Surgery, said, “These patients tend to be the most severely injured — nevertheless the care that they receive from medical staff at the scene and during transport, plus speed of transport, means that patients are more likely to survive. This needs to be taken into account when deciding to start or continue with air ambulance services.”Share this story on Facebook, Twitter, and Google:Other social bookmarking and sharing tools:|Story Source: The above story is reprinted from materials provided by BioMed Central Limited. Note: Materials may be edited for content and length. …

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New technique for deep brain stimulation surgery proves accurate and safe

June 5, 2013 — The surgeon who more than two decades ago pioneered deep brain stimulation surgery in the United States to treat people with Parkinson’s disease and other movement disorders has now developed a new way to perform the surgery — which allows for more accurate placement of the brain electrodes and likely is safer for patients.The success and safety of the new surgical technique could have broad implications for deep brain stimulation, or DBS, surgery into the future, as it may increasingly be used to help with a wide range of medical issues beyond Parkinson’s disease and familial tremors.The new surgery also offers another distinct advantage: patients are asleep during the surgery, rather than being awake under local anesthesia to help surgeons determine placement of the electrodes as happens with the traditional DBS surgery.A study detailing the new surgical technique is being published in the June 2013 edition of the Journal of Neurosurgery, and has been published online at the journal’s website.”I think this will be how DBS surgery will be done in most cases going forward,” said Kim Burchiel, M.D., F.A.C.S., chair of neurological surgery at Oregon Health & Science University and the lead author of the Journal of Neurosurgery article. “This surgery allows for extremely accurate placement of the electrodes and it’s safer. Plus patients don’t need to be awake during this surgery — which will mean many more patients who can be helped by this surgery will now be willing to consider it.”DBS surgery was first developed in France in 1987. Burchiel was the first surgeon in North America to perform the surgery, as part of a Food and Drug Administration-approved clinical trial in 1991.The FDA approved the surgery for “essential tremor” in 1997 and for tremors associated with Parkinson’s disease in 2002. The surgery has been performed tens of thousands of times over the last decade or so in the United States, most often for familial tremor and Parkinson’s disease. Burchiel and his team at OHSU have performed the surgery more than 750 times.The surgery involves implanting very thin wire electrodes in the brain, connected to something like a pacemaker implanted in the chest. The system then stimulates the brain to often significantly reduce the tremors.For most of the last two decades, the DBS patient was required to be awake during surgery, to allow surgeons to determine through monitoring the patient’s symptoms and getting other conscious patient feedback whether the electrodes were placed in the right spots in the brain.But the traditional form of the surgery had drawbacks. Many patients who might have benefitted weren’t willing to undergo the sometimes 4 to 6 hour surgery while awake. There also is a small chance of hemorrhaging in the brain as the surgeon places or moves the electrodes to the right spot in the brain.The new technique uses advances in brain imaging in recent years to place the electrodes more safely, and more accurately, than in traditional DBS surgery. The surgical team uses CT scanning during the surgery itself, along with an MRI of the patient’s brain before the surgery, to precisely place the electrodes in the brain, while better ensuring no hemorrhaging or complications from the insertion of the electrode.The Journal of Neurosurgery article reported on 60 patients who had the surgery at OHSU over an 18-month period beginning in early 2011.”What our results say is that it’s safe, that we had no hemorrhaging or complications at all — and the accuracy of the electrode placement is the best ever reported,” Burchiel said.Burchiel and his team have done another 140 or so surgeries with the new procedure since enrollment in the study ended. …

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Procedures saving limbs of more peripheral arterial disease patients

June 1, 2013 — Peripheral arterial disease is a common circulation problem in which reduced blood flow can lead to complications that jeopardize the limbs, possibly even requiring amputation. Procedures known as revascularization have reduced the need for amputations 40 percent over two decades, Mayo Clinic research shows. The findings were among several studies presented at the Society for Vascular Surgery annual meeting in San Francisco.In the amputation study, Mayo researchers analyzed patients in the Rochester Epidemiology Project, a National Institutes of Health-funded medical records pool that makes Olmsted County, Minn., the home of Mayo Clinic, one of the few places worldwide where scientists can study virtually an entire geographic population to identify health trends. They found that as use of revascularization to improve circulation rose, the amputation rate dropped. The study covered 1990-2009.”This is an important study because frequently patients who have peripheral arterial disease — and there are about 12 million Americans who have some leg pain that can be connected to it — may progress to amputation. They may develop rest pain, gangrene, and if an intervention is not performed, they may lose the limb,” says senior author Peter Gloviczki, M.D., a Mayo Clinic vascular surgeon and president of the Society for Vascular Surgery. “This study shows that the use of endovascular interventions — stents, balloons or other catheter-based interventions — or open surgical bypass effectively reduced the amputation rate.”Patients with leg pain should report it to their physicians, and people with risk factors for peripheral arterial disease, such as smoking, high cholesterol, male gender, hypertension or diabetes, should take care of the medical conditions that may lead to or complicate peripheral arterial disease, he says.”In addition, patients who have leg pain and peripheral arterial disease frequently have silent heart disease, so the patient and primary care doctor should evaluate, and if the condition is significant, if the pain is something that interferes with the quality of life, then they should consult with a vascular surgeon,” says Dr. Gloviczki, the Joe M. and Ruth Roberts Professor of Surgery at Mayo Clinic.Other Mayo studies presented at the conference found that:There are very few deaths in the initial weeks after open-abdomen surgery or the minimally invasive endovascular stent repair of life-threatening abdominal aortic aneurysms. Patients who get stent grafts have shorter hospitalizations and fewer early complications, but the procedure was associated with a slightly higher rate of late death from all causes, the need for a repeat procedure at some point and a small but definite risk of eventual rupture, the researchers found.”The trend is that we do more and more stent procedures because it is easier for the patient, it can be performed in very high-risk patients and there is less early complication. …

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Breast cancer patients prefer silicone over saline implants after mastectomy

Nov. 8, 2010 — A new study has found that women who receive silicone implants after a double mastectomy are more satisfied with their breasts than women who receive saline implants. Published early online in CANCER, a peer-reviewed journal of the American Cancer Society, the findings may help physicians and breast cancer survivors as they together make decisions related to postmastectomy reconstructive surgery.


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Women who have one or both of their breasts removed as a treatment for breast cancer may wish to undergo breast reconstructive surgery with implants. Such postmastectomy implants may be filled with either saline (salt water) or silicone gel, and while both types have been approved by the US Food and Drug Administration, the safety and effectiveness of breast implants remain under close scrutiny. In addition to safety and efficacy, patient satisfaction and quality of life are also important considerations when comparing implant types. To this end, Colleen McCarthy, MD, of Memorial Sloan-Kettering Cancer Center in New York City led a team that surveyed 672 women who had undergone postmastectomy reconstructive surgery with implants at one of three centers in North America.

A total of 472 patients in the study completed questionnaires. In 176 women, silicone implants were placed; in 306, saline implants were used. The investigators found that patients with silicone implants were more satisfied with their reconstructed breasts than patients with saline implants. Receiving radiation therapy after a mastectomy had a significantly negative effect on breast satisfaction in both silicone and saline implant recipients. In addition, for women who received either silicone or saline implants, satisfaction diminished over time.

“We now know that women who elect to proceed with the placement of a silicone implant report higher satisfaction with their reconstructed breasts than those who choose saline implants,” said Dr. McCarthy. “It also appears that patient satisfaction with postmastectomy implant-based reconstruction is generally high and that individual treatment variables — such as implant type — explain only a relatively small amount of the variance. Patient counseling should reflect these realities in order to reassure patients that high satisfaction may be obtained with both saline and silicone implants,” she added.

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The above story is reprinted from materials provided by Wiley-Blackwell, via EurekAlert!, a service of AAAS.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.


Journal Reference:

  1. Colleen M. McCarthy, Anne F. Klassen, Stefan J. Cano, Amie Scott, Nancy VanLaeken, Peter A. Lennox, Amy K. Alderman, Babak J. Mehrara, Joseph J. Disa, Peter G. Cordeiro and Andrea L. Pusic. Patient satisfaction with postmastectomy breast reconstruction : A comparison of saline and silicone implants. Cancer, 8 NOV 2010 DOI: 10.1002/cncr.25552

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Assessment tool predicts blood clot risk after plastic surgery

Nov. 18, 2010 — Patients undergoing plastic or reconstructive surgery should receive a risk assessment before their procedure to predict whether they’ll develop potentially fatal blood clots in the legs or lungs, according to research at the University of Michigan Medical School. Researchers also found that 1 in 9 patients at highest risk based on that assessment will develop clots if not given clot-preventing medications after surgery.

Published in the November 2010 Journal of the American College of Surgeons, the study evaluated the Caprini Risk Assessment Model, a standard measurement tool used to assess the likelihood a patient will develop dangerous clots in the deep veins of the legs or lungs after surgery. While all patients admitted to U-M for surgery receive a Caprini risk assessment, it is not standard practice among plastic surgeons nationwide.

“Our data demonstrates that the Caprini Risk Assessment Model is a useful and effective tool for predicting how likely a patient is to develop venous thromboembolism (VTE) after plastic surgery,” says Christopher J. Pannucci, M.D., M.S., resident in the U-M Section of Plastic and Reconstructive Surgery and the study’s lead author.

Because past studies have shown that some plastic and reconstructive surgery patients are at high risk for developing clots and only about 50 percent of surgeons administer clot-preventing medications after surgery, Pannucci and fellow researchers sought to specifically validate whether the Caprini model was an effective tool for predicting risk and whether administering clot-preventing medications after surgery can reduce their risk.

“We found that the higher a patient’s Caprini score, the more likely the patient is to develop blood clots after surgery. We also found that patients with the highest scores were at disproportionately greater risk for developing clots if no clot-preventing medications were administered within 60 days after surgery,” Pannucci says.

For the study, researchers reviewed medical record data from 1,126 patients who had plastic or reconstructive surgery and who received no clot-preventing medicines after surgery.

Findings include:

The Caprini Risk Assessment tool is effective in predicting which plastic and reconstructive surgery patients will develop VTE. This study is the first time this theory was tested for plastic and reconstructive surgical patients.

A specific, high-risk group was identified. Patients with a Caprini score greater than 8 are at disproportionately higher risk for developing late VTE; 1 in 9 of these patients can expect to have an event if no clot-preventing medication is given within 60 days after the surgery.

“We used to think people developed blood clots while still on the operating table,” Pannucci says. “But we showed that patients with lower risk scores tend to develop VTEs within two weeks after surgery, while patients with higher risk scores continue to be at risk 20, 40 and even 60 days after their operation.”

The appropriate frequency and duration, and subsequent effectiveness of administering clot-preventing medications after surgery are currently being studied.

Risk Factors:

The most common risk factors for developing blood clots after surgery are age, obesity, surgery duration, pregnancy or oral contraceptive use, cancer, personal or family history of clots, and when a person’s blood clots easier than most due to genetically abnormal clotting factors.

Once an injury or surgery occurs, additional risk factors that increase clot risk include multi-system trauma, lower extremity fractures, immobility, multiple operations, need for indwelling central venous catheters, and various post-operative complications like systemic infection.

Effects of VTE:

Patients who develop deep vein thrombosis (blood clots deep in the artieries of the legs) are at risk for developing pulmonary embolism. Pulmonary embolism occurs when a deep clot is pushed with the flow of blood toward the heart. This clot can subsequently pass through the heart and obstruct the pulmonary artery — main artery of the lungsresponsible for carrying oxygen-rich blood to the rest of the body — resulting in major heart and lung dysfunction and sometimes death.

Ten percent of patients who develop pulmonary embolism will die within one hour of the onset of symptoms. For patients who survive a PE event, 50 percent suffer strain to the right ventricle of the heart and 5 percent eventually develop chronic pulmonary hypertension.

Patients who develop DVT may suffer damage to the valves in the veins of their legs which can cause venous reflux and post-thrombotic syndrome, a condition where blood pools in the lower extremities causing chronic swelling, tenderness and painful ulcers.

Statistics:

In 2008, members of the American Society for Plastic Surgeons performed 1.7 million cosmetic/plastic surgical procedures and 4.9 million reconstructive procedures.

VTE occurs with particularly high frequency after post-bariatric body contouring surgery, including circumferential abdominoplasty (7.7 percent), abdominoplasty (5 percent), and breast or upper body contouring (2.9 percent) and certain types of breast reconstruction (2.2 percent) procedures.

Additional authors: Steven Bailey, M.D., George Dreszer, M.D., Justin Zumsteg, M.D., Reda Jaber, B.S., Jenni Hamill, M.P.H., Keith Hume, M.A., Peter Rubin, M.D., Peter Neligan, M.D., Loree Kallianen, M.D., Ronald Hoxworth, M.D., Andrea Pusic, M.D., M.H.S., Edwin Wilkins, M.D., M.S.

This study was funded by the Plastic Surgery Educational Foundation.

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Men fuel rebound in plastic surgery: Sizeable increases in facelifts and other surgical procedures for men

Apr. 13, 2011 — Statistics released by the American Society of Plastic Surgeons (ASPS) show that more men are going under the knife. Overall cosmetic plastic surgery procedures in men were up 2 percent in 2010 compared to 2009. However, many male surgical procedures increased significantly. Facelifts for men rose 14 percent in 2010 while male liposuction increased 7 percent.

2010 ASPS statistics show that men underwent more than 1.1 million cosmetic procedures, both minimally-invasive and surgical. The majority of the the Men’s Top 10 fastest-growing cosmetic procedures are surgical, which bucks the previous trend of growth in minimally-invasive treatments.

“The growth in cosmetic surgical procedures for men may be a product of our aging baby boomers who are now ready to have plastic surgery,” said ASPS President Phillip Haeck, MD. “Minimally-invasive procedures such as Botox® and soft tissue fillers work to a point. However, as you age and gravity takes over, surgical procedures that lift the skin are necessary in order to show significant improvement.”

Men’s Top Ten: Fastest-Growing Male Cosmetic Procedures (by percentage increase)

The list comprises the fastest-growing surgical and minimally-invasive procedures from 2009 to 2010. Criteria for inclusion: Procedure performed on at least 1,000 men in 2010. (Surgical procedures are listed in bold).

  1. Facelift — 14% Increase
  2. Ear Surgery (Otoplasty) — 11% Increase
  3. Soft Tissue Fillers — 10% Increase
  4. Botulinum Toxin Type A — 9% Increase
  5. Liposuction — 7% Increase
  6. Breast Reduction in Men — 6% Increase
  7. Eyelid Surgery — 4% Increase
  8. Dermabrasion — 4% Increase
  9. Laser Hair Removal — 4% Increase
  10. Laser Treatment of Leg Veins — 4% Increase

Plastic surgeons say that another trend they see in male plastic surgery is the type of patient seeking their services.

“Typically people think of celebrities and high profile men going under the knife,” said Stephen Baker, MD, an ASPS Member Surgeon based in Washington DC. “And while that may be true, the typical male cosmetic surgery patient that I see is an average guy who wants to look as good as he feels. Most of my patients are ‘men’s men,’ the kind of guy you might not think would have plastic surgery.”

Dr. Baker said that baby boomers who are now reaching retirement age are the new face of the male plastic surgery trend. “They want to look good. So when they have the financial means to do it, they are ready to do it now,” said Dr. Baker.

In fact, one of Dr. Baker’s patients is an “average Joe” named Joe Marek. Joe recently underwent a facelift and eyelid surgery. The 57-year old said, “I didn’t feel that old. I felt young. I was working out. I was pretty active and I wanted to look like I felt inside.”

Joe also said his 52-year-old girlfriend supported his decision to have plastic surgery.

Men’s Top Ten: Most Popular Male Cosmetic Procedures (by volume)

This list comprises the top five surgical and top five minimally-invasive procedures by volume in 2010:

2010 Top Five Male Cosmetic Surgical Procedures

  1. Nose Reshaping (64,000)
  2. Eyelid Surgery (31,000)
  3. Liposuction (24,000)
  4. Breast Reduction in Men (18,000)
  5. Hair Transplantation (13,000)

2010 Top Five Male Cosmetic Minimally-Invasive Procedures

  1. Botulinum Toxin Type A (337,000)
  2. Laser Hair Removal (165,000)
  3. Microdermabrasion (158,000)
  4. Chemical Peel (90,000)
  5. Soft Tissue Fillers (78,000)
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New technique doubles breast size using patient’s own fat

June 7, 2011 — A plastic surgery procedure in which the patient’s own fat is transplanted to the breasts — used along with treatment to expand the breast tissue before surgery — can achieve up to a twofold increase in breast size, according to a study in the June issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons.

The procedure builds on previous fat transfer techniques to provide excellent outcomes of breast enhancement surgery. “Pre-expansion to the breast allows for mega-volume (over 300 cc) grafting with reproducible, long lasting results that can be achieved in less than two hours,” according to Drs. Daniel Alexander Del Vecchio and Louis Paul Bucky, authors of the new report.

“Pre-Expansion” Maximizes Results of Breast Fat Transfer

The technique is an adaptation of the increasingly popular autologous fat transplantation technique. In these procedures, fat obtained by liposuction from one part of the body — for example, the thighs — is transferred for use in breast enlargement and reshaping.

In the procedure used by Drs. Del Vecchio and Bucky, the patient first undergoes several weeks of “pre-expansion” treatment. This is done with a bra-like device that uses gentle negative pressure to gradually expand the breast. The pre-expansion procedure provides extra room in the breast, which is “backfilled” using the liposuctioned fat.

The authors report their experience using pre-expansion and autologous fat transfer in 46 breasts of 25 women. Some of the patients wanted to increase their breast size or to replace implants; others were seeking treatment for certain types of breast deformities. On average, about 300cc of fat was transplanted per treated breast.

When evaluated after six months, the women had significant improvements in breast size and shape. On average, the treated breasts approximately doubled in size, with a “soft and natural…appearance and feel,” the researchers write. Follow-up magnetic resonance imaging scans showed no cysts, masses or other abnormalities.

As they gained experience, the surgeons were able to perform the breast fat transfer procedure within less than two hours. There were no significant complications.

While the idea of breast fat transfer is not new, it has seen a resurgence in recent years, with several plastic surgery groups reporting good results. Drs. Del Vecchio and Bucky believe pre-transplant breast expansion is an important technical advance, providing increased space to be occupied by the patient’s own fat. Patients also used the vacuum device for a few weeks after the procedure, which may act as a “splint” to help promote healing.

Further research will be needed to assess the results of the pre-expansion and fat transplantation technique — including not only the long-term outcomes, but also important safety issues. As reported in recent issues of Plastic and Reconstructive Surgery, there is some question as to whether breast fat transfer procedures interfere with mammographic screening for breast cancer.

In the meantime, Drs. Del Vecchio and Bucky believe their results — a two-fold increase in breast size, achieved in two hours or less — are a significant step forward in the use of autologous fat transplantation for breast enhancement. They conclude, “These results serve as a standard to objectively compare other techniques of fat grafting to the breast in the future.”

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Study compares two types of botulinum toxin for cosmetic use

June 21, 2011 — Not all varieties of botulinum toxin seem to be equally effective in reducing crow’s feet wrinkles, according to a report published online in Archives of Facial Plastic Surgery, one of the JAMA/Archives journals.

Botulinum toxin, a protein long considered harmful, is now known as a neuromodulator (a chemical that affects nerve impulses) that has cosmetic and medical uses, according to background information in the article. In 1989, botulinum toxin type A was approved in the United States for two muscular conditions that affect the appearance of the eyes. In 2002, one type — onabotulinumtoxinA — was approved for the treatment of wrinkles between the eyebrows; a second type, abobotulinumtoxinA, received approval for the same indication in 2009. The authors sought to compare both types of the protein, head to head. “Such an assessment could characterize and contrast their efficacy in clinical performance in the treatment of hyperfunctional lines and muscular relaxation,” the authors write.

Kartik D. Nettar, M.D., from The Maas Clinic, San Francisco, and the University of California, San Francisco, and colleagues conducted a randomized, double-blind split-face study, using one agent on the right side and the other agent on the left side. “By using a split-face (internally controlled) paradigm, this would provide direct comparison of each product in the same patient,” they explain. Ninety patients received injections of onabotulinumtoxinA and of abobotulinumtoxinA on either side of their faces; the lateral orbital rhytids, or “crow’s feet” wrinkles, were the site treated. Investigators assessed the site’s appearance using a five-point scale, and patients were also surveyed for their opinions.

According to the researchers, the difference between the two agents was significant when participants contracted the muscles as much as possible, with abobotulinumtoxinA producing a greater effect. This difference persisted in both investigators’ and patients’ assessments. Approximately two-thirds of participants said they favored the side of their faces that was treated with abobotulinumtoxinA.

The authors remark that the study’s results, while favorable to abobotulinumtoxinA, are limited in their scope. No statistical significance between the two agents was seen when the muscles were at rest. The researchers call for further comparative studies in other facial muscles, as well as of why one agent would perform better than the other. “Ongoing studies will determine whether the demonstrated patient preference and early advantage in clinical outcomes is persistent,” they write, “as both the efficacy in line effacement and duration of effect are both important factors in patient and physician decision-making as it related to the use of neuromodulators.”

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Improving surgical outcomes for children, cancer patients

July 13, 2011 — Faculty and students at the Cockrell School of Engineering at The University of Texas at Austin are developing ways for cancer patients and children born with facial deformities to make more informed decisions about which reconstructive surgeries would be most aesthetically pleasing and practical based on their individual body types and personal preferences.

The interdisciplinary research, which includes biomedical engineering Professor Mia K. Markey and aerospace engineering Professor K. Ravi-Chandar, pairs faculty and students with doctors and patients at The University of Texas MD Anderson Cancer Center and Dell Children’s Medical Center of Central Texas.

Researchers at both medical centers are using novel 3D surface imaging technology and algorithms to address one of the most difficult questions for cancer patients and children facing reconstructive surgery: What procedure is right for me?

“With breast cancer patients, they are usually candidates for more than one kind of reconstructive surgery and the only reason to choose one over another is the patient’s own preference,” Markey said. “So that patient may be able to understand differences in costs or how long one procedure will require her to be in the hospital, but in terms of understanding how it will change her appearance, she wouldn’t know a reason to pick one procedure over the other.”

Options based off of patients’ preferences

But Markey, along with a team of surgeons, doctors and psychologists at MD Anderson, aims to change that. The researchers are in the midst of several research projects — funded by the American Cancer Society and the National Institutes of Health — to develop technology for quantifying surgical outcomes and understanding patients’ perceptions of changes in their appearance.

Traditionally, the area of a patient’s body that will be reconstructed is measured by doctors with measuring tape. But it’s hard to know upfront which measurements are important — meaning multiple measurements may be required — and the method can be uncomfortable for patients.

Markey and her team are simplifying the process, however, by using commercially available 3D surface imaging technology. The technology takes multiple photos of patients prior to their surgery and builds 3D models and measurements of the photographed area in a matter of minutes.

Such models then can be used to build simulations of what a patient would look like if he or she had a procedure. For cancer patients undergoing facial reconstructive surgery, the models would help better define cosmetic outcomes. And for breast cancer patients, who often must choose from multiple procedures, the simulations would make it easier to decide which procedure provides the most desired physical effect.

“We’re trying to do this in an honest way, so that these aren’t just fancy computer graphics. They provide patients with a realistic picture of what they would look like after their surgery and are constrained by what is actually surgically possible,” Markey said.

The bigger goal of one of the research projects is to identify underlying commonalities among breast cancer patients — like age, feelings on body image issues, disease history, etc. — so that surgeons and doctors can provide women with reconstructive surgery options that are more tailored to their individual needs, expectations post-surgery and physical and mental characteristics.

Markey, along with Fatima Merchant, an engineering alumna and University of Houston assistant professor, and Michelle Fingeret, a clinical psychologist and an assistant professor at The University of Texas MD Anderson Cancer Center, are in the process of collecting up to 500 surveys from breast cancer patients undergoing reconstructive surgery at MD Anderson. Responses from the surveys will eventually help researchers create complex algorithms that — similarly to how Netflix and Amazon can predict what movies or products a person will like based on his or her shopping history and interests — a doctor could recommend surgical procedures based on a patient’s health history and desired physical appearance post-surgery.

While the surveys and research won’t benefit women currently being treated for breast cancer, Fingeret said many of them want to participate because they know the “body image profiles” derived from their responses will help another patient down the road.

“We have extremely high participation rates [in the surveys.]” said Fingeret, an assistant professor in the Department of Behavioral Science with joint appointments in the Departments of Plastic Surgery and Head and Neck Surgery at The University of Texas MD Anderson Cancer Center. “When we tell people the goal of this research, they’re very interested in helping others because they’ll tell you it’s probably the most difficult decision they’ve had to make.”

The group is also leading a separate study on how cancer patients requiring facial reconstructive surgery adjust to body image issues and changes over time. In such instances, patients typically don’t have a choice over the type of reconstructive procedures because the goal of surgery is to remove cancerous tumors while maintaining or restoring as much function as possible.

The research aims to develop a way for better defining cosmetic outcomes.

Creating the face of Central Texas children

In Adriana Da Silveira’s day to day job, the need to better define cosmetic outcomes for patients is great.

Children born with facial deformities such as cleft palate or hemifacial microsomia — a condition characterized by asymmetrical face and skull — pass through her office at Dell Children’s Medical Center, where she is chief of orthodontics at the Craniofacial& Reconstructive Plastic Surgery Center. Because the deformities of her patients have existed since birth, Da Silveira, Dr. Patrick Kelley and other plastic surgeons struggle to explain to parents what their child will look like following a surgical procedure. After all, there is no frame of reference for what the child would have looked like had the deformity never occurred.

“Basically, it’s like we’re having to guess,” Da Silveira said. “Parents want to know what their child is going to look like in the end but when they can’t see it and there’s no visual way to show it, they just have to trust us. And for a kid it’s hard to say what the normal or acceptable appearance of a face is.”

Markey and UT engineering students are applying the same 3D imaging technology used at MD Anderson to eventually help Da Silveira and other surgeons.

Researchers are in the process of collecting 3D images and measurements of Hispanic children ages 7-12 who do not have facial deformities. The group represents the largest child population treated at the center and images of them could help researchers determine what facial characteristics are considered normal or aesthetically-pleasing on the face of a Hispanic child in that age group.

After a total of 80 images are collected, the attractiveness of the photos will be rated. Researchers plan to develop statistical correlations from these ratings and provide doctors with guides or computer simulations of which facial characteristics are considered most attractive — be it when a nose is shaped smaller or the width of a smile is larger.

In a sense, such advances will help put a face to Central Texas children. Along the way, they are providing Markey’s students with hands-on research opportunities that they otherwise would not receive.

“If you go into a hospital and volunteer, you’re not going to get this same level of interaction as I get here,” said Brian Ku, who will be a senior in biomedical engineering this fall and is helping lead the task of collecting images.

Ku is among a group of students — from undergraduate through postdoctoral and representing a range of engineering disciplines — who contribute to the research. The students have had the chance to watch surgeries and interact with patients undergoing reconstructive surgery — experiences that Markey says are crucial to their education.

“As I was developing my research career and thinking of the direction I could go, it was important for me to do something where people didn’t say, ‘Why?’ I wanted people to recognize its importance,” Markey said. “And with this, we can see where the research is going to help someone. So while it’s exciting to discover something new in our work, it’s equally exciting to know we can impact a person’s life for the better.”

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Women seek labial reduction surgery for cosmetic reasons, study finds

Aug. 23, 2011 — Women with normal sized labia minora still seek labial reduction surgery for cosmetic reasons finds new research published in BJOG: An International Journal of Obstetrics and Gynaecology.

Female cosmetic genital surgery is increasingly popular and the number of labial reduction procedures in the National Health Service has increased five fold in the past 10 years.

This is the first study looking specifically at the labial dimensions of women seeking cosmetic surgery. It looked at 33 women who had requested labial reduction surgery and who had been referred by their general practitioner. The average age of the group was 23.

All of the women were examined by a gynaecologist and the width and length of the labia minora were measured and compared with published normal values.

The study found that all women seeking surgery had normal sized labia minora, with an average width of 26.9 mm (right), and 24.8 mm (left).

Three women out of the total number were offered surgery to address a significant asymmetry. Of the women who were refused surgery, 12 (40%) of the women still remained keen to pursue surgery by another route, 11 women accepted a referral for psychology and one participant was referred to mental health services.

The women were asked what they would like to achieve with surgery and 20 women (60%) wished to make the labia smaller to improve appearance. Other reasons included reducing discomfort, improving confidence and wanting to improve sexual intercourse.

The study also looked at how old the women were when they first became dissatisfied with the labia minora. Twenty-seven women (81%) were able to pinpoint this. Of these, 5 women (15%) reported this to be under the age of 10, 10(30%) between the ages of 11 and 15, 5 (15%) between 16 and 20, 4 (12%) in their twenties, and 3 (9%) in their thirties.

Reasons for this dissatisfaction included an increasing self awareness of the genital area, physical discomfort, comments from a partner and watching TV programmes on cosmetic genital surgery.

Sarah Creighton, UCL Elizabeth Garrett Anderson Institute of Women’s Health and lead author said: “It is surprising that all of the study participants had normal sized labia minora and despite this nearly half were still keen to pursue surgery as an option.

“A particular concern is the age of some of the referred patients, one as young as 11 years old. Development of the external genitalia continues throughout adolescence and in particular the labia minora may develop asymmetrically initially and become more symmetrical in time.”

BJOG Deputy Editor-in-Chief, Pierre Martin-Hirsch, added: “Many women who are worried may have normal sized labia minora. Clear guidance is needed for clinicians on how best to care for women seeking surgery.”

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Hospital-based exercise programs benefit people with osteoarthritis, study finds

Nov. 11, 2012 — A low-cost exercise program run by Hospital for Special Surgery in New York City has significantly improved pain, function and quality of life in participants with osteoarthritis, according to new research.

The study adds to the growing evidence that exercise is beneficial for osteoarthritis and shows that a hospital-based program can work. The study will be reported at the annual meeting of the American College of Rheumatology/Association of Rheumatology Health Professionals (ACR/ARHP), to be held Nov. 9-14, in Washington D.C.

The new study showed that the weekly exercise programs significantly improved enjoyment of life and balance, and decreased pain and the severity and frequency of falls. “When participants were asked to report their level of pain severity, there were statistically significant reductions in pain from pre- to post-test. Pain is a huge factor in quality of life,” said Sandra Goldsmith, director of the Public and Patient Education Department at Hospital for Special Surgery. “If we can offer classes that help to reduce pain, that is a good thing.”

Roughly ten years ago, HSS launched its Osteoarthritis Wellness Initiative, which has grown to encompass both an educational component, including lectures and workshops, as well as exercise classes. In the study to be presented at the recent ACR/ARHP meeting, Special Surgery researchers evaluated the effectiveness of the exercise programs on 200 participants.

The classes, which met weekly throughout the year, included Tai Chi, yoga, mat and chair pilates, yoga-lates and dance fitness. Instructors who could tailor exercises for those with osteoarthritis and other musculoskeletal issues supervised the exercise programs. The researchers analyzed results from surveys that were administered before and after the exercise programs. The surveys included measures of self-reported pain, balance, falls and level of physical activity. An 11-point numeric pain intensity scale was used to quantify intensity of muscle or joint pain. The 10-point Brief Pain Inventory was used to measure pain interference on aspects of quality of life, including general activity, mood, walking ability, sleep, normal work (both outside the home and housework), and enjoyment of life.

In the sample of 200 participants, roughly 53% indicated that they experienced pain relief as a result of participating in the exercise programs. In fact, when researchers analyzed the subset of 66 participants who completed both pre and post surveys, a larger proportion, 62%, indicated they experienced pain relief after participating in the exercise programs. The level of pain intensity that participants experienced also significantly dropped from 4.5 to 2.7 in this group, where 0 was no pain and 10 was the worst pain imaginable. When researchers compared participants’ estimation of how much pain interfered with various aspects of an individual’s life, they identified a 54% improvement in general activity, mood, walking ability, sleep, normal work, and enjoyment of life.

“We asked participants to rate their balance, and we found a statistically significant increase in those who rated their balance as excellent, very good or good, from pre- to post-intervention, ” said Dana Friedman, MPH, outcomes manager in the HSS Public and Patient Education Department. Fewer respondents reported falling from pre- to post-test (14.5% vs. 13.1%), as well as sustaining injuries that required hospitalization (12.1% vs. 10.6%).

Linda Russell, M.D., a rheumatologist at HSS who is chair of the Public and Patient Education Advisory Committee, points out that the classes are low cost for patients and the fees cover the majority of costs associated with offering these types of programs, including salaries for the instructors. “We like to get all of our patients involved in exercise, and if we can help with a low-cost alternative to exercising in New York City, because gyms are expensive, then it is wonderful,” said Dr. Russell. “Patients benefit from supervised exercise programs with regard to their overall sense of well-being and pain due to their arthritis. We encourage other institutions to launch these types of program.”

“We’d like to be a role model for other hospitals, showing them that offering this type of program can help their patients reduce pain and improve quality of life,” said Ms. Goldsmith. “We are willing to discuss the details about how to start these programs.”

All exercise programs were run through the HSS Public and Patient Education Department, which includes the Greenberg Academy for Successful Aging, a collaborative program between the HSS Public and Patient Education Department and NewYork-Presbyterian Hospital’s Irving Sherwood Wright Center for the Aging.

Osteoarthritis is the leading cause of disability in the United States. According to the Centers for Disease Control and Prevention, an estimated 50 million U.S. adults, 22% of the population, suffered from osteoarthritis in 2009, compared with 46 million in 2003-2005. Arthritis affected the daily activities of 21 million adults in 2009. Body mass index influences the prevalence of arthritis; 29.6% of obese adults have arthritis.

Other Hospital for Special Surgery authors involved in the study include Linda Roberts, LCSW, Dana Sperber and Laura Robbins, DSW.

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