Differences in Complication Rates of Gluteoplasty Procedures That Utilize Autologous Fat Grafting, Implants, or Local Flaps.

BACKGROUND:Gluteoplasty (gluteal augmentation) procedures are increasing in popularity, but there is not a universally accepted technique to produce optimal outcomes while minimizing risk. In this systematic review, we perform a meta-analysis to evaluate rates of complication from autologous fat grafting, implants, and local flaps, which are the three most common gluteoplasty operations. METHODS:A search of the PubMed/MEDLINE database for articles including the terms "gluteoplasty" OR "gluteal augmentation" OR "buttock augmentation" OR "Brazilian butt lift" OR "gluteal autologous fat graft" OR "buttock autologous fat graft" OR "gluteal implant" OR "buttock implant" OR "gluteal flap" OR "buttock flap" generated 229 articles. This number was brought down to 134 after initial screening by title. Inclusion criteria then removed those not written in English, those without access to the full text, those without extractable data on complications, and duplicates, leaving 46 articles to examine. RESULTS:A total of 4362 patients who underwent gluteoplasty between 1992 and 2017 were found. The overall complication rate was 12.4%. Implants had the highest rate (31.4%), whereas fat grafting had the lowest (6.8%); flaps were intermediate (23.1%). A χ test yielded a statistically significant (P < 0.001) nonindependent relationship between combined complication rate and type of surgery. Individual complications, such as asymmetry, capsular contracture, fat embolism, hematoma, infection, necrosis, pain, seroma, wide scar formation, and wound dehiscence, were also analyzed. CONCLUSIONS:Fat grafting by plastic surgeons might be the best option for gluteoplasty with regard to complications. In certain cases, however, there may only exist one choice for an operation because of anatomical limitations, which predisposes patients to those associated complications

Review of the Pathways Involved in the Osteogenic Differentiation of Adipose-Derived Stem Cells.

Grafts and prosthetic materials used for the repair of bone defects are often accompanied by comorbidity and rejection. Therefore, there is an immense need for novel approaches to combating the issues surrounding such defects. Because of their accessibility, substantial proportion, and osteogenic differentiation potential, adipose-derived stem cells (ASCs) make for an ideal source of bone tissue in regenerative medicine. However, efficient induction of ASCs toward an osteoblastic lineage in vivo is met with challenges, and many signaling pathways must come together to secure osteoblastogenesis. Among them are bone morphogenic protein, wingless-related integration site protein, Notch, Hedgehog, fibroblast growth factor, vascular endothelial growth factor, and extracellular regulated-signal kinase. The goal of this literature review is to conglomerate the present research on these pathways to formulate a better understanding of how ASCs are most effectively transformed into bone in the context of tissue engineering

Differences in Complication Rates of Gluteoplasty Procedures That Utilize Autologous Fat Grafting, Implants, or Local Flaps.

BACKGROUND:Gluteoplasty (gluteal augmentation) procedures are increasing in popularity, but there is not a universally accepted technique to produce optimal outcomes while minimizing risk. In this systematic review, we perform a meta-analysis to evaluate rates of complication from autologous fat grafting, implants, and local flaps, which are the three most common gluteoplasty operations. METHODS:A search of the PubMed/MEDLINE database for articles including the terms "gluteoplasty" OR "gluteal augmentation" OR "buttock augmentation" OR "Brazilian butt lift" OR "gluteal autologous fat graft" OR "buttock autologous fat graft" OR "gluteal implant" OR "buttock implant" OR "gluteal flap" OR "buttock flap" generated 229 articles. This number was brought down to 134 after initial screening by title. Inclusion criteria then removed those not written in English, those without access to the full text, those without extractable data on complications, and duplicates, leaving 46 articles to examine. RESULTS:A total of 4362 patients who underwent gluteoplasty between 1992 and 2017 were found. The overall complication rate was 12.4%. Implants had the highest rate (31.4%), whereas fat grafting had the lowest (6.8%); flaps were intermediate (23.1%). A χ test yielded a statistically significant (P < 0.001) nonindependent relationship between combined complication rate and type of surgery. Individual complications, such as asymmetry, capsular contracture, fat embolism, hematoma, infection, necrosis, pain, seroma, wide scar formation, and wound dehiscence, were also analyzed. CONCLUSIONS:Fat grafting by plastic surgeons might be the best option for gluteoplasty with regard to complications. In certain cases, however, there may only exist one choice for an operation because of anatomical limitations, which predisposes patients to those associated complications

Association of Baseline Frailty and Age With Postoperative Outcomes in Metastatic Brain Tumor Patients

BACKGROUND: The impact of baseline frailty status versus that of chronological age on surgical outcomes of metastatic brain tumor patients remains largely unknown. The present study aimed to evaluate this relationship for preoperative risk stratification using a large national database. METHODS: The National Surgical Quality Improvement Program database was queried to extract data of metastatic brain tumor patients who underwent surgery between 2015 and 2019 (n=5,943). Univariate and multivariate analyses were performed to assess the effect of age and modified frailty index-5 (mFI-5) on mortality, major complications, unplanned readmission and reoperation, extended length of stay (eLOS), and non-home discharge. RESULTS: Both univariate and multivariate analyses demonstrated that frailty status was significantly predictive of 30-day mortality, major complications, eLOS, and non-home discharge. Although increasing age was also a significant predictor of eLOS and discharge to non-home destination, effect sizes were smaller compared with frailty. CONCLUSIONS: The present study, based on analysis of data from a large national registry, shows that frailty, when compared with age, is a superior predictor of postoperative outcomes in metastatic brain tumor patients. A future prospective study, namely a randomized controlled trial, would be beneficial in helping to corroborate the findings of this retrospective study

Superior Discrimination of the Risk Analysis Index Compared With the 5-Item Modified Frailty Index in 30-Day Outcome Prediction After Anterior Cervical Discectomy and Fusion

OBJECTIVE: The objective of this paper was to compare the predictive ability of the recalibrated Risk Analysis Index (RAI-rev) with the 5-item modified frailty index-5 (mFI-5) for postoperative outcomes of anterior cervical discectomy and fusion (ACDF). METHODS: This study was performed using data of adult (age \u3e 18 years) ACDF patients obtained from the National Surgical Quality Improvement Program database during the years 2015-2019. Multivariate modeling and receiver operating characteristic (ROC) curve analysis, including area under the curve/C-statistic calculation with the DeLong test, were performed to evaluate the comparative discriminative ability of the RAI-rev and mFI-5 for 5 postoperative outcomes. RESULTS: Both the RAI-rev and mFI-5 were independent predictors of increased postoperative mortality and morbidity in a cohort of 61,441 ACDF patients. In the ROC analysis for 30-day mortality prediction, C-statistics indicated a significantly better performance of the RAI-rev (C-statistic = 0.855, 95% CI 0.852-0.858) compared with the mFI-5 (C-statistic = 0.684, 95% CI 0.680-0.688) (p \u3c 0.001, DeLong test). The results were similar for postoperative ACDF morbidity, Clavien-Dindo grade IV complications, nonhome discharge, and reoperation, demonstrating the superior discriminative ability of the RAI-rev compared with the mFI-5. CONCLUSIONS: The RAI-rev demonstrates superior discrimination to the mFI-5 in predicting postoperative ACDF mortality and morbidity. To the authors\u27 knowledge, this is the first study to document frailty as an independent risk factor for postoperative mortality after ACDF. The RAI-rev has conceptual fidelity to the frailty phenotype and may be more useful than the mFI-5 in preoperative ACDF risk stratification. Prospective validation of these findings is necessary, but patients with high RAI-rev scores may benefit from knowing that they might have an increased surgical risk for ACDF morbidity and mortality