Background:Scholarly activity is a key aspect of plastic surgery training, influencing resident selection and career progression. However, research productivity among Canadian plastic surgery residents has not been quantified. Methods:This cross-sectional study included Canadian plastic surgery residents enrolled between 2015 and 2024, identified through a systematic web search. Scholarly metrics were extracted from Scopus and PubMed. Descriptive statistics summarized demographics and research metrics of residents. Multivariable logistic and negative binomial regression analyses were used to identify associations and predictors of research productivity, defined as publications-per-postgraduate year (PGY). Results:Overall, 309 trainees were included (163 active, 146 graduates). Among 163 active residents, 53% identified as female, 41% held a graduate degree, and 11% of active residents were enrolled in a Clinician-Investigator Program (CIP). Mean publication-per-PGY was 0.62 ± 0.92. Higher research productivity was independently associated with preresidency publications (incidence rate ratio [IRR] = 1.09, P < .001), CIP enrolment (IRR=1.88, P = .041), and female identification (IRR=0.58 for males, P = .017). Among 146 graduates, 58% were female, 46% held a graduate degree, and 84% pursued at least one fellowship. Twenty-seven percent hold faculty positions. Faculty appointment was associated with higher research metrics (P < .001), and graduate degree status was the sole independent predictor (odds ratio = 3.41, P = .015). Program requirements and the productivity of PDs and RDs were not significant. Conclusions:Research productivity among Canadian plastic surgery residents is primarily influenced by individual factors, specifically preresidency research and CIP enrolment. Program-level factors such as research requirements and metrics of PDs and RDs are not associated with higher productivity in residents. Graduate degree status is a predictor of academic career pursuit, but not of fellowship. These findings aim to enhance scholarly involvement throughout the trainee lifespan and those aspiring for a faculty appointment.
Introduction:Increased limb salvage rates necessitate greater attention to flap durability during subsequent staged or revisional orthopedic procedures in the lower extremity. Direct evidence comparing outcomes in this specific context is limited, thus we compared the performance of muscle flaps (MF) and fasciocutaneous flaps (FCF) and sought to identify predictors of complications following flap re-elevation. Methods:Adults (>18 years) with lower extremity injuries (knee and below) who underwent flap reconstruction and subsequent flap re-elevation for a secondary orthopedic procedure between years 2000 and 2020 were reviewed. Patient factors, operative details, and postoperative trajectory were documented. Complications following a secondary orthopedic procedure were classified as minor or major (Clavien-Dindo ≥ III). Categorical data were assessed for independence with Fisher Exact test and continuous variables with Mann-Whitney U test. Results:Of 64 patients included (MF = 52, FCF = 12), 14.1% experienced a major complication with similar rates between FCFs (n = 2, 16.7%) and MFs (n = 7, 13.5%). However, the occurrence of a primary complication (OR = 7.82, CI [1.47-41.66]) and an unplanned secondary orthopedic procedure (n = 9, 100%) were strong predictors of major complications after flap re-elevation. Current smoking (OR = 6.39, CI [1.43-28.53]) and alcohol use (OR = 9.0, CI [1.92-42.40]) were also significant risk factors. Conclusion:Our findings indicate that the risk of flap failure is primarily associated with patient factors and peri-operative trajectory, rather than flap type alone. We propose minimizing unplanned flap re-elevations or primary complications by selecting a flap that optimally obliterates dead space and provides durable coverage.
Introduction: Patient education is crucial for informed decision-making in breast reconstruction surgery. Large language models (LLMs) have emerged as potential tools for providing medical information, but their comparative accuracy and reliability for specialized surgical topics remain unclear. This study aims to evaluate the performance of multiple artificial intelligence (AI) models, including general-purpose LLMs and a specialized retrieval-augmented generation (RAG) system, in providing breast reconstruction patient education. Methods: We developed 10 standardized breast reconstruction questions covering reconstruction options, complications, recovery, and insurance coverage. Five AI systems were evaluated: ChatGPT o3-high, ChatGPT 4.5, Grok 3, Claude Haiku 3.5, and our specialized MicroRAG system trained on 4876 microsurgical publications. Responses were assessed using the Global Quality Score (1-5 scale) by 4 plastic surgeons, measuring accuracy, relevance, clarity, and completeness. Results: Performance varied across models and question types, with each system demonstrating distinct strengths. ChatGPT o3-high achieved the highest overall mean score (3.73), followed by Grok 3 (3.55), Claude Haiku 3.5 (3.52), MicroRAG (3.42), and ChatGPT 4.5 (3.30). MicroRAG excelled in evidence-based clinical recovery topics, achieving perfect scores (5.0) for specialized areas and providing literature-cited responses. Statistical analysis revealed that ChatGPT o3-high significantly outperformed ChatGPT 4.5 (P = .005), while differences between other model pairs were not statistically significant. Conclusions: Different AI systems demonstrated complementary strengths for breast reconstruction patient education. While general-purpose LLMs like ChatGPT o3-high provided consistent performance across diverse patient information needs, specialized RAG systems like MicroRAG offered superior evidence-based responses in specific clinical domains. These findings indicate that healthcare providers should consider complementary system strengths and domain-specific requirements when selecting AI tools for patient education.
Radiation therapy complicates implant-based breast reconstruction by inducing fibrosis, vascular compromise, and capsular contracture, often resulting in significant breast asymmetry. Reoperation on irradiated implant pockets carries a high risk of wound-healing complications and implant loss, limiting reconstructive options. We present a case demonstrating a contralateral reconstructive strategy to address radiation-induced asymmetry without revising the irradiated breast. A woman with a history of bilateral mastectomy and implant-based reconstruction developed severe asymmetry following postmastectomy radiation to the left breast. Given the patient's preference for the irradiated breast position and the risks of operating on irradiated tissue, revision was performed on the nonirradiated side using a narrow, ultra-high-profile implant wrapped in acellular dermal matrix that was positioned cephalad. This approach restored symmetry when surgical intervention of the irradiated breast was not advised, and nonsurgical treatment of the contracted breast was not preferred. This technique avoids the morbidity associated with operating on irradiated tissue and represents a safe, reproducible treatment option for select patients.
Brodie's abscess is a rare form of subacute osteomyelitis, most commonly affecting the metaphysis of long bones in pediatric patients. Involvement of the hand is exceptional, and its indolent course combined with nonspecific imaging features can make diagnosis challenging. Here, we describe a case of Brodie's abscess following an animal bite and compare it with the few reported cases of Brodie's abscess of the hand in the literature.
Introduction:Velopharyngeal insufficiency (VPI) is an unfavorable outcome of primary palatoplasty. Clinical and surgical risk factors for VPI are well described, yet the impact of social determinants of health (SDoH) on VPI is less understood. This study aimed to estimate the effect of income, ethnicity, and geographical location on VPI. Methods:Non-syndromic patients who had primary palatoplasty at British Columbia Children's Hospital between 2005 and 2015 were retrospectively reviewed. Patient demographics, including income, ethnicity, and distance to hospital were collected, as well as primary palatoplasty details, VPI diagnosis, and any secondary speech surgery. Logistic regression models were used to examine associations with VPI. Results:A total of 209 patients were included: 30% (n = 63) developed VPI. Complete cleft palate was a significant predictor of VPI (odds ratio (OR) 4.35, P ≤ .001). Indigenous identity, sex assigned at birth, average income, and distance to the hospital were not predictors of VPI. For those with complete cleft palate, there was a 24% greater likelihood of developing VPI for every month older the patient was at the time of initial palate repair (OR 1.27, P = .018). Conclusions:Cleft palate severity and age at primary palatoplasty for patients with complete cleft palate had the largest effect on VPI. SDoH factors (income and geographical location) were not associated with VPI; however, there was a trend between Indigenous identity and the development of VPI. The effect of Indigenous identity was limited by incomplete data and may be an area of future research. These findings are reassuring for a multidisciplinary clinic with dedicated social work support in a public healthcare system.
Introduction: Patient-indications for pursuing otoplasty for prominent ears and post-operative satisfaction vary. This study examines patients' quality of life (QoL) following Mustardé otoplasty for prominent ears and examines associations between surgical indications and post-operative ear appearance satisfaction on QoL. Methods: Patients who underwent Mustardé otoplasty for prominent ears from 2009 to 2023 were invited to complete the EAR-Q scale (scores range from 0 to 100), and the Glasgow Benefit Inventory (GBI) or Glasgow Children's Benefit Inventory (GCBI) (scores range from -100 to +100). Associations with QoL (GBI/GCBI score) and surgical indications were analyzed using linear regression. Associations between QoL (GBI/GCBI) and post-operative ear appearance satisfaction were analyzed using Spearman's correlation. Results: Forty-two patients completed the questionnaire (59% response rate, average age 18.9 years). Nearly all (41/42) patients reported a positive change in QoL. The median GBI and GCBI scores were 30.0 [16.7, 46.7] and 33.3 [17.7, 44.8], respectively. The median EAR-Q score was 64 (56.0-76.0). Patients whose primary indication was self-consciousness had, on average, a 13.8-point higher GBI/GCBI score than those with parent- or peer-driven indications (P=.04). Conclusions: In general, the Mustardé otoplasty was associated with an increase in patients' post-operative QoL and satisfaction with ear appearance. The greatest increases in QoL were seen when the indication for surgery was patient motivated (patient concern). These findings suggest that patient-driven motivation for surgery is associated with greater post-operative QoL improvements and may be an important consideration in surgical counselling and timing.
Radial nerve palsy may result from various pathologies, including trauma, nerve sheath tumor, neuritis, or compression neuropathy. In most instances, the underlying cause is apparent preoperatively and an appropriate operative plan can be formulated. Here, we present a case where the preoperative diagnosis was inaccurate and intraoperative decision-making required deviation from the planned procedure. The patient's history, physical examination, and imaging were consistent with a radial nerve tumor; however, surgical exploration revealed a compression neuropathy with pseudoneuroma formation. This case reinforces the importance of including compression neuropathy and pseudoneuroma in the differential diagnosis of a mass-associated motor nerve palsy, even at sites where nerve compression is relatively uncommon. Surgeons should be prepared to abort a planned biopsy and instead perform complete nerve decompression at the time of exploration when intraoperative findings are inconsistent with a neoplasm.
Background: Biodegradable Temporizing Matrix (BTM) is a synthetic dermal regeneration template composed of a polyurethane bilayer matrix. Although the use of BTM is well established in adult burn populations, its application for complex pediatric wounds is only beginning to emerge. This case series describes our institution's early experience with BTM for managing a variety of complex pediatric wounds. Method: A retrospective chart review was conducted at the Alberta Children's Hospital examining children with complex wounds treated with BTM. Data collected included etiology of the wound, rationale for BTM selection, size of wound, time to wound closure or coverage with split-thickness skin graft (STSG), complications and cosmetic/functional outcomes. Results: Eleven children (age range: 2 weeks to 15 years) had wounds treated with BTM between December 2023 and December 2024. The etiology of the wounds varied (eg, trauma, infection, pressure, and postsurgical). Several patients had wound with complicating factors including sepsis, immunosuppression, or exposed critical structures (eg, dura and joint capsule). There was 1 treatment failure in a patient with cognitive delay who removed the BTM 1 week after application. Following BTM application, 6 patients subsequently underwent application of STSG while the other 5 patients healed spontaneously by secondary intention. Wound colonization was the most common complication (5 patients); these were all successfully managed with oral antibiotics. Conclusion: BTM is a useful reconstructive option for managing challenging wounds in children and can be utilized in variety of ways. Specific indications for BTM and its relative position on the reconstructive ladder are still evolving. We outline 5 key learning points that may be considered when using BTM in a pediatric population.
Background Canada has a strong historical legacy in facial reanimation, yet few comprehensive programs exist nationally. Facial reanimation requires specialized expertise, multidisciplinary care, and resource-intensive interventions, which naturally centralize services in high-volume centers. Conversely, timely assessment and longitudinal follow-up are essential, creating challenges in a geographically vast country with provincially siloed healthcare systems. This study aimed to characterize the availability, structure, and perceived barriers to facial reanimation care across Canadian academic centers. Methods : A 15-item cross-sectional survey was distributed to department heads or delegates from Canadian university-affiliated plastic surgery (N = 15) and otolaryngology departments (N = 12). The survey assessed available services, multidisciplinary resources, outcome tracking, and perceived barriers. Responses were collected anonymously using REDCap and analyzed descriptively. Results : Fifteen of 27 departments responded (55.6%), representing six provinces. Core interventions including static suspension, periocular procedures, and nerve transfers were widely available. Cross-facial nerve grafting (80%), regional muscle transfer (67%), and free muscle transfer (73%) were less consistently offered. Only 53% of departments performed surgical procedures for non-flaccid facial paralysis. Outcome evaluation relied primarily on clinician-graded scales and subjective patient reports, with limited use of validated patient-reported outcome measures and standardized photo/video documentation. Half of centers reported a formal multidisciplinary team, with variable access to neuromuscular retraining therapists and psychologists. Common barriers included limited awareness among referring physicians, restricted operating room time, and insufficient allied health resources. Conclusion: Canadian centers provide broad access to foundational facial reanimation interventions, but gaps remain in advanced procedures, multidisciplinary support, and standardized outcomes tracking. Respondents unanimously supported expanding facial reanimation services.
Introduction:Large language models (LLMs) such as OpenAI's GPT-4o are increasingly used to summarize information and report trends in available data for medical education. For integrated plastic surgery, the utility of LLMs to recommend taking a research year has not been established. We aim to establish the reliability of ChatGPT reproducibility of research year recommendations for medical students applying to integrated plastic surgery. Methods:De-identified, self-reported integrated plastics applicant profiles in publicly available Google Sheets from 2022-2025 were assembled. Inputs provided to GPT-4o (three runs per profile) included Step 2 CK (Clinical Knowledge) score, AOA designation, and research productivity. Research-year status and match outcome were withheld. The model returned a binary recommendation to pursue a research year. Reproducibility was summarized as cross-run concordance. We compared model recommendations with applicants' actual research-year decisions. Results:Of 98 entries, 55 complete profiles were retained. Mean Step 2 CK was 258.3 (SD = 10.4). Applicants reported a mean 20.1 (SD = 19.9) research presentations, 3.84 (SD = 3.6) first-author publications, and 9.18 (SD = 6.4) total publications. Twenty-one eligible applicants (51.2%) reported AOA. Overall, 98.2% (54/55) matched. Across the three computed runs, there was a 98% concordance in recommendations. The LLM recommended a research year for 32.7% (18/55) of entries, whereas 45.5% (25/55) actually undertook one (p = 0.208). Agreement between model recommendations and applicant decisions was 41.8% (p = 0.28). Conclusion:ChatGPT demonstrated internal consistency, but its recommendations could not predict which students would take a research year en route to a successful residency match.
Thumb carpometacarpal (CMC) osteoarthritis is a common condition that can affect a patient's ability to function normally in daily life. Surgical CMC denervation of the thumb has emerged as a less invasive option for patients who want to recover and return to activity sooner. Here, we report the use of the Wide-Awake Local Anesthesia No Tourniquet technique for first CMC denervation under field sterility.
Introduction: Intraoperative hypothermia is a common yet underrecognized concern in plastic surgery, contributing to increased risks of surgical site infections, coagulopathy, and delayed recovery. This study characterizes intraoperative temperature dynamics and identifies procedure-specific risks to guide warming strategies. Methods: We performed a retrospective review of 1923 elective plastic and reconstructive surgeries under general anesthesia at a single academic institution. Preincision and postoperative core temperatures were recorded using nasopharyngeal or esophageal monitoring. Intraoperative temperature change was defined as the difference between these measurements. Multivariable linear and logistic regression models assessed associations between procedure type and both temperature change and postoperative hypothermia (<36.0 °C), adjusting for surgery duration, inpatient status, and preincision temperature. Results: The mean intraoperative temperature change across all procedures was +0.16 °C. However, substantial variation existed by procedure. Free flap breast reconstruction, facial procedures, oncoplastic breast reduction, and panniculectomy were associated with temperature increases, while hand surgery showed significant decreases (P = .002). Preincision hypothermia was present in 36.6% of cases and postoperative hypothermia in 32.3%. On multivariable analysis, body contouring (OR = 1.84, P = .005) and hand procedures (OR = 3.91, P = .004) were significantly associated with increased odds of postoperative hypothermia, while aesthetic breast revision trended toward significance (OR = 1.84, P = .055). Neither surgery duration nor inpatient status predicted postoperative hypothermia. Conclusions: Hypothermia remains highly prevalent in plastic surgery procedures performed under general anesthesia, particularly among patients undergoing hand and body contouring procedures. High rates of preincision hypothermia further underscore the need for improved perioperative warming protocols. Multimodal warming strategies should be implemented consistently to maintain normothermia and reduce the risk of hypothermia-related complications.
Vertical rectus abdominis myocutaneous (VRAM) flaps remain a reliable option for perineal reconstruction following abdominoperineal resection (APR). Despite their robust vascularity, postoperative factors can compromise flap perfusion. We present a two-case series of patients who developed flap congestion secondary to postoperative bladder distension after APR with VRAM reconstruction. In both cases, removal of the Foley catheter led to urinary retention, abdominal distension, and venous congestion of the flap. Imaging in one patient demonstrated direct pedicle compression by the distended bladder. Prompt reinsertion of the Foley catheter and decompression restored flap perfusion, with both patients ultimately achieving full healing. To our knowledge, bladder distension as a cause of VRAM flap compromise has not been previously reported. These cases highlight the importance of vigilant postoperative urinary monitoring and consideration of prolonged catheterization protocols to prevent reversible, avoidable flap congestion in perineal reconstructions using pedicled VRAM flaps.
Background: An increasing number of transgender and non-binary (TNB) individuals are presenting for gender-affirming surgery (GAS) in Canada. The purpose of this study is to understand demand and completion rates of GAS among transgender and non-binary (TNB) individuals. Methods: The Trans PULSE Canada cross-sectional survey recruited TNB individuals aged 14+ living in Canada in 2019. Using Trans PULSE Canada data, we analyzed desired and completed procedures according to surgery type and gender identity. Results: Among 2118 respondents who answered surgery questions, vaginoplasty (84% of trans women and 32% of non-binary people who were assigned male at birth) and mastectomy (98% of trans men and 63% of non-binary people who were assigned female at birth) were among the most desired procedures. There were low levels of completion across all types of surgery. The highest level of completion was 48% for mastectomy in trans men. Surgeries not consistently covered by provincial health insurance had completion levels between 0% and 5%. Those with non-binary identities had lower completion percentages across all surgery types. Conclusion: This study highlights significant demand for GAS among TNB individuals in Canada, with completion percentages varying based on gender identity and surgery type. The low completion percentages speak to persistent challenges despite provincial health insurance coverage for some surgeries. This emphasizes the need to address barriers to ensure equitable access to gender-affirming care. Further research is needed to understand how to mitigate these barriers effectively.
Introduction: Hand injuries can lead to lasting impairments that limit one's ability to perform activities of daily living. Many individuals who undergo surgery following a hand injury participate in post-operative rehabilitation. Evidence suggests that geographical and socioeconomic barriers may hinder rehabilitation progress and limit recovery after surgery. Telemedicine and augmented reality may be useful tools for addressing issues concerning accessibility and adherence in rehabilitation. This study validates the use of a novel movement sonification interface that uses Google's MediaPipe hand-tracking technology to map single-digit PIP joint motion to real-time auditory feedback. Methods: Nineteen healthy adults (mean age 32 years; 10 males, 9 females) with no prior exposure to movement sonification participated. Through webcam, participants interacted with a web-based program that mapped fourth digit PIP joint flexion and extension to musical pitch changes (low pitch for extension, high pitch for flexion). Construct, face, content, and predictive criterion validity were assessed through structured surveys after participants viewed and explored the program. Results: Construct validity was 89%, with participants correctly identifying the relationship between fourth digit PIP movement and pitch changes. Both face and content validity were 100%, with participants recognizing the sound-movement relationship and that only the fourth digit produced sound. Predictive criterion validity demonstrated high accuracy, with participants correctly matching hand configurations to sounds (95%) and predicting sounds from muted videos (95%). Conclusions: Results demonstrate excellent construct, face, content, and predictive criterion validity. This supports the feasibility of using music sonification as an intuitive and accessible tool for augmented hand rehabilitation.
INTRODUCTION:Surgical simulation has become an important component of surgical residency. Several animal and synthetic flexor tendon repair simulators have been described, with variable degrees of fidelity. The purpose of this study was to determine the effectiveness of a silicone flexor tendon repair model in comparison to a porcine tendon repair model. Methods: A silicone flexor tendon model was created using polypropylene fibres bound in cured silicone to simulate epitenon with the use of a 3D printed mold. Deep flexor tendons were harvested from porcine forelimbs for comparison. Participants tested the models by completing core and epitendinous tendon repairs. Models were evaluated with 5-point Likert Scale questions and a comment section. Results: Nine plastic surgery residents and three plastic surgeons participated in the study. Simulation realism was 3.9/5 for the silicone model and 4.6/5 for the porcine model (p = 0.001). Educational utility was 4.6/5 for the silicone model and 4.6/5 for the porcine model (p = 0.546). Overall, the silicone model scored 4.3/5 and the porcine model 4.6/5 (p = 0.078). Conclusion: We created a moderate-fidelity tendon repair model that is convenient to use, easily reproducible, and of equal educational utility to a porcine model based on our study results. This model has significant potential for simulation learning in postgraduate surgical education. Further validation is required to confirm its efficacy in postgraduate surgical education and skill transfer to the operating room.
Introduction: Frostbite in children is uncommon; however, when severe, it can be associated with amputation of digits. Frostbite protocols have been established for adults but not for children. This project outlines our experience with the use of a newly developed iloprost-driven protocol for managing frostbite in children. Methods: Motivated by a severe case of frostbite in a teenager, resulting in amputations of multiple digits, the adult Yukon Frostbite Protocol was modified for use in children. Key elements of the new Frostbite Management in Children Protocol include rewarming, iloprost infusion, alteplase administration, and hyperbaric oxygen therapy, if required. Frostbite severity is categorized according to the Cauchy grading system which in turn dictates specific treatment. A review of 3 subsequent cases treated using the protocol was performed. Outcomes recorded included digital amputation rate, motor/sensory recovery, and adverse effects of treatment. Results: In December 2022 to March 2024, 3 patients met the criteria for treatment with iloprost under the new protocol: a 9-year-old female with grade 3 frostbite; a 15-year-old male with grade 2 frostbite; and a 16-year-old male with grade 2 frostbite. There were no amputations. All 3 patients recovered motor and sensory function, though one patient experienced significant hypersensitivity. There were no adverse effects from the treatment protocol, and it was well accepted by nursing and medical staff. Conclusion: An iloprost-based protocol has been developed for children with frostbite. The protocol was accepted by hospital staff and well tolerated by the patients.
Introduction: It is often challenging to achieve recommended excision margins in head and neck cutaneous melanoma (HNCM). This study assessed the impact of reduced radial excision margins on disease-specific survival (DSS), disease-free survival (DFS), and local recurrence-free survival (LRFS) in these patients. Given ongoing uncertainty regarding optimal margin width for melanomas ≥1 mm, a secondary contemporary margin-based analysis was performed. Methods: This population-based study included patients diagnosed with HNCM in Manitoba, Canada, between 1970 and 2020. Radial excision margins were classified as "recommended" or "reduced" according to National Comprehensive Cancer Network guidelines. A secondary analysis compared outcomes between narrower (∼1 cm) and wider (∼2 cm) excision margins in patients with Breslow thickness ≥1.0 mm. Survival outcomes were evaluated using Kaplan-Meier analysis and multivariable Cox proportional hazards models. Results: A total of 716 patients met inclusion criteria; 177 had recommended margins and 539 had reduced margins. Patients in the reduced-margin group had thicker tumors (2.36 vs 1.72 mm, p = .007) and fewer Stage I melanomas (58.6% vs 78%, p < .001). Local recurrence occurred in 4.3% of reduced-margin and 6.2% of recommended-margin patients. Kaplan-Meier analysis showed no differences in DSS, DFS, or LRFS. On multivariable analysis, margin status was not an independent predictor of survival, whereas advanced stage and scalp location were associated with worse outcomes. In the secondary margin-based analysis, margin width was not independently associated with DSS, DFS, or LRFS. Conclusion: Reduced radial excision margins were not associated with inferior oncologic outcomes in HNCM. These findings support the oncologic safety of selective margin reduction in appropriately selected patients.
Introduction: Carpal tunnel release (CTR) is one of the most common performed hand surgery procedures, yet the estimated yearly cost of carpal tunnel syndrome in the United States is $2 billion, resulting in significant costs to both healthcare systems and patients. Recently, there has been a trend to move minor hand surgery cases from the hospital operating room (OR) to a clinic-based procedure room (PR). This study aimed to examine CTR costs within our institution performed in the PR compared to the OR. Methods: All CTR surgeries performed by three fellowship-trained orthopedic hand surgeons in the OR and PR at a rural health system from 2019-2020 were reviewed. The operative times, number of personnel and supplies required in each clinical location were examined to calculate costs. CTR cost and insurance revenue models were created, and total costs, revenue, and net revenue were compared. Results: A total of 1416 CTRs were performed during the study period, with 855 in the OR and 561 in the PR. The average total cost for CTR in the OR was $2196.10 compared to $549.07 in the PR. The average net revenue of CTR was significantly greater when done in the OR versus PR at $1011.06 and $85.87, respectively. The average reimbursement rate was greater in the OR at 55% compared to 30% for CTRs done in the PR. Conclusion: Overall, the average total cost and net revenue for OR CTR were significantly higher than PR CTR, secondary to higher reimbursement rates in the hospital setting.
