Mentorship is a cornerstone of surgical education, fostering professional growth, research productivity, and career guidance. In plastic surgery, mentorship profoundly impacts career choices and professional development, yet structured one-on-one programs are notably limited. Challenges such as time constraints, mismatched expectations, and disparities in representation often hinder traditional mentorship models. To address these issues, we developed a computational algorithm to facilitate team-based mentorship in plastic surgery. This algorithm utilizes a weighted Jaccard similarity index and recursive stability optimization to optimize compatibility among participants by aligning career goals, clinical interests, and mentorship priorities. A survey of 171 Professional Resource Opportunities in Plastic and Reconstructive Surgery Education and Leadership (PROPEL) members informed the pilot matching process, resulting in 36 teams with a median pooled similarity score of 0.823. Our approach offers distinct advantages, including equitable opportunity, scalability, and reduced administrative burden. Future efforts should focus on integrating qualitative feedback, evaluating long-term outcomes, and exploring advanced technologies such as natural language processing to refine the model further.

BACKGROUND:Financial toxicity (FT) is the economic burden of medical care that negatively affects patients' well-being and quality of life. FT disproportionately impacts surgical patients. Although prior studies have quantified FT, few have explored patient-identified interventions to mitigate it. This study explores solutions to FT through qualitative interviews with surgical patients. METHODS:A multicenter prospective study was conducted to characterize FT in adult surgical trauma patients across three tertiary care centers in India. A total of 854 patients were surveyed. Semi-structured interviews were conducted amongst a randomized subset of these patients within 1 year of surgery. Interviews were recorded, transcribed, translated, and coded. Recurring themes were identified using a qualitative thematic analysis with a deductive approach. RESULTS:A total of 39 patients were interviewed, with a median age of 37.7 years (SD 14.6). Almost all reported needing to borrow money or sell assets to cope with FT resulting from surgical care, leading to long-term social distress. Themes for patient-proposed solutions emerged: (1) addressing insurance deficits, (2) providing direct non-medical cost support, (3) increasing social support schemes, and (4) infrastructure for acute financial assistance. CONCLUSIONS:Surgical trauma patients in India face substantial postoperative FT, necessitating contextualized solutions. Increasing awareness and use of existing government schemes is crucial. Patients facing FT should be identified upon admission and educated about financial options. Comprehensive support strategies such as governmental resources, monetary support systems, and social services are essential. Implementing patient-reported solutions to mitigate FT is vital to improving patient outcomes after surgery.

Introduction As family dynamics evolve, an increasing number of male residents are embracing parenthood during their training. Consequently, paternity leave has emerged as a crucial consideration. The aim of this study was to determine the gap in public availability of paternity leave policies in surgical residency programs across the United States. Methods We evaluated publicly available information regarding paternity leave policies across both program-specific and Graduate Medical Education (GME) websites of 1242 surgical residency programs across eight surgical specialties. This information was further evaluated in relation to program size, program director gender, specialty type, and geographic location using logistic regression models. Results Paternity leave policies were found on only 4.3% of program-specific websites and 18.8% of GME websites. Neurosurgery had the greatest number of programs that publicly advertised their policies—11.7% on program-specific websites and 82.5% on GME websites. Vascular surgery and ear, nose, and throat surgery had no policies available on program-specific websites, and general surgery had the least paternity leave policies publicly available as per the GME websites (7.9%). Programs in the northeast were significantly less likely to have paternal leave policies publicly available (odds ratio: 0.55; 95% confidence interval: 0.31-0.96; P = 0.034), whereas programs in the west were significantly more likely (odds ratio: 2.1; 95% confidence interval: 1.2-3.67; P = 0.009) compared to the midwest. Conclusions This study highlights the pressing need for standardization and transparency across all surgical specialties regarding paternity leave policies. Addressing this gap is crucial for empowering applicants in family planning decisions and fostering a culture supportive of parental leave uptake.

Importance:Food insecurity, defined as uncertain access to enough food for a healthy life, is a growing issue in the US. While its link to chronic conditions is well documented, little is known regarding its impact on surgical patients. Objective:To assess food insecurity, identify associated characteristics, and measure the rate of Supplemental Nutrition Assistance Program (SNAP) enrollment among surgical patients using a nationally representative sample. Design, Setting, and Participants:This was a cross-sectional study using National Health Interview Survey (NHIS) data from 2011 through 2018. These data were analyzed from February 2024 through April 2025. Multivariable logistic regression models were used to analyze the association between surgery, food insecurity, and enrollment in SNAP. Data for this study came from the NHIS, a nationally representative survey used for health information, health access, and health behaviors of the civilian, noninstitutionalized US population, enabling broad applicability to surgical patients. The study included 254 283 individuals with data on surgery within the past year and 30-day food insecurity. Surgical and nonsurgical cohorts were created based on answers to, "During the past 12 months, have you had surgery or other surgical procedures as an inpatient or outpatient?" Exposures:The main exposure included undergoing surgery in the past year. Other exposures were age, race, sex, employment status, household income, marital status, number of family members in the household, geographic region, health status, and insurance status. Main Outcomes and Measures:The proportion of food insecurity among the surgical cohort was the main outcome. Secondary outcomes included factors linked to food insecurity and SNAP enrollment, especially for those with incomes below 200% of the federal poverty level. Results:Surgical patients (13 180 male [40.2%] and 19 643 female [59.8%]) reported higher food insecurity prevalence (11.6%) than nonsurgical patients (100 924 male [45.6%] and 120 536 female [54.4%]) (10.5%). Adjusted analyses indicated significantly higher odds of food insecurity among surgical patients (odds ratio, 1.12; 95% CI, 1.07-1.18; P < .001). Food insecurity was strongly linked to lower income and poor health. SNAP enrollment was 16% overall and 40% among surgical patients with incomes less than 200% federal poverty level, associated with younger, low-income, unemployed, less educated, or publicly insured patients. Conclusions and Relevance:Food insecurity is a significant burden among surgical patients. Interventions, including food insecurity screening, may improve food access and health outcomes in this cohort.

BACKGROUND:Bone fractures in low- and middle-income countries are commonly managed by traditional bonesetters (TBSs). Past studies emphasize the potential for improved fracture care through intersectoral cooperation. This review gauged support among stakeholders for intersectoral collaboration and the results of previous initiatives. METHODS:Five medical databases were reviewed. Studies focusing on stakeholder perspectives and articles detailing collaborative initiatives were included. Data extraction and synthesis were carried out using the Cochrane Consumers and Communication Review Group's template. Additionally, all studies underwent quality assessment. RESULTS:Of the 3821 identified articles, 16 were included after full-text screening. Twelve articles presented stakeholder perspectives, whereas four discussed collaborative initiatives. The overall article quality was low: articles on stakeholder perspectives scored on average 1.42 out of 4 points, whereas articles on collaborative initiatives scored a mean 1.25 points. In total, 62% of stakeholders (75% of TBSs, 92% of hospital staff, and 52% of patients) expressed support for intersectoral collaboration. The ratio between stakeholders expressing support versus those opposing was 4.4:1. No articles presented data on governmental perspectives. The most mentioned collaborative forms were TBS training (24% of stakeholders) and an integrative model (16% of stakeholders). Interventional studies all consisted of TBS training, reporting improved clinical outcomes and increased practice integration. CONCLUSION:Despite the limited and low-quality evidence on collaboration initiatives and perspectives, most stakeholders seem supportive of intersectoral collaboration, with training and integration being commonly suggested. Future research efforts exploring the feasibility of embedding TBSs into current primary care systems should ensure the involvement of local and national government.

BACKGROUND:Limited research exists on the burden of extremity fractures in Sub-Saharan Africa. Underreporting is likely, as patients often seek out traditional bonesetters (TBSs). This study aims to determine the annual incidence and impact of extremity fractures, alongside health-seeking behavior of patients in rural Tanzania. METHODS:We conducted a cross-sectional household survey in Rorya district, Tanzania, enrolling 497 households with 2667 members, using spatial random sampling. We surveyed household heads regarding access to fracture care and fracture occurrence among household members. We then randomly selected up to three members per household to survey, using the 1448 responses to calculate extremity fracture incidence. Any (self-)reported fractures were questioned on healthcare-seeking behavior and assessed through radiological evaluation. Confirmed cases completed a survey on disability and financial impact. RESULTS:We radiologically confirmed 11 extremity fractures among 1448 randomly selected respondents, yielding an annual incidence of 0.76%. Five additional fractures were identified among nonrandomized individuals totaling 16 confirmed cases. TBS attendance among patients suspecting fracture was significantly higher than hospital attendance (95% vs. 32%, p < 0.0005). Primary reasons for choosing TBSs were lower cost (62%) and perceived faster healing (29%). Sixty-two percent of patients reported reduced work capacity or requiring help with transport and 50% experienced a decrease in income. CONCLUSIONS:The annual incidence of extremity fractures in this study was 0.76%. TBSs were largely preferred over hospitals due to lower cost and perceived faster healing. Over half of patients experienced reduced ability to work and income loss. Improved communication between TBSs and hospitals, along with better access to hospital care, could reduce complications.

Importance:Food insecurity, which is the lack of consistent access to sufficient and nutritious food, impacts over 1.3 billion individuals worldwide. The impact of food insecurity on primary care and medical subspecialties is recognized, but its influence on surgical outcomes remains underexplored. Objective:To investigate the association between food insecurity and postoperative clinical outcomes in adult surgical trauma patients. Design, Setting, and Participants:This prospective longitudinal cohort study was conducted from October 2021 to June 2023 and surveyed patients at admission and at 1 and 3 months postoperatively. This multicenter study was conducted across 3 public and private tertiary care centers in India. Adult patients who underwent inpatient operative intervention for traumatic injury were included through consecutive sampling. Exposures:Food insecurity, which was identified using the validated Hunger Vital Sign tool. This was determined at admission as preoperative food insecurity. Also assessed was a subset of participants who were food secure at admission but then became food insecure during the follow-up period. Main Outcomes and Measures:Postoperative complications and length of stay. These outcomes were tracked during hospitalization and also at 1 month and 3 months after discharge to compare between time points. Results:A total of 848 patients (median [IQR] age, 32 [24-45] years; 692 male [82%]) were included in this analysis. Of the total cohort, 174 participants (21%) reported experiencing food insecurity in the year before admission. Patients with food insecurity had significantly higher rates of postoperative complications compared with those without food insecurity (41.4% [72 of 174] vs 12.5% [84 of 671]; odds ratio [OR], 3.68; 95% CI, 2.24-6.05). Additionally, patients with food insecurity had a longer median (IQR) length of stay (13 [6-28] days vs 5 [3-9] days; incidence rate ratio, 1.51; 95% CI, 1.31-1.74). Furthermore, new-onset food insecurity at 1 month postoperatively was associated with an increased risk of new complications at 3 months postoperatively (OR, 5.06; 95% CI, 2.21-11.13). Conclusions and Relevance:Results demonstrate that food insecurity was significantly associated with increased postoperative complications and longer hospital stays in surgical trauma patients. Routine screening for food insecurity and targeted interventions like medically tailored meals, food prescription programs, and philanthropic food resources may mitigate the detrimental impact of food insecurity on surgical outcomes.

INTRODUCTION:Food insecurity, defined as a lack of access to adequate nutrition, impacts approximately 30% of the global population. Despite clear evidence regarding the benefit of proper nutrition on clinical outcomes, the burden of incident food insecurity after surgical intervention in previously food secure patients is unknown. The goal of the study was to quantify incident food insecurity post operatively and to identify associated risk factors. METHODS:A multicenter, prospective, longitudinal study was conducted among adult surgical trauma patients at tertiary care public and private hospitals in India. The primary outcome was new food insecurity from initial admission for traumatic injury to 6 mo post operatively. Cox proportional hazards models were used to evaluate associations between clinical and sociodemographic variables and incident food insecurity. RESULTS:Of 774 patients enrolled, 20% were food insecure at baseline. During the follow-up period, 21% of patients who were food secure at baseline experienced new food insecurity. Incident food insecurity was associated with longer length of stay (hazard ratio (HR): 3.76, 95% confidence interval (CI): 1.62-8.74; P = 0.002), intensive care unit admission (HR: 1.87, 95% CI: 1.05-3.31; P = 0.032), receiving welfare support (HR: 2.00, 95% CI: 1.00-3.98; P = 0.049) and daily wage, rather than salaried, employment (HR: 2.95, 95% CI: 1.24-7.06; P = 0.015). Higher total household income was associated with maintaining food security (HR: 0.24, 95% CI: 0.13-0.44; P < 0.001). Hospitalization-related financial toxicity was significantly associated with incident food insecurity (HR: 3.07, 95% CI: 2.09-4.50; P < 0.001). CONCLUSIONS:High levels of incident food insecurity were observed among surgical trauma patients. This highlights the need for serial food insecurity assessment post discharge. In lieu of serial follow-up, risk factors associated with incident food insecurity can be used to identify high-risk patients prior to discharge to facilitate connection to food insecurity interventions such as food prescription programs, monetary support, and nutritional welfare policies.

Background: Standardized estimates of global economic losses from burn injuries are lacking. The primary objective of this study was to determine the global macroeconomic consequences of burn injuries and their geographic distribution. Methods: Using the Institute of Health Metrics and Evaluation database (2009 and 2019), mean and 95% uncertainty interval (UI) data on incidence, mortality, and disability-adjusted life-years (DALYs) from injuries caused by fire, heat, and hot substances were collected. Gross domestic product (GDP) data were analyzed together with DALYs to estimate macroeconomic losses globally using a value of lost welfare approach. Results: There were 9 million global burn cases (95% UI, 6.8 to 11.2 million) and 111,000 deaths from burns (95% UI, 88,000 to 132,000 deaths) in 2019, representing a total of 7.5 million DALYs (95% UI, 5.8 to 9.5 million DALYs). This represented welfare losses of $112 billion (95% UI, $78 to $161 billion), or 0.09% of GDP (95% UI, 0.06% to 0.13%). Welfare losses as a share of GDP were highest in low- and middle-income countries (LMICs) of Oceania (0.24%; 95% UI, 0.09% to 0.42%) and Eastern Europe (0.24%; 95% UI, 0.19% to 0.30%) compared with high-income country regions such as Western Europe (0.06%; 95% UI, 0.04% to 0.09%). Mortality–incidence ratios were highest in LMIC regions, highlighting a lack of treatment access, with southern sub-Saharan Africa reporting a mortality–incidence ratio of 40.1 per 1000 people compared with 1.9 for Australasia. Conclusions: Burden of disease and resulting economic losses because of burn injuries are substantial worldwide and are disproportionately higher in LMICs. Possible effective solutions include targeted education, advocacy, and legislation to decrease incidence and investing in existing burn centers to improve treatment access.

Background: Out-of-pocket costs are burdensome for breast cancer patients. Cost-reducing interventions, though implemented, have unclear comparative efficacy. This study aimed to critically evaluate characteristics of successful versus unsuccessful interventions designed to decrease out-of-pocket costs for breast cancer patients. Methods: A systematic review was conducted in accordance with the PRISMA checklist. Embase, PubMed, Global Index Medicus, and Global Health were queried from inception to February 2021. Articles describing a financial intervention targeting costs for breast cancer screening, diagnosis, or treatment and addressing clinical or patient-level financial outcomes were included. Methodological quality was evaluated using the QualSyst tool. Interventions were organized in accordance with timing of implementation, with narrative description of intervention type, success, and outcomes. Results: Of the 11,086 articles retrieved, 21 were included in this review. Of these, 14 consisted of interventions during screening, and seven during diagnosis or treatment. Free/subsidized screening mammography was the most common screening intervention; 91% of these programs documented successful outcomes. Patient navigation and gift voucher programs demonstrated mixed success. The most successful intervention implemented during diagnosis/treatment was reducing medication costs. Low-cost programs and direct patient financial assistance were also successful. Limitations included lack of standardization in outcome metrics across studies. Conclusions: Financial interventions reducing prices through free screening mammography and decreasing medication costs were most successful. Less successful interventions were not contextually tailored, including gift card incentivization and low-cost treatment modalities. These findings can facilitate implementation of broader, more generalizable programs to reduce costs and improve outcomes during evaluation and management of breast cancer.

Background: Despite the high prevalence and morbidities associated with interpersonal violence (IPV), its estimated costs vary widely, with studies primarily focusing on data from high-income countries. This study aims to determine the incidence and mortality rates attributable to IPV and quantify the global macroeconomic cost of IPV.Methods: The Global Burden of Disease data on IPV reported by the Institute of Health Metrics and Evaluation was collected for the years 2009 and 2019 for 173 countries, categorized into 21 regions. Incidence and mortality rates were determined. Macroeconomic cost as defined by value of lost welfare was calculated with disability-adjusted-life years lost to IPV, value of statistical life lost, and country-specific gross domestic product (GDP) adjusted for income elasticity.Findings: The global welfare loss of IPV comprised 0·11% of GDP in 2019, at an absolute value of 131 billion USD, 2017 with purchasing power parity (PPP) adjustment. Although the global incidence, mortality, and disability rates of IPV decreased between 2009 and 2019, the absolute incidence increased. The mortality-to-incidence ratios were higher in low/middle-income regions than in high-income regions, with the highest regional ratios being 61·41 and 7·04, respectively. Welfare loss as a percentage of GDP was higher in low/middle-income regions than in high-income regions.Interpretation: Low/middle-income regions face a disproportionate burden of IPV with substantial global welfare loss. Global health efforts should prioritize and identify effective strategies to address both the prevention and the management of medical consequences of IPV.Funding: None.Declaration of Interest: No competing interests.Ethical Approval: A retrospective study was conducted using publicly available data categorized on a country level to quantify the global macroeconomic consequences of IPV in the years 2009 and 2019. Since de-identified, publicly available data was used, the study was exempt from ethical review by our Institutional Review Board.

Background: Financial toxicity is the detrimental impact of health care costs that must be mitigated to achieve universal health coverage. Catastrophic health expenditure (CHE) is widely used to measure financial toxicity but does not capture patient perspectives of unaffordable health care costs. Financial hardship (FH), a patient-reported outcome measure, is currently underutilized but may be an important adjunct metric. The authors compare CHE to FH as metrics evaluating financial toxicity. Methods: A prospective, multicenter cohort study was conducted across 3 public and private tertiary-care hospitals in India. Adult surgical trauma inpatients in plastic and orthopedic surgery departments were assessed. The development of CHE, health expenditures >10% of annual income, and FH, the patient-reported impact of financial toxicity in the form of asset liquidation, debt acquisition, and job loss, were compared by the health system and using logistic regression models. Results: Among 744 surgical trauma patients, low income, longer hospital stays, and increased injury severity were significantly associated with the likelihood of incurring CHE and FH (P<0.05). Only FH was significantly associated with lack of insurance (OR: 0.22; 95% CI: 1.14-2.71). Public hospitals had higher rates of FH than CHE (55% versus 23%). Private hospitals had more CHE than FH (53% versus 32%). Conclusions: FH is an important metric of financial toxicity that provides important adjunct information to CHE for at-risk populations. FH is particularly informative for public institutions with low direct medical costs. Nuanced utilization of CHE and FH provides a more comprehensive, patient-oriented approach to evaluating unaffordable health care costs that can help shape financial risk protection policy.

In 1789, Margaret Ann Bulkley, often regarded as the first female surgeon in the United Kingdom, had to disguise herself as a man to practice surgery [1]. Presently, women make up 49% of U.S. surgeons [2], yet global disparities persist, with only 22% and 12.5% female representation among surgeons in Brazil and India respectively [3, 4]. While women no longer need to hide their identities, fostering gender parity in a field entrenched in male achievements remains a universal challenge. Nevertheless, a growing force of women surgeons have successfully defied gender stereotypes and made groundbreaking contributions worldwide. Women surgeons contribute objective benefits to gender parity. In healthcare, women physicians exhibit higher adherence to clinical guidelines, offer more preventive care, and employ patient-centered communication, leading to improved outcomes and greater patient satisfaction [5]. Organizations with top-quartile gender diversity also showcase better decision-making, effective crisis management, and above-average profits [6]. The global surgery community advocates for safe and affordable surgical care through reform in health policies. The community's voice can also play a crucial role in addressing and overcoming the challenges hindering gender parity in global surgery. In this piece, we propose concrete solutions to common challenges faced by women surgeons engaging in global surgery work worldwide. While we strongly support equitable parental leave policies, equal pay, and objective promotion criteria, we focus on additional, less-discussed solutions critical for lasting change. These solutions not only empower women surgeons but also promote success across healthcare institutions and organizations internationally.

OBJECTIVE:This study evaluated how surgical and anesthesiology departments adapted their resources in response to the coronavirus disease 2019 (COVID-19) pandemic. DESIGN:This scoping review used the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews protocol, with Covidence as a screening tool. An initial search of PubMed, Embase, Web of Science, Global Index Medicus, and Cochrane Systematic Reviews returned 6,131 results in October 2021. After exclusion of duplicates and abstract screening, 415 articles were included. After full-text screening, 108 articles remained. RESULTS:Most commonly, studies were retrospective in nature (47.22 percent), with data from a single institution (60.19 percent). Nearly all studies occurred in high-income countries (HICs), 78.70 percent, with no articles from low-income countries. The reported responses to the COVID-19 pandemic involving surgical departments were grouped into seven categories, with multiple responses reported in some articles for a total of 192 responses. The most frequently reported responses were changes to surgical department staffing (29.17 percent) and task-shifting or task-sharing of personnel (25.52 percent). CONCLUSION:Our review reflects the mechanisms by which hospital surgical systems responded to the initial stress of the COVID-19 pandemic and reinforced the many changes to hospital policy that occurred in the pandemic. Healthcare systems with robust surgical systems were better able to cope with the initial stress of the COVID-19 pandemic. The well-resourced health systems of HICs reported rapid and dynamic changes by providers to assist in and ultimately improve the care of patients during the pandemic. Surgical system strengthening will allow health systems to be more resilient and prepared for the next disaster.

This Viewpoint discusses strategies to mitigate food insecurity in patients undergoing surgery.

Background Burns constitute a major global health challenge, causing over 11 million injuries and 300,000 deaths annually and surpassing the economic burden of cervical cancer and HIV combined. Despite this, patient-level financial consequences of burn injuries remain poorly quantified, with a significant gap in data from low- and middle-income countries. In this study, we evaluate financial toxicity in burn patients. Methods A prospective, multicenter cohort study was conducted across two tertiary care hospitals in India, assessing 123 adult surgical in-patients undergoing operative interventions for burn injuries. Patient sociodemographic, clinical, and financial data were collected through surveys and electronic records during hospitalization and at 1, 3, and 6 months postoperatively. Out-of-pocket costs (OOPCs) for surgical burn treatment were evaluated during hospitalization. Longitudinal changes in income, employment status, and affordability of basic subsistence needs were assessed at the 1-, 3-, and 6-month postoperative time point. Degree of financial toxicity was calculated using a combination of the metrics catastrophic health expenditure and financial hardship. Development of financial toxicity was compared by sociodemographic and clinical characteristics using logistic regression models. Results Of the cohort, 60% experienced financial toxicity. Median OOPCs was US$555.32 with the majority of OOPCs stemming from direct nonmedical costs (US$318.45). Cost of initial hospitalization exceeded monthly annual income by 80%. Following surgical burn care, income decreased by US$318.18 within 6 months, accompanied by a 53% increase in unemployment rates. At least 40% of the cohort consistently reported inability to afford basic subsistence needs within the 6-month perioperative period. Significant predictors of developing financial toxicity included male gender (odds ratio, 4.17; 95% confidence interval, 1.25–14.29; P = 0.02) and hospital stays exceeding 20 days (odds ratio, 11.17; 95% confidence interval, 2.11–59.22; P ≤ 0.01). Conclusions Surgical treatment for burn injuries is associated with substantial financial toxicity. National and local policies must expand their scope beyond direct medical costs to address direct nonmedical and indirect costs. These include burn care insurance, teleconsultation follow-ups, hospital-affiliated subsidized lodging, and resources for occupational support and rehabilitation. These measures are crucial to alleviate the financial burden of burn care, particularly during the perioperative period.