Dhupati, Pooja

Background: Nerve transfers have been heralded as a “quantum leap” in peripheral nerve surgery, fundamentally altering the reconstructive paradigm over the past 2 decades. This study analyzed national trends in adult traumatic brachial plexus injury (BPI) management, tracking specialty-specific adoption of nerve transfers and comparing 30-day postoperative outcomes with traditional reconstruction. Methods: Data were extracted from the National Surgical Quality Improvement Program (2006 to 2022). Adult patients (18 years or older) with a primary BPI diagnosis, who underwent nerve reconstruction, were included. Cases were categorized by the presence of a nerve transfer using CPT code 64905. Analyses included descriptive statistics, standardized mean differences, and multivariable logistic regression. Results: Among 544 BPI patients, 80 underwent reconstruction involving a nerve transfer. Plastic surgeons performed 60% of nerve transfers despite accounting for only 33.5% of all BPI reconstructions. Neurosurgeons had the lowest overall nerve transfer utilization but increased to a rate matching orthopedic surgeons in the final 4 years. Nerve transfers were associated with lower 30-day complication rates than traditional reconstruction (2.5% vs. 11%, P =0.034), despite being performed on patients with higher preoperative morbidity risk. In multivariable analysis, orthopedic and neurosurgeons remained significantly less likely than plastic surgeons to perform nerve transfers (OR: 0.26, P <0.001; OR: 0.18, P <0.001, respectively). Conclusion: Nerve transfer use in BPI reconstruction has increased steadily, with a recent increase among neurosurgeons. Despite being used in higher-risk patients, nerve transfers were associated with significantly lower short-term complication rates. These findings support continued adoption of nerve transfers and highlight their favorable safety profile.

Background: Gender-based reimbursement disparities in orthopedic surgery remain poorly understood, particularly when accounting for practice composition and setting. The purpose of this study was to compare and evaluate gender-based differences in Medicare reimbursement and practice patterns among female and male orthopedic surgeons. Methods: A cross sectional analysis of public Medicare data from 2013 to 2021 was performed. Outcomes included annual Medicare payments, submitted charges, total services, service categories, and beneficiaries treated by orthopedic surgeons who bill Medicare. Univariate and multivariable analyses quantified differences in payment, practice volume and composition, geographic adjustment, and Current Procedural Terminology (CPT)-matched reimbursements. Results: A total of 29,357 orthopedic surgeons (27,442 men and 1,919 women) billed Medicare fee-for-service during the study period. Female surgeons, on average, submitted 48.3% fewer total charges and received 44.1% lower annual Medicare payments per surgeon compared with male surgeons. These differences persisted after multivariable regression adjusted for practice metrics and excluded top and bottom earners. Female surgeons also billed fewer services, treated fewer beneficiaries, and submitted fewer unique CPT codes. However, payment disparities persisted even after matching surgeons by volume of services, beneficiaries, and years in practice. Male surgeons performed higher volumes of all 10 highest-paying orthopedic CPT codes. In CPT matched analyses, female surgeons received lower reimbursement per service than male surgeons performing identical procedures. Conclusion: These findings suggest that the observed gender-based disparities in orthopedic surgery Medicare reimbursement cannot be explained by differences in volume, procedural mix, or geographic practice cost. Instead, they likely reflect a combination of structural and behavioral mechanisms described in prior literature that may influence how access to clinical opportunities, referrals, and reimbursement practices unfold in surgical practices. Variations in coding practices may represent an important focus for future investigation and targeted educational initiatives. Level of Evidence: Level III , Retrospective Cohort Study. See Instructions for Authors for a complete description of levels of evidence.

Background In 2019, the “Facts on Hand” direct-to-consumer advertising (DTCA) campaign, featuring former NFL quarterback John Elway, was launched to raise awareness of Dupuytren's contracture (DC) and its nonsurgical treatment options. Although DTCA has been shown to influence health care behavior in other specialties, its impact on treatment patterns for hand conditions remains unclear. Methods Google Trends was used to examine the influence of direct-to-consumer advertising (DTCA) on Internet-based information-seeking behavior related to DC. Changes in the proportion of surgical and nonsurgical management of DC were evaluated using 2016–2021 Medicare provider billing claims. Results Search interest in DC peaked during the campaign period, with breakout-level increases (>5000%) for terms such as “John Elway,” “needle aponeurotomy,” and “hand surgeon near me.” Medicare data revealed regionally significant increases in CCH utilization, particularly in the Midwest (+10%) and Northeast (+5%), with corresponding declines in fasciectomy. Regional overlap between increased search activity and shifts in treatment patterns suggests a geographically reinforced campaign effect. Conclusion The “Facts on Hand” campaign was associated with increased public interest in DC and coincided with regionally specific shifts in treatment utilization. Although the campaign emphasized a nonsurgical option, breakout searches for terms such as “hand surgeon near me” and “Dupuytren's surgery” suggest that treatment-specific advertising may have encouraged broader engagement with treatment overall. These findings highlight the potential for DTCA to not only raise awareness of the condition itself but also prompt patients to seek specialist care.

Abstract Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used for weight management and cardiometabolic health. Common peroneal neuropathy (CPN) associated with rapid weight loss is attributed to adipose tissue reduction and subsequent nerve compression at the fibular head. Cases of “Slimmer’s Palsy” have been described in conditions involving rapid weight loss, including anorexia, malignancy, and post-biliary surgery, yet it remains underrecognized as a potential complication of GLP-1RA therapy. This case report describes two nondiabetic patients who developed acute foot drop after losing 14% and 18% of their total body weight over 3–6 months of semaglutide and tirzepatide use, respectively. As use of GLP-1RAs continues to rise, peripheral nerve surgeons should be aware of Slimmer's Palsy as a predictable and treatable complication of rapid weight loss and be prepared to intervene before permanent denervation occurs.

Background: Documentation burden is a major contributor to surgeon burnout, particularly in high-volume outpatient specialties such as hand surgery. These encounters often involve multiple concurrent diagnoses, procedural planning, and longitudinal care. Ambient artificial intelligence (AI) tools, which passively transcribe and summarize clinical encounters in real time, have the potential to streamline note generation and reduce cognitive load. Methods: Following institutional rollout of a commercially available ambient AI tool in early 2025, the system was adopted across all outpatient visits in a hand surgery clinic. Observations were collected regarding workflow adaptation, documentation quality, and perceived cognitive impact. To assess note characteristics, 14 carpal tunnel syndrome visit notes (7 AI-generated and 7 surgeon-written) were compared by word count, Flesch-Kincaid readability score, and inclusion of social and medical history. Results: AI-generated histories were longer and exhibited greater linguistic complexity compared with surgeon-written notes. Surgeon-written assessments were longer, more readable, and more consistent in structure and tone. Social history was documented more frequently in AI-generated notes. All AI-generated assessment and plan sections followed a structured, problem-based format. Conclusions: Ambient AI documentation can support the creation of more structured and contextually rich clinical notes in hand surgery settings. However, successful integration requires active clinician engagement and workflow alignment to balance efficiency with clinical accuracy. These findings highlight both the promise and the practical considerations of incorporating ambient AI into surgical documentation workflows.

Glucagon-like peptide-1 (GLP-1) receptor agonists are medications used to treat type 2 diabetes and may aid in weight loss efforts. The surgical management of patients taking GLP-1 agonists differs from others due to the slowed gastric emptying effects of GLP-1 medications. Patients taking these medications may have a higher risk of pulmonary aspiration during hand surgery than other patients, which affects their presurgical management. This article reviews GLP-1 agonists and their role in diabetes and weight loss, as well as current recommendations for surgical management of patients taking GLP-1 agonists.