Anup Patel

Yale-New Haven Hospital, New Haven, Connecticut, United States

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Publications (57)128.17 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Traditionally, narcotics have been used for analgesia after breast surgery. However, these agents have unpleasant side effects. Intercostal nerve blockade is an alternative technique to improve postoperative pain. In this study, the authors investigate outcomes in patients who receive thoracic intercostal nerve blocks for implant-based breast reconstruction. Methods: A retrospective chart review was performed. The operative technique for breast reconstruction and administration of nerve blocks is detailed. Demographic factors, length of stay, and complications were recorded. The consumption of morphine, Valium, Zofran, and oxycodone was recorded. Data sets for patients receiving thoracic intercostal nerve blocks were compared against those that did not. Results: One hundred thirty-two patients were included. For patients undergoing bilateral reconstruction with nerve blocks, there was a significant reduction in length of stay (1.87 days versus 2.32 days; p = 0.001), consumption of intravenous morphine (5.15 mg versus 12.68 mg; p = 0.041) and Valium (22.24 mg versus 31.13 mg; p = 0.026). For patients undergoing unilateral reconstruction with nerve blocks, there was a significant reduction in consumption of intravenous morphine (2.80 mg versus 8.17 mg; p = 0.007). For bilateral reconstruction with intercostal nerve block, cost savings equaled $2873.14 per patient. For unilateral reconstruction with intercostal nerve block, cost savings equaled $1532.34 per patient. Conclusion: The authors' data demonstrate a reduction in the consumption of pain medication, in the hospital length of stay, and in hospital costs for patients receiving intercostal nerve blocks at the time of pectoralis elevation for implant-based breast reconstruction. Clinical question/level of evidence: Therapeutic, III.
    Plastic and Reconstructive Surgery 10/2015; 136(5):584e-591e. DOI:10.1097/PRS.0000000000001717 · 2.99 Impact Factor

  • Journal of Plastic Reconstructive & Aesthetic Surgery 07/2015; DOI:10.1016/j.bjps.2015.07.018 · 1.42 Impact Factor
  • Anup Patel · Rajendra F Sawh-Martinez · Ajul Shah ·

    Plastic and Reconstructive Surgery 07/2015; 136(5). DOI:10.1097/PRS.0000000000001673 · 2.99 Impact Factor
  • Anup Patel · Ajul Shah · Jesse C Acosta · James E Clune ·

    Plastic and Reconstructive Surgery 07/2015; 136(5). DOI:10.1097/PRS.0000000000001664 · 2.99 Impact Factor
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    ABSTRACT: Cleft lip and palate (CLP) constitute a significant global disease burden. There are two general models that exist to deliver cleft care: surgical missions and comprehensive cleft centers (CCC). While surgical missions offer high quality surgical care to patients who would be unlikely to ever receive treatment, they may fail to provide sustainable solutions. The development of CCC is growing in popularity worldwide. CCC are permanent centers that offer a multidisciplinary team approach to the treatment of cleft lip and palate. Operation Smile has adopted the concept of specialized surgical care centers. These centers are shown to be safe, cost-effective, and provide sustainable solutions for cleft care. The authors discuss some of the benefits and drawbacks of the classic mission-based model and highlight why there may be a paradigm shift towards CCC.
    The Journal of craniofacial surgery 06/2015; 26(4):1126-8. DOI:10.1097/SCS.0000000000001682 · 0.68 Impact Factor
  • Ajul Shah · Anup Patel · Andrew Kenler · Shareef Jandali ·

    Plastic and Reconstructive Surgery 04/2015; 136(2). DOI:10.1097/PRS.0000000000001433 · 2.99 Impact Factor

  • Plastic and Reconstructive Surgery 02/2015; 136(1). DOI:10.1097/PRS.0000000000001179 · 2.99 Impact Factor

  • Plastic &amp Reconstructive Surgery 02/2015; 135(3). DOI:10.1097/PRS.0000000000001109 · 2.99 Impact Factor

  • Plastic &amp Reconstructive Surgery 02/2015; DOI:10.1097/PRS.0000000000001112 · 2.99 Impact Factor
  • Roberto Travieso · Anup Patel · Alexander F Au ·

    Plastic &amp Reconstructive Surgery 11/2014; 134(5):858e-9e. DOI:10.1097/PRS.0000000000000605 · 2.99 Impact Factor
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    ABSTRACT: To compare the immediate application of continuous negative pressure wound therapy (NPWT) versus standard, closed-suction drains (CS) in prevention of seroma in patients undergoing panniculectomy. In a prospective, randomized-controlled, single-surgeon study, patients seeking panniculectomy were randomized to NPWT or CS drains. Patients were compared on multiple demographic criteria including age, gender, BMI, incision length, pannus weight, nutritional status, comorbidities, prior surgery and duration of drain placement. Abdominal ultrasound was performed 2 weeks following drain removal to objectively quantify persistent fluid collections. Statistical analysis using T-test and logistic Regression was performed. The NPWT (n=12) and CS (n=10) groups showed no statistically significant differences in age (p=0.407), BMI (p=0.151), incision length (p=0.528), pannus weight (p=0.743), smoking status (p=0.594), diabetes (p=0.293), nutritional status (p>0.05), history of prior surgeries (p=0.378), or drain duration (p=0.429). Both BMI (r=0.679, p=0.001) and pannus weight (r=0.536, p=0.010) showed strong positive correlations with presence of seroma. No significant correlations were identified between age, incision length, and drain duration and presence of seroma (p>0.05). Following drain removal, the mean fluid volumes on ultrasound were 44.6cm3 (0-166) and 11.2cm3 (0-45) for CS and NPWT, respectively. There is a statistically significant difference is seroma presence in CS vs NPWT groups (p=0.037). Controlling for age, BMI, incision length, and drain duration, NPWT drain systems confer a 96.7% risk reduction in seroma presence when compared to standard, closed-suction drains in panniculectomy patients. Negative pressure wound therapy drain systems reduce the risk of seroma presence in panniculectomy patients compared to standard, closed suction bulb drains. Increases in BMI and increases in pannus weight correlate with increases in presence of seroma formation. Continuous negative pressure wound therapy connected directly to drains may impact the post-operative outcomes in massive weight loss patients undergoing panniculectomy and other body-contouring procedures.
    Plastic Surgery: The Meeting 2014; 10/2014

  • Plastic &amp Reconstructive Surgery 10/2014; 134(4S-1 Suppl):108-109. DOI:10.1097/01.prs.0000455467.54807.78 · 2.99 Impact Factor
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    ABSTRACT: Background: The relationship between age at the time of surgery and long-term neuropsychological (NP) outcomes in sagittal-suture craniosynostosis (SSC) remains equivocal. In current clinical practice, whole-vault cranioplasty (WVC) and strip-craniectomy (SC) are performed at various times in individuals with SSC. This study used comprehensive neurological testing to examine the relationship between age at the time of surgery and long-term NP function. Methods: Seventy SSC patients who had previously undergone either WVC or SC were examined. Patients were divided by age of surgery into three groups: treatment before 6 months (n=41), between 6 and 12 months (n=21), and after 12 months (n=8). In order to examine long-term cognitive functioning, participants between the ages of 5 and 25 years underwent a battery of neurodevelopmental tests to evaluate intelligence, achievement, and learning disabilities (Beery VMI, WASI, and Wechsler Fundamentals). Results: Compared to those treated between 6 and 12 months and after 12 months, patients who underwent surgery before 6 months demonstrated higher full-scale IQ (p < .01) and verbal IQ (p < .01). Patients who received surgery before 6 months also demonstrated superior abilities in word reading (p < .01), reading comprehension (p < .01), spelling (p < .01), and numerical operations (p <.05) relative to those who had surgery between 6 and 12 months of age. A statistically significant higher percentage of patients treated after 6 months had one or more reading-related learning disabilities as compared to those undergoing earlier surgery. Conclusion: This study suggests that surgery before 6 months of age results in improved long-term neurological outcomes, as evaluated by intellect, achievement, and a reduction in learning disabilities. Future studies should examine how the technique of surgery impacts these neuropsychological measures.
    Plastic &amp Reconstructive Surgery 10/2014; 134(4). DOI:10.1097/PRS.0000000000000511 · 2.99 Impact Factor
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    ABSTRACT: Over the past 12 years, U.S. cosmetic surgery volume has nearly doubled. The bulk of this growth can be attributed to minimally invasive procedures (MIPs). Despite the recent economic recession, MIP volume growth year-over-year (YoY) remained stable compared to major surgical (MS) procedure growth, which declined nearly 27% between 2006-2009, suggesting that MIP is less sensitive U.S. market fluctuations. Prior studies have shown that self-payment revenue in a private plastic surgery group proved indicative of market trends approximately one month in advance. The aim of this study is to investigate which market indices may predict MS and MIP volume. An investigation of the U.S. total reported procedural volume was performed from 2000 to 2012. The rolling YoY volume averages of a single-surgeon practice were compared to state and national industry data and market indices including unemployment, inflation, GDP, and the DJI. Multivariate statistical analysis and linear regressions were used to identify correlations and predictive trends between market fluctuations and case volume. Statistically-significant, independent, state-level predictors of MIP volume include overall GDP, media, food, healthcare, real estate, and unemployment. Only retail is an independent predictor of MS volume. U.S. GDP and unemployment were found to be statistically-significant, independent predictors of MIP volume. The DJI and national inflation rates are independently predictive of MS. No national indicators were jointly predictive of MIP and surgical volume. Altogether, the state and national predictors explain ~40% and ~35% of fluctuations in MIP volume and ~20% and ~7% of MS, respectively. The DJI correlates with surgical volume with a 2-month lag period. The drivers of the MIP:surgical ratio at the state level are finance, legal, entrepreneurship, entertainment, and unemployment. Fluctuations in state and national unemployment are predictive of similar changes in MIP volume at 1 and 2 months, respectively. U.S. GDP is predictive of changes in MIP volume with a quarterly lag. These findings demonstrate that trends in state and national economic indicators may be a useful means of analyzing and predicting future trends in cosmetic surgery and MIP volume. The outcomes of such an analysis may be employed to guide the diversification of a clinical practice, such that clinical revenues might be less vulnerable to fluctuations in the economy.
    Plastic &amp Reconstructive Surgery 10/2014; 134(4S-1 Suppl):43-44. DOI:10.1097/ · 2.99 Impact Factor
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    ABSTRACT: Introduction: Dermoid cysts are common, benign, embryologically derived soft tissue cysts that can arise at a variety of craniofacial sites. It is not known whether specific histological variations exist between the different craniofacial sites. This study aims to establish whether inter-site histologic differences exist between periorbital, nasal, scalp, and postauricular dermoid cysts and analyze these in context of their distinct embryological origin and varied clinical presentation. Methods: A retrospective review of craniofacial dermoid cysts was performed. Using light microscopy with hematoxylin and eosin staining, histological appearance was directly compared between craniofacial sites. Results: All (n = 16) cysts contained keratinizing, stratified squamous epithelial lining, intraluminal keratin, and hair. Sebaceous glands were commonly present (n = 13). Eccrine (sweat) glands were less common (n = 3). Structures of mesodermal origin were seen in three periorbital cysts. Only the six ruptured cysts showed evidence of inflammation. Conclusions: Histological properties of dermoid cysts are conserved between craniofacial sites (periorbital, nasal, scalp, and postauricular). This reflects the consistency of ectodermal inclusion during early embryological development, which is independent of specific craniofacial site or surrounding anatomical structures.
    The Yale journal of biology and medicine 09/2014; 87(3):349-57.
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    ABSTRACT: Sex trafficking remains a flagrant violation of human rights, creating many public health concerns. During the initiation period, these victims experience acts of violence including gang rapes, subjecting them to traumatic injuries that include burns. Furthermore, lack of access to health care, particularly surgical, keeps them from receiving treatment for these functionally debilitating contractures caused by burns. This piece provides an overview of burns among sex-trafficked victims in India and the efforts by Cents of Relief to address the associated surgical burden of disease.
    The Yale journal of biology and medicine 09/2014; 87(3):263-267.

  • Plastic and Reconstructive Surgery 08/2014; 134(2):338e-9e. DOI:10.1097/PRS.0000000000000358 · 2.99 Impact Factor
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    ABSTRACT: The prevalence of deformational plagiocephaly has risen dramatically in recent years, now affecting 15 percent or more of infants. Prior research using developmental scales suggests that these children may be at elevated risk for developmental delays. However, the low positive predictive value of such instruments in identifying long-term impairment, coupled with their poor reliability in infants, warrants the development of methods to more precisely measure brain function in craniofacial patients. Event-related potentials offer a direct measure of cortical activity that is highly applicable to young populations and has been implemented in other disorders to predict long-term cognitive functioning. The current study used event-related potentials to contrast neural correlates of auditory perception in infants with deformational plagiocephaly and typically developing children.
    Plastic &amp Reconstructive Surgery 06/2014; 133(6):835e-41e. DOI:10.1097/PRS.0000000000000219 · 2.99 Impact Factor
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    ABSTRACT: The optimal type of surgical management for isolated sagittal synostosis (ISS) remains a source of significant debate. A paucity of data exists on possible differences in long-term neuropsychological outcomes following treatment with whole vault cranioplasty or endoscopic strip craniectomy. This study provides the first comparative analysis examining the effects of the two techniques related to long-term intellectual functioning. A total of 70 patients were enrolled in this multicenter study, 29 of whom had previously undergone endoscopic strip craniectomy and 41 of whom had previously undergone whole vault cranioplasty. All patients completed a battery of neurodevelopmental tests (Beery VMI, WASI, and Wechsler Fundamentals) in order to evaluate various domains of neuropsychological function. In a group comparison of those treated before six months of age, whole vault patients obtained higher scores relative to endoscopic strip craniectomy patients on visual-motor integration, full scale IQ, verbal IQ, word reading, and reading comprehension (all p values < .05). When compared against strip craniectomy performed before three months of age, the whole vault group still showed significantly higher scores in verbal IQ, reading comprehension, and word reading (all p values < .05). The type of surgical intervention for ISS impacts long-term neuropsychological outcomes. Patients undergoing early whole vault cranioplasty attained higher IQ and achievement scores relative to those undergoing strip craniectomy. Surgical management with whole vault cranioplasty performed before six months of age provides the most favorable long-term intellectual outcomes in patients with ISS.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutics, III.
    Plastic &amp Reconstructive Surgery 05/2014; DOI:10.1097/PRS.0000000000000420 · 2.99 Impact Factor

  • Plastic and Reconstructive Surgery 05/2014; 133(5):730e-1e. DOI:10.1097/PRS.0000000000000118 · 2.99 Impact Factor

Publication Stats

81 Citations
128.17 Total Impact Points


  • 2013-2015
    • Yale-New Haven Hospital
      • Department of Laboratory Medicine
      New Haven, Connecticut, United States
  • 2009-2015
    • Yale University
      • Department of Surgery
      New Haven, Connecticut, United States
  • 2014
    • University of Pittsburgh
      Pittsburgh, Pennsylvania, United States