Cayo Alexander Gonzalez

All Publications

• The effect of prophylactic antibiotics on second-stage breast reconstruction: A retrospective analysis. Journal of plastic, reconstructive & aesthetic surgery : JPRAS Barrera, J., Lakhlani, D., Francis, S., Maheta, B., Gonzalez, C., Nino, G., Choi, H., Buckman, C., Baah, C. A., Johnstone, T., Yesantharao, P., Goli, R., Thawanyarat, K., Sivaraj, D., Nazerali, R. 2025; 102: 176-184

  Abstract

  Implant-based breast reconstruction has a higher infection risk than cosmetic augmentation, leading to routine prophylactic antibiotic use. We previously found extended prophylaxis reduced infections during the first-stage reconstruction with tissue expander/acellular dermal matrix placement. However, the most appropriate antibiotic class and duration of prophylaxis in the second-stage reconstruction remains unclear. This retrospective study aims to address this gap, focusing on antibiotic selection and duration during second-stage implant-based breast reconstruction.A single-center retrospective cohort study involved 359 patients undergoing second-stage breast reconstruction with tissue expander-implant exchange between January 2018 and January 2021. Chart reviews were performed to collect patient and surgical factors, antibiotic prophylaxis information, and postoperative outcomes. Multivariate logistic regression and likelihood ratio tests assessed associations between prophylaxis, covariates, and complications.Beyond a single perioperative dose of cefazolin, extended antibiotic prophylaxis did not significantly affect postoperative infection likelihood after second-stage breast reconstruction. Patients were grouped by antibiotic prophylaxis duration: 0 days (62 patients), 1 to 6 days (58 patients), and 7 or more days (239 patients). Extending antibiotic prophylaxis duration did not improve the prediction of 3-month postoperative infection rate (p = 0.581). A previous history of breast infection was a significant predictor for infection (p < 0.001).Extending antibiotics prophylaxis beyond a single preoperative dose of intravenous cefazolin does not reduce complication rates for patients undergoing second-stage breast reconstruction. Limiting prolonged prophylactic antibiotic use beyond the anesthetic period may reduce side effects (e.g., upset GI tract) and associated complications, including allergic reactions, Clostridium difficile colitis, and the emergence of new antibiotic-resistant pathogens.

  View details for DOI 10.1016/j.bjps.2025.01.032

  View details for PubMedID 39933364

• Thoracic and Lumbar Spine Injury: Evidence-Based Diagnosis, Management, and Outcomes. The American surgeon Gomez, G. I., Li, G. Q., Valido, A. A., Stoner, A. J., Bromley-Dulfano, R. A., Sheira, D., Gonzalez, C. A., Khan, S. I., Choi, J., Zygourakis, C. C., Weiser, T. G. 2023: 31348231216479

  Abstract

  Traumatic thoracolumbar spine injuries are associated with significant morbidity and mortality. Targeted for non-spine specialist trauma surgeons, this systematic scoping review aimed to examine literature for up-to-date evidence on presentation, management, and outcomes of thoracolumbar spine injuries in adult trauma patients.This review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. We searched four bibliographic databases: PubMed, EMBASE, Web of Science, and the Cochrane Library. Eligible studies included experimental, observational, and evidence-synthesis articles evaluating patients with thoracic, lumbar, or thoracolumbar spine injury, published in English between January 1, 2010 and January 31, 2021. Studies which focused on animals, cadavers, cohorts with N <30, and pediatric cohorts (age <18 years old), as well as case studies, abstracts, and commentaries were excluded.A total of 2501 studies were screened, of which 326 unique studies were fully text reviewed and twelve aspects of injury management were identified and discussed: injury patterns, determination of injury status and imaging options, considerations in management, and patient quality of life. We found: (1) imaging is a necessary diagnostic tool, (2) no consensus exists for preferred injury characterization scoring systems, (3) operative management should be considered for unstable fractures, decompression, and deformity, and (4) certain patients experience significant burden following injury.In this systematic scoping review, we present the most up-to-date information regarding the management of traumatic thoracolumbar spine injuries. This allows non-specialist trauma surgeons to become more familiar with thoracolumbar spine injuries in trauma patients and provides a framework for their management.

  View details for DOI 10.1177/00031348231216479

  View details for PubMedID 37983195

• Social Disparities in Lung Cancer. Thoracic surgery clinics Elliott, I., Gonzalez, C., Backhus, L., Lui, N. 2022; 32 (1): 33-42

  Abstract

  Social disparities in lung cancer diagnosis, treatment, and survival have been studied using national databases, statewide registries, and institution-level data. Some disparities emerge consistently, such as lower adherence to treatment guidelines and worse survival by race and socioeconomic status, whereas other disparities are less well studied. A critical appraisal of current data is essential to increasing equity in lung cancer care.

  View details for DOI 10.1016/j.thorsurg.2021.09.009

  View details for PubMedID 34801193