Devi Lakhlani

All Publications

• Ventral Hernia Repair With Onlay Placement of Biosynthetic Ovine Rumen Is Noninferior to Retrorectus Placement. Plastic and reconstructive surgery. Global open Kim, T. S., Sivaraj, D., Lakhlani, D., Johnstone, T., Szotek, P., Henn, D., Nazerali, R. S. 2025; 13 (4): e6666

  Abstract

  Mesh placement impacts postoperative outcomes in ventral hernia repair (VHR). The retrorectus technique is associated with lower recurrence rates than the onlay technique. Hybrid meshes, combining synthetic and biologic benefits, have been introduced, but the effect of placement location on outcomes remains unclear.We retrospectively analyzed 71 patients who underwent VHR with biosynthetic ovine rumen in either an onlay (n = 38) or retrorectus (n = 33) position. We compared demographics, comorbidities, complications, and recurrent rates. Multivariate logistic regression assessed associations between mesh placement and outcomes.Onlay patients were older (mean 62.9 versus 57.4 y, P = 0.03) and had larger hernias (158 versus 73.8 cm2, P < 0.001). Most patients had grade 2 or 1 hernias according to the modified ventral hernia working group classification, with no significant differences in postoperative complications. Hernia recurrence occurred in 5.41% of onlay patients and 0% of retrorectus patients.No significant differences in complications or recurrence rates were observed between placement techniques. These findings suggest that hybrid mesh placement in an onlay position is a safe and durable strategy for VHR.

  View details for DOI 10.1097/GOX.0000000000006666

  View details for PubMedID 40182300

  View details for PubMedCentralID PMC11964383

• Triage and Admission of Burn Patients Based on Race and Payer. Journal of burn care & research : official publication of the American Burn Association Steeman, S., Lakhlani, D., Stanton, E., Sheckter, C. 2025

  Abstract

  For-profit burn centers may prioritize commercially insured burn patients, exacerbating disparities for Medicaid (Medi-Cal) and uninsured patients who are more often racial minorities. We hypothesize that for-profit burn centers accept fewer burn transfers with Medi-Cal compared to safety-net and nonprofit centers. California's all-payer database was queried from 2009-2019 to evaluate ED-to-inpatient transfers for all burn patients within the state. The proportion of transfers with Medi-Cal payer was compared relative to profit status, safety-net status, and trauma center status. The likelihood of a burn transfer being accepted to for-profit center was modeled with logistic regression, adjusting for burn severity and demographics. Among 5,728 ED transfers, 89% went to nonprofit centers. Medi-Cal was the primary payer in 37.3% of transfers to nonprofit centers versus 24.0% to for-profit centers (p<.001). Medi-Cal payer (aOR 95% CI 0.49-0.76), Black race (aOR 95% CI 0.36-0.73), and Hispanic race (aOR 0.51-0.77) were all independently associated with reduced odds of transfer to for-profit burn centers. Profit status was negatively associated with the proportion of Medi-Cal transfers, while trauma center status and safety-net center status were not correlated. There was an overall increase in the proportion of Medi-Cal patients treated at nonprofit (21.8%) and for-profit (16.48%) centers over the study period. Disparities persist in burn care access by race, ethnicity, and insurance status. Nonprofit centers more frequently serve Medi-Cal and minority patients, while for-profit centers appear to demonstrate potential preference for caring for commercially insured, white patients.

  View details for DOI 10.1093/jbcr/iraf024

  View details for PubMedID 40052463

• Postoperative complications of ADM use in previously irradiated patients during stage I of implant-based breast reconstruction: A national database propensity score-matched analysis. Journal of plastic, reconstructive & aesthetic surgery : JPRAS Lakhlani, D., Lin, E., Kruayatidee, A., Wu, R., Palacios, C., Sheckter, C., Nazerali, R. 2025; 104: 181-190

  Abstract

  Acellular dermal matrix (ADM) is widely used in implant-based reconstruction to prevent capsular contracture, but its safety in irradiated patients is underexplored. We aimed to evaluate postoperative complications associated with ADM use in stage I of implant-based breast reconstruction in patients with premastectomy radiation.Using the Merative MarketScan Research Databases, 2012-2020, previously irradiated patients undergoing outpatient stage I implant breast reconstruction (prepectoral and submuscular) were stratified by ADM use and propensity score-matched. Postoperative complications and additional surgical interventions within 90 days were analyzed using multivariate logistic regression.Among 1234 matched patients (617 ADM and 617 non-ADM), ADM use was first recorded in 2012, and its frequency showed a positive correlation over the study (r = 0.214, p <.001). Patients with ADM experienced higher rates of wound (8.5% vs. 7.8%) and tissue necrosis (5.5% vs. 4.0%) than non-ADM patients, but these differences were not statistically significant. Additionally, no significant differences were observed between ADM and non-ADM groups in the rates of seroma formation, hematoma, fat necrosis, or postoperative infections. ADM use was associated with significantly lower odds of requiring image-guided fluid drainage for hematomas or seromas (OR 0.11, 95% CI 0.01-0.89, p =.039).No significant difference in complication rates was found between previously irradiated breast cancer patients with and without ADM on a large scale, even with ADM usage increasing over time. Its adoption should balance cost, surgeon preferences, and esthetic outcomes, with further research needed on its role in various reconstruction planes and cost impacts.

  View details for DOI 10.1016/j.bjps.2025.02.042

  View details for PubMedID 40138755

• Evaluating large language models for surgical chart review of second stage implant-based breast reconstruction: a comparative analysis of manual review, GPT-3.5 Turbo, and GPT-4 Turbo EUROPEAN JOURNAL OF PLASTIC SURGERY Lakhlani, D., Dadhania, D., Nazerali, R. 2025; 48 (1)

  View details for DOI 10.1007/s00238-025-02274-w

  View details for Web of Science ID 001418234200002

• 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

• Carpal tunnel syndrome diagnosis as a risk factor for falls. International orthopaedics Lakhlani, D., Shahoumian, T. A., Curtin, C. 2025

  Abstract

  PURPOSE: Subclinical peroneal neuropathy without overt foot drop has been linked to increased fall risk in adults, yet remains underreported due to subtle symptoms and lack of awareness. Patients with carpal tunnel syndrome (CTS) often experience other nerve entrapments, prompting this study to evaluate CTS (a proxy for peroneal nerve entrapment) as a significant predictor of time to first fall.METHODS: Data from the Merative MarketScan Research Databases (2007-2021) were used to identify adult patients using ICD-9/10 codes. Patients were stratified by CTS diagnosis and fall occurrences, with relevant comorbidities recorded. A survival analysis employing the Cox proportional hazards model assessed relationships between CTS, comorbidities, and future fall risk, accounting for changes in health status over time. Age was the time scale with CTS as a time-varying predictor. This approach isolated CTS-associated risk, while considering the natural increase in fall risk with age.RESULTS: Among 63,187,681 subjects (mean age=52.82 years±7.61), 1,411,695 had a diagnosis of CTS. Of those with CTS, 45,479 patients had a future fall. Univariate analysis showed significant associations between CTS and higher rates of arthritis and diabetes, while heart disease was less prevalent. CTS increased fall risk by 25% (HR 1.25, p<.005). Heart disease was associated with a 10% increase in fall risk (HR 1.10, p<.005), while arthritis and diabetes increased fall risk by 2% (both HR 1.02, p<.005). Kaplan-Meier curve illustrated a steeper decline in survival probability for the CTS group, indicating they experienced falls at younger ages and at a higher rate than those without CTS (chi = 4386.4, p<.001).CONCLUSION: Prior diagnosis of CTS is associated with an increased fall risk. Providers should screen CTS patients for fall risk and implement appropriate monitoring strategies. Further investigation on the role of peroneal nerve entrapment in this increased fall risk is warranted. This study identifies a treatable cause of falls, with potential to enhance patient safety and reduce fall-related morbidity.

  View details for DOI 10.1007/s00264-024-06395-y

  View details for PubMedID 39755784

• Burn Center Verification and Safety-net Status: Are There Differences in Discharge to Inpatient Rehabilitation? Journal of burn care & research : official publication of the American Burn Association Lakhlani, D., Steeman, S., Stanton, E. W., Sheckter, C. 2024

  Abstract

  Discharge to acute rehabilitation following major burn injury is crucial for patient recovery and quality of life. However, barriers to acute rehabilitation, including race and payor type impede access. The effect of burn center organizational structure on discharge disparities remains unknown. This study aims to investigate associations between patient demographics, burn center factors, and discharge to acute rehabilitation on a population level. Using the California Healthcare Access and Information Database, 2009-2019, all inpatient encounters at verified and non-verified burn centers were extracted. The primary outcome was the proportion of patients discharged to acute rehabilitation. Key covariates included age, race, burn center safety net status, diagnosis related group, American Burn Association (ABA) verification status, and American College of Surgeons (ACS) Level 1 trauma center designation. Logistic regression and mixed-effects modeling were performed, with Bonferroni adjustment for multiple testing. Among 27,496 encounters, 0.8% (228) were discharged to inpatient rehabilitation. By race/ethnicity, the proportion admitted to inpatient rehabilitation was 0.9% for White, 0.6% for Black, 0.7% for Hispanic, and 1% for Asian. After adjusting for burn severity and age, notable predictors for discharge to inpatient rehabilitation included Medicare as payor (OR 0.30-0.88, p=0.015) compared to commercial insurance, trauma center status (OR 1.45-3.43, p<.001), ABA verification status (OR 1.16-2.74, p=0.008), and safety-net facility status (OR 1.09-1.97, p=0.013). Discharge to inpatient rehabilitation varies by race, payor status, and individual burn center. Verified and safety-net burn centers had more patients discharge to inpatient rehabilitation adjusted for burn severity and demographics.

  View details for DOI 10.1093/jbcr/irae113

  View details for PubMedID 38874931