Pub Date : 2024-04-26DOI: 10.1177/00031348241248801
Tamir E Bresler, Shivam Pandya, Ryan Meyer, Zin Htway, Manabu Fujita
INTRODUCTION Artificial intelligence continues to play an increasingly important role in modern health care. ChatGPT-3.5 (OpenAI, San Francisco, CA) has gained attention for its potential impact in this domain. OBJECTIVE To explore the role of ChatGPT-3.5 in guiding clinical decision-making specifically in the context of pancreatic adenocarcinoma and to assess its growth over a period of time. PARTICIPANTS We reviewed the National Comprehensive Cancer Network® (NCCN) Clinical Practice Guidelines for the Management of Pancreatic Adenocarcinoma and formulated a complex clinical question for each decision-making page. ChatGPT-3.5 was queried in a reproducible fashion. We scored answers on the following Likert scale: 5) Correct; 4) Correct, with missing information requiring clarification; 3) Correct, but unable to complete answer; 2) Partially incorrect; 1) Absolutely incorrect. We repeated this protocol at 3-months. Score frequencies were compared, and subgroup analysis was conducted on Correctness (defined as scores 1-2 vs 3-5) and Accuracy (scores 1-3 vs 4-5). RESULTS In total, 50-pages of the NCCN Guidelines® were analyzed, generating 50 complex clinical questions. On subgroup analysis, the percentage of Acceptable answers improved from 60% to 76%. The score improvement was statistically significant (Mann-Whitney U-test; Mean Rank = 44.52 vs 56.48, P = .027). CONCLUSION ChatGPT-3.5 represents an interesting but limited tool for assistance in clinical decision-making. We demonstrate that the platform evolved, and its responses to our standardized questions improved over a relatively short period (3-months). Future research is needed to determine the validity of this tool for this clinical application.
{"title":"From Bytes to Best Practices: Tracing ChatGPT-3.5's Evolution and Alignment With the National Comprehensive Cancer Network® Guidelines in Pancreatic Adenocarcinoma Management.","authors":"Tamir E Bresler, Shivam Pandya, Ryan Meyer, Zin Htway, Manabu Fujita","doi":"10.1177/00031348241248801","DOIUrl":"https://doi.org/10.1177/00031348241248801","url":null,"abstract":"INTRODUCTION\u0000Artificial intelligence continues to play an increasingly important role in modern health care. ChatGPT-3.5 (OpenAI, San Francisco, CA) has gained attention for its potential impact in this domain.\u0000\u0000\u0000OBJECTIVE\u0000To explore the role of ChatGPT-3.5 in guiding clinical decision-making specifically in the context of pancreatic adenocarcinoma and to assess its growth over a period of time.\u0000\u0000\u0000PARTICIPANTS\u0000We reviewed the National Comprehensive Cancer Network® (NCCN) Clinical Practice Guidelines for the Management of Pancreatic Adenocarcinoma and formulated a complex clinical question for each decision-making page. ChatGPT-3.5 was queried in a reproducible fashion. We scored answers on the following Likert scale: 5) Correct; 4) Correct, with missing information requiring clarification; 3) Correct, but unable to complete answer; 2) Partially incorrect; 1) Absolutely incorrect. We repeated this protocol at 3-months. Score frequencies were compared, and subgroup analysis was conducted on Correctness (defined as scores 1-2 vs 3-5) and Accuracy (scores 1-3 vs 4-5).\u0000\u0000\u0000RESULTS\u0000In total, 50-pages of the NCCN Guidelines® were analyzed, generating 50 complex clinical questions. On subgroup analysis, the percentage of Acceptable answers improved from 60% to 76%. The score improvement was statistically significant (Mann-Whitney U-test; Mean Rank = 44.52 vs 56.48, P = .027).\u0000\u0000\u0000CONCLUSION\u0000ChatGPT-3.5 represents an interesting but limited tool for assistance in clinical decision-making. We demonstrate that the platform evolved, and its responses to our standardized questions improved over a relatively short period (3-months). Future research is needed to determine the validity of this tool for this clinical application.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"7 46","pages":"31348241248801"},"PeriodicalIF":0.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140653109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-26DOI: 10.1177/00031348241248805
Chaiss Ugarte, Shannon Zielsdorf, Ramsey Ugarte, Odeya Kagan, Ryan Murphy, Matthew J Martin, Kenji Inaba, M. Schellenberg
Background: Bile duct injury (BDI) is one of the most severe complications during cholecystectomy. Early identification of risk factors for BDI may permit risk reduction strategies and inform patient consent.Objective: This study aimed to define patient, provider, and systemic factors associated with BDI; BDI incidence; and short-term outcomes of BDI after urgent cholecystectomy.Methods: Patients who underwent urgent cholecystectomy for acute cholecystitis were retrospectively screened (2020-2022). All patients who sustained BDI were included without exclusions. Demographics, clinical data, and outcomes were collected and compared with descriptive statistics.Results: During the study period, BDI occurred in 4 (0.5%) of 728 patients who underwent urgent cholecystectomy for acute cholecystitis. Most BDI cases (75%) took place overnight or during the weekend. The attending surgeon was almost exclusively (75%) in their first year of practice. BDI was recognized during index operation in 2 cases (50%). Hepatobiliary surgery performed the bile duct repair in all 4 cases. Two complications occurred (50%). All patients were followed by hepatobiliary surgery in the outpatient setting and returned to their baseline level of function within 2 months of hospital discharge.Conclusion: Most BDI occurred in procedures attended by first-year faculty during after hours cholecystectomies, suggesting a role for increased proctorship in early career attendings in addition to in-hours cholecystectomy for acute cholecystitis. The timely return to baseline function experienced by these patients emphasizes the favorable outcomes associated with early recognition of BDI and involvement of hepatobiliary surgery. Further examination with multicenter evaluation would be beneficial to validate these study findings.
{"title":"Bile Duct Injuries During Urgent Cholecystectomy at a Safety Net Teaching Hospital: Attending Experience and Time of Day May Matter.","authors":"Chaiss Ugarte, Shannon Zielsdorf, Ramsey Ugarte, Odeya Kagan, Ryan Murphy, Matthew J Martin, Kenji Inaba, M. Schellenberg","doi":"10.1177/00031348241248805","DOIUrl":"https://doi.org/10.1177/00031348241248805","url":null,"abstract":"Background: Bile duct injury (BDI) is one of the most severe complications during cholecystectomy. Early identification of risk factors for BDI may permit risk reduction strategies and inform patient consent.Objective: This study aimed to define patient, provider, and systemic factors associated with BDI; BDI incidence; and short-term outcomes of BDI after urgent cholecystectomy.Methods: Patients who underwent urgent cholecystectomy for acute cholecystitis were retrospectively screened (2020-2022). All patients who sustained BDI were included without exclusions. Demographics, clinical data, and outcomes were collected and compared with descriptive statistics.Results: During the study period, BDI occurred in 4 (0.5%) of 728 patients who underwent urgent cholecystectomy for acute cholecystitis. Most BDI cases (75%) took place overnight or during the weekend. The attending surgeon was almost exclusively (75%) in their first year of practice. BDI was recognized during index operation in 2 cases (50%). Hepatobiliary surgery performed the bile duct repair in all 4 cases. Two complications occurred (50%). All patients were followed by hepatobiliary surgery in the outpatient setting and returned to their baseline level of function within 2 months of hospital discharge.Conclusion: Most BDI occurred in procedures attended by first-year faculty during after hours cholecystectomies, suggesting a role for increased proctorship in early career attendings in addition to in-hours cholecystectomy for acute cholecystitis. The timely return to baseline function experienced by these patients emphasizes the favorable outcomes associated with early recognition of BDI and involvement of hepatobiliary surgery. Further examination with multicenter evaluation would be beneficial to validate these study findings.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"11 12","pages":"31348241248805"},"PeriodicalIF":0.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140652509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-25DOI: 10.1177/00031348241248809
Ramsey S Elsayed, Avian Pham, Nikilish Chitibomma, Macey Yates, Kaylene Barrera, Marvin J Atchison, Titio F Gorski
BACKGROUND Skydiving is an increasingly popular recreational activity in the United States and worldwide. While it is considered a high-risk sport, the United States Parachute Association reported a fatality of .28 per 100 000 jumps in 2022. Although mortality rates are low, the true rate of survivable injuries is unknown. Injuries requiring hospitalization are not uncommon and may be underreported in the literature. Anticipating these injuries and analyzing short-term outcomes following parachuting accidents would be useful for the development of mitigation strategies and to increase the safety of jumpers. METHODS A retrospective cohort review of 126 consecutive patients presenting to a Level II Trauma Center after skydiving accidents between 2016 and 2023. Patient baseline characteristics, patterns of injury, surgical procedures, and in-hospital outcomes were reviewed. RESULTS A total of 126 patients were included. One hundred and seventeen patients (93%) presented immediately following the accident, 65 (51.6%) were trauma activations, and 14 (11.1%) patients experienced loss of consciousness. Fractures of the lower extremity occurred in 57 (45%), fractures of the spine 48 (38%), upper extremity 13 (10%), pelvis 11 (9%). Of the spinal injuries, 10 injuries occurred in the cervical spine, 16 thoracic, 22 lumbar, 5 sacral, and 3 coccygeal spine. Eleven patients (9%) suffered multilevel spine injuries. Mean injury severity score was 7 (range 0-75). A third of patients required at least 1 surgical procedure (n = 43, 34%). Median length stay was 2 days (IQR 1, 5). Of patients who survived to our trauma center, there were two mortalities, both due to catastrophic intracranial hemorrhage. DISCUSSION Although the 30-day mortality rate for patient who presented to our trauma center is low, it can bear significant risks including major injury. The most common injuries were lower extremity and spinal in origin with a third of patients overall requiring at least one operation.
{"title":"Contemporary Outcomes and Patterns of Injury Associated With Parachuting Accidents.","authors":"Ramsey S Elsayed, Avian Pham, Nikilish Chitibomma, Macey Yates, Kaylene Barrera, Marvin J Atchison, Titio F Gorski","doi":"10.1177/00031348241248809","DOIUrl":"https://doi.org/10.1177/00031348241248809","url":null,"abstract":"BACKGROUND\u0000Skydiving is an increasingly popular recreational activity in the United States and worldwide. While it is considered a high-risk sport, the United States Parachute Association reported a fatality of .28 per 100 000 jumps in 2022. Although mortality rates are low, the true rate of survivable injuries is unknown. Injuries requiring hospitalization are not uncommon and may be underreported in the literature. Anticipating these injuries and analyzing short-term outcomes following parachuting accidents would be useful for the development of mitigation strategies and to increase the safety of jumpers.\u0000\u0000\u0000METHODS\u0000A retrospective cohort review of 126 consecutive patients presenting to a Level II Trauma Center after skydiving accidents between 2016 and 2023. Patient baseline characteristics, patterns of injury, surgical procedures, and in-hospital outcomes were reviewed.\u0000\u0000\u0000RESULTS\u0000A total of 126 patients were included. One hundred and seventeen patients (93%) presented immediately following the accident, 65 (51.6%) were trauma activations, and 14 (11.1%) patients experienced loss of consciousness. Fractures of the lower extremity occurred in 57 (45%), fractures of the spine 48 (38%), upper extremity 13 (10%), pelvis 11 (9%). Of the spinal injuries, 10 injuries occurred in the cervical spine, 16 thoracic, 22 lumbar, 5 sacral, and 3 coccygeal spine. Eleven patients (9%) suffered multilevel spine injuries. Mean injury severity score was 7 (range 0-75). A third of patients required at least 1 surgical procedure (n = 43, 34%). Median length stay was 2 days (IQR 1, 5). Of patients who survived to our trauma center, there were two mortalities, both due to catastrophic intracranial hemorrhage.\u0000\u0000\u0000DISCUSSION\u0000Although the 30-day mortality rate for patient who presented to our trauma center is low, it can bear significant risks including major injury. The most common injuries were lower extremity and spinal in origin with a third of patients overall requiring at least one operation.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"30 5","pages":"31348241248809"},"PeriodicalIF":0.0,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140656342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-25DOI: 10.1177/00031348241248798
Andrew Hall, Alexander Alba, C. Olsen, Nicholas Greene, Kasey Hales, Darienne DeWalt, Brendon Drew, Ryan Comes, Matthew Hanson
The walking blood bank (WBB) is a system for emergency blood acquisition from nearby donors if a patient's blood needs exceed the immediate supply. USCENTCOM medical units will perform a walking blood bank if immediate blood requirements exceed the local supply. A benchmark WBB performance time was needed to provide a training goal for military WBB exercises. An expeditionary WBB performance time benchmark was created from prospective measurements of USCENTCOM medical unit performance times over 9 months. The mean total time, and new performance benchmark, for a WBB in USCENTCOM was 41.4 min +/- 13.2 min. USCENTCOM time from donor arrival to a transfusable unit mean time was 34.4 +/- 12.1 min. Expeditionary medical units conducting a WBB should expect to meet or exceed the provided benchmark.
{"title":"The USCENTCOM Walking Blood Bank Performance Benchmark and Anticipated Benefit of Universal Low Titer Type O Screening.","authors":"Andrew Hall, Alexander Alba, C. Olsen, Nicholas Greene, Kasey Hales, Darienne DeWalt, Brendon Drew, Ryan Comes, Matthew Hanson","doi":"10.1177/00031348241248798","DOIUrl":"https://doi.org/10.1177/00031348241248798","url":null,"abstract":"The walking blood bank (WBB) is a system for emergency blood acquisition from nearby donors if a patient's blood needs exceed the immediate supply. USCENTCOM medical units will perform a walking blood bank if immediate blood requirements exceed the local supply. A benchmark WBB performance time was needed to provide a training goal for military WBB exercises. An expeditionary WBB performance time benchmark was created from prospective measurements of USCENTCOM medical unit performance times over 9 months. The mean total time, and new performance benchmark, for a WBB in USCENTCOM was 41.4 min +/- 13.2 min. USCENTCOM time from donor arrival to a transfusable unit mean time was 34.4 +/- 12.1 min. Expeditionary medical units conducting a WBB should expect to meet or exceed the provided benchmark.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"80 11","pages":"31348241248798"},"PeriodicalIF":0.0,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140655066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-24DOI: 10.1177/00031348241248795
Sara Sakowitz, S. Bakhtiyar, Saad Mallick, N. Y. Cho, Shineui Kim, Nguyen K. Le, Hanjoo Lee, P. Benharash
BACKGROUND Readmission at a non-index hospital, or care fragmentation (CF), has been previously linked to greater morbidity and resource utilization. However, a contemporary evaluation of the impact of CF on readmission outcomes following elective colectomy is lacking. We additionally sought to evaluate the role of hospital quality in mediating the effect of CF. METHODS All records for adults undergoing elective colectomy were tabulated from the 2016 to 2020 Nationwide Readmissions Database. Patients readmitted non-electively within 30 days to a non-index center comprised the CF cohort (others: Non-CF). Hierarchical mixed-effects models were constructed to ascertain risk-adjusted rates of major adverse events (MAEs, a composite of in-hospital mortality and any complication) attributable to center-level effects. Hospitals with risk-adjusted MAE rates ≥50th percentile were considered Low-Quality Hospitals (LQHs) (others: High-Quality Hospitals [HQHs]). RESULTS Of 68,185 patients readmitted non-electively within 30 days, 8968 (13.2%) were categorized as CF. On average, CF was older, of greater comorbidity burden, and more often underwent colectomy for cancer, relative to Non-CF. Following risk adjustment, CF remained independently associated with greater likelihood of MAE (adjusted odds ratio [AOR] 1.16, 95% Confidence Interval [CI] 1.05-1.27) and per-patient expenditures (β+$2,280, CI +$1080-3490). Further, readmission to non-index LQH was linked with significantly increased odds of MAE, following initial care at HQH (AOR 1.43, CI 1.03-1.99) and LQH (AOR 1.72, CI 1.30-2.28; Reference: Non-CF). CONCLUSIONS Care fragmentation was associated with greater morbidity and resource utilization at readmission following elective colectomy. Further, rehospitalization at non-index LQH conferred significantly inferior outcomes. Novel efforts are needed to improve continuity of care.
{"title":"Hospital Quality Mediates Impact of Care Fragmentation Following Elective Colectomy.","authors":"Sara Sakowitz, S. Bakhtiyar, Saad Mallick, N. Y. Cho, Shineui Kim, Nguyen K. Le, Hanjoo Lee, P. Benharash","doi":"10.1177/00031348241248795","DOIUrl":"https://doi.org/10.1177/00031348241248795","url":null,"abstract":"BACKGROUND\u0000Readmission at a non-index hospital, or care fragmentation (CF), has been previously linked to greater morbidity and resource utilization. However, a contemporary evaluation of the impact of CF on readmission outcomes following elective colectomy is lacking. We additionally sought to evaluate the role of hospital quality in mediating the effect of CF.\u0000\u0000\u0000METHODS\u0000All records for adults undergoing elective colectomy were tabulated from the 2016 to 2020 Nationwide Readmissions Database. Patients readmitted non-electively within 30 days to a non-index center comprised the CF cohort (others: Non-CF). Hierarchical mixed-effects models were constructed to ascertain risk-adjusted rates of major adverse events (MAEs, a composite of in-hospital mortality and any complication) attributable to center-level effects. Hospitals with risk-adjusted MAE rates ≥50th percentile were considered Low-Quality Hospitals (LQHs) (others: High-Quality Hospitals [HQHs]).\u0000\u0000\u0000RESULTS\u0000Of 68,185 patients readmitted non-electively within 30 days, 8968 (13.2%) were categorized as CF. On average, CF was older, of greater comorbidity burden, and more often underwent colectomy for cancer, relative to Non-CF. Following risk adjustment, CF remained independently associated with greater likelihood of MAE (adjusted odds ratio [AOR] 1.16, 95% Confidence Interval [CI] 1.05-1.27) and per-patient expenditures (β+$2,280, CI +$1080-3490). Further, readmission to non-index LQH was linked with significantly increased odds of MAE, following initial care at HQH (AOR 1.43, CI 1.03-1.99) and LQH (AOR 1.72, CI 1.30-2.28; Reference: Non-CF).\u0000\u0000\u0000CONCLUSIONS\u0000Care fragmentation was associated with greater morbidity and resource utilization at readmission following elective colectomy. Further, rehospitalization at non-index LQH conferred significantly inferior outcomes. Novel efforts are needed to improve continuity of care.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"59 9","pages":"31348241248795"},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140664532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-24DOI: 10.1177/00031348241248787
S. A. Karim, JustinJ Turcotte, Scott T Rehrig, C. Feather, J. Klune
BACKGROUND Liver failure patients are at increased risk of surgical complications. The decision to perform a colonic anastomosis vs a colostomy in urgent colorectal surgery remains unclear. METHODS The ACS-NSQIP database was queried for patients undergoing nonelective colorectal surgery between 2016 and 2018. MELD score was calculated and stratified into 3 groups. Subgroup analysis of the high-MELD group was performed. RESULTS Higher MELD scores were associated with significantly higher mortality. Colostomy formation was consistent between intermediate and high-MELD groups. In high-MELD patients, colonic anastomosis was associated with higher mortality than those receiving colostomy (41.1% vs 28.4%, P < .001). Patients receiving colostomy had higher rates of wound complications, but lower rates of return to OR and non-wound complications. Regression analysis revealed that colostomy formation remained an independent predictor of survival (mortality OR = .594, P < .001). DISCUSSION High-MELD patients undergoing nonelective colorectal surgery have increased risk of complications such as mortality. Patients in this group receiving an anastomosis have increased complications and mortality, and may benefit from colostomy formation.
{"title":"Colorectal Anastomosis Versus Colostomy Creation in High MELD Patients: An ACS-NSQIP Analysis.","authors":"S. A. Karim, JustinJ Turcotte, Scott T Rehrig, C. Feather, J. Klune","doi":"10.1177/00031348241248787","DOIUrl":"https://doi.org/10.1177/00031348241248787","url":null,"abstract":"BACKGROUND\u0000Liver failure patients are at increased risk of surgical complications. The decision to perform a colonic anastomosis vs a colostomy in urgent colorectal surgery remains unclear.\u0000\u0000\u0000METHODS\u0000The ACS-NSQIP database was queried for patients undergoing nonelective colorectal surgery between 2016 and 2018. MELD score was calculated and stratified into 3 groups. Subgroup analysis of the high-MELD group was performed.\u0000\u0000\u0000RESULTS\u0000Higher MELD scores were associated with significantly higher mortality. Colostomy formation was consistent between intermediate and high-MELD groups. In high-MELD patients, colonic anastomosis was associated with higher mortality than those receiving colostomy (41.1% vs 28.4%, P < .001). Patients receiving colostomy had higher rates of wound complications, but lower rates of return to OR and non-wound complications. Regression analysis revealed that colostomy formation remained an independent predictor of survival (mortality OR = .594, P < .001).\u0000\u0000\u0000DISCUSSION\u0000High-MELD patients undergoing nonelective colorectal surgery have increased risk of complications such as mortality. Patients in this group receiving an anastomosis have increased complications and mortality, and may benefit from colostomy formation.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"53 12","pages":"31348241248787"},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140662843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-24DOI: 10.1177/00031348241248804
Shea P. Gallagher, Vanya Vojvodic, Joshua Dilday, Stephen Park, Chaiss Ugarte, Patrick McGillen, Anastasia Plotkin, Gregory A Magee, Kenji Inaba, Matthew Martin
BACKGROUND Disruption score (DS) is a novel bibliometric created to identify research that shifts paradigms, which may be overlooked by citation count (CC). We analyzed the most disruptive, compared to the most cited, literature in vascular surgery, and hypothesized that DS and CC would not correlate. METHODS A PubMed search identified vascular surgery publications from 1954 to 2014. The publications were linked to the iCite NIH tool and DS algorithm to identify the top 100 studies by CC and DS, respectively. The publications were reviewed for study focus, design, and contribution, and subsequently compared. RESULTS A total of 56,640 publications were identified. The top 100 DS papers were frequently published in J Vasc Sur (43%) and Eur J Vasc Endovasc Surg (13%). The top 100 CC papers were frequently published in N Engl J Med (32%) and J Vasc Sur (20%). The most cited article is the fifth most disruptive; the most disruptive article is not in the top 100 cited papers. The DS papers had a higher mean DS than the CC papers (.17 vs .0001, P < .0001). The CC papers had a higher mean CC than the DS papers (866 vs 188, P < .0001). DS and CC are weakly correlated metrics (r = .22, P = .03). DISCUSSION DS was weakly correlated with CC and captured a unique subset of literature that created paradigm shifts in vascular surgery. DS should be utilized as an adjunct to CC to avoid overlooking impactful research and influential researchers, and to measure true academic productivity.
背景中断评分（Disruption score，DS）是一种新颖的文献计量学方法，用于识别可能被引文次数（CC）忽略的改变研究范式的研究。我们分析了血管外科中最具破坏性的文献与被引次数最多的文献，并假设DS与CC并不相关。这些出版物与 iCite NIH 工具和 DS 算法相连接，以分别确定 CC 和 DS 排名前 100 位的研究。对这些出版物的研究重点、设计和贡献进行了审查，随后进行了比较。排名前 100 的 DS 论文经常发表在《J Vasc Sur》（43%）和《Eur J Vasc Endovasc Surg》（13%）上。前100篇CC论文经常发表在《N Engl J Med》（32%）和《J Vasc Sur》（20%）上。被引用次数最多的文章是干扰性排名第五的文章；干扰性最强的文章不在被引用次数前 100 的论文之列。DS论文的平均DS值高于CC论文（.17 vs .0001，P < .0001）。CC论文的平均CC值高于DS论文（866 vs 188，P < .0001）。DS 和 CC 是弱相关指标（r = .22, P = .03）。DS 应作为 CC 的辅助指标，以避免忽略有影响力的研究和有影响力的研究人员，并衡量真正的学术生产力。
{"title":"Paradigm Shifts in Vascular Surgery: Analysis of the Top 100 Innovative and Disruptive Academic Publications.","authors":"Shea P. Gallagher, Vanya Vojvodic, Joshua Dilday, Stephen Park, Chaiss Ugarte, Patrick McGillen, Anastasia Plotkin, Gregory A Magee, Kenji Inaba, Matthew Martin","doi":"10.1177/00031348241248804","DOIUrl":"https://doi.org/10.1177/00031348241248804","url":null,"abstract":"BACKGROUND\u0000Disruption score (DS) is a novel bibliometric created to identify research that shifts paradigms, which may be overlooked by citation count (CC). We analyzed the most disruptive, compared to the most cited, literature in vascular surgery, and hypothesized that DS and CC would not correlate.\u0000\u0000\u0000METHODS\u0000A PubMed search identified vascular surgery publications from 1954 to 2014. The publications were linked to the iCite NIH tool and DS algorithm to identify the top 100 studies by CC and DS, respectively. The publications were reviewed for study focus, design, and contribution, and subsequently compared.\u0000\u0000\u0000RESULTS\u0000A total of 56,640 publications were identified. The top 100 DS papers were frequently published in J Vasc Sur (43%) and Eur J Vasc Endovasc Surg (13%). The top 100 CC papers were frequently published in N Engl J Med (32%) and J Vasc Sur (20%). The most cited article is the fifth most disruptive; the most disruptive article is not in the top 100 cited papers. The DS papers had a higher mean DS than the CC papers (.17 vs .0001, P < .0001). The CC papers had a higher mean CC than the DS papers (866 vs 188, P < .0001). DS and CC are weakly correlated metrics (r = .22, P = .03).\u0000\u0000\u0000DISCUSSION\u0000DS was weakly correlated with CC and captured a unique subset of literature that created paradigm shifts in vascular surgery. DS should be utilized as an adjunct to CC to avoid overlooking impactful research and influential researchers, and to measure true academic productivity.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"12 8","pages":"31348241248804"},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140663566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-24DOI: 10.1177/00031348241248800
Alexandra Moulton, Jessica K. Liu, Christian Miguel de Virgilio, J. Ozao-Choy, A. Moazzez
Introduction: Preoperative Coronavirus Disease 2019 (COVID-19) infections are associated with postoperative adverse outcomes. However, there is limited data on the impact of postoperative COVID-19 infection on postoperative outcomes of common general surgery procedures.Objective: To evaluate the impact of postoperative COVID-19 diagnosis on laparoscopic cholecystectomy outcomes.Methods: Patients with symptomatic cholelithiasis, acute cholecystitis, or gallstone pancreatitis who underwent laparoscopic cholecystectomy with or without intraoperative cholangiogram were identified using the 2021 National Surgical Quality Improvement Program (NSQIP) database. Patients were categorized into two groups: patients with and without a postoperative COVID-19 diagnosis. Coarsened Exact Matching was used to match the groups based on preoperative risk factors, and outcomes were compared.Results: A total of 47,948 patients were included. In the aggregate cohort, 31% were male, and mean age was 50 years. Age, BMI, smoking, COPD, CHF, preoperative sepsis, and ASA class were significantly different between the two groups. After matching, there were no differences in characteristics. 30-day morbidity (OR = 2.7, 95% CI 1.4-5.1), pneumonia (OR = 5.0, 95% CI 1.7-15.0), DVT (OR = 8.22, 95% CI 1.0-66), reoperation (OR = 9.3, 95% CI 1.2-73.8), and readmission (OR = 4.8, 95% CI 2.3-10.1) continued to be significantly worse in the matched cohort.Conclusion: Postoperative COVID-19 infection was associated with worse outcomes after laparoscopic cholecystectomy. These findings suggest that even postoperative COVID-19 diagnosis increases the risk for adverse outcomes in patients recovering from laparoscopic cholecystectomy and may indicate that precautions should be taken and new COVID-19 infections even after surgery should be closely monitored.
导言：术前冠状病毒病 2019（COVID-19）感染与术后不良后果有关。然而，关于术后COVID-19感染对普通普外科手术术后结果的影响的数据有限：评估术后 COVID-19 诊断对腹腔镜胆囊切除术结果的影响：方法：利用 2021 年国家外科质量改进计划 (NSQIP) 数据库，对有症状的胆石症、急性胆囊炎或胆石性胰腺炎患者进行鉴定，这些患者均接受了腹腔镜胆囊切除术，并进行或未进行术中胆管造影。患者分为两组：术后诊断为 COVID-19 和未诊断为 COVID-19 的患者。根据术前风险因素，采用粗化精确匹配法对两组患者进行匹配，并对结果进行比较：结果：共纳入 47948 名患者。结果：共纳入 47948 名患者，其中男性占 31%，平均年龄为 50 岁。两组患者的年龄、体重指数、吸烟、慢性阻塞性肺病、慢性心力衰竭、术前败血症和 ASA 分级有显著差异。配对后，两组特征无差异。匹配队列的 30 天发病率（OR = 2.7，95% CI 1.4-5.1）、肺炎（OR = 5.0，95% CI 1.7-15.0）、深静脉血栓（OR = 8.22，95% CI 1.0-66）、再次手术（OR = 9.3，95% CI 1.2-73.8）和再次入院（OR = 4.8，95% CI 2.3-10.1）仍明显低于匹配队列：结论：术后COVID-19感染与腹腔镜胆囊切除术后较差的预后有关。结论：术后COVID-19感染与腹腔镜胆囊切除术后不良预后相关。这些发现表明，即使术后诊断出COVID-19也会增加腹腔镜胆囊切除术后患者出现不良预后的风险，因此应采取预防措施，并密切监测术后新的COVID-19感染。
{"title":"The Impact of Postoperative COVID-19 Infection on 30-day Outcomes of Laparoscopic Cholecystectomy.","authors":"Alexandra Moulton, Jessica K. Liu, Christian Miguel de Virgilio, J. Ozao-Choy, A. Moazzez","doi":"10.1177/00031348241248800","DOIUrl":"https://doi.org/10.1177/00031348241248800","url":null,"abstract":"Introduction: Preoperative Coronavirus Disease 2019 (COVID-19) infections are associated with postoperative adverse outcomes. However, there is limited data on the impact of postoperative COVID-19 infection on postoperative outcomes of common general surgery procedures.Objective: To evaluate the impact of postoperative COVID-19 diagnosis on laparoscopic cholecystectomy outcomes.Methods: Patients with symptomatic cholelithiasis, acute cholecystitis, or gallstone pancreatitis who underwent laparoscopic cholecystectomy with or without intraoperative cholangiogram were identified using the 2021 National Surgical Quality Improvement Program (NSQIP) database. Patients were categorized into two groups: patients with and without a postoperative COVID-19 diagnosis. Coarsened Exact Matching was used to match the groups based on preoperative risk factors, and outcomes were compared.Results: A total of 47,948 patients were included. In the aggregate cohort, 31% were male, and mean age was 50 years. Age, BMI, smoking, COPD, CHF, preoperative sepsis, and ASA class were significantly different between the two groups. After matching, there were no differences in characteristics. 30-day morbidity (OR = 2.7, 95% CI 1.4-5.1), pneumonia (OR = 5.0, 95% CI 1.7-15.0), DVT (OR = 8.22, 95% CI 1.0-66), reoperation (OR = 9.3, 95% CI 1.2-73.8), and readmission (OR = 4.8, 95% CI 2.3-10.1) continued to be significantly worse in the matched cohort.Conclusion: Postoperative COVID-19 infection was associated with worse outcomes after laparoscopic cholecystectomy. These findings suggest that even postoperative COVID-19 diagnosis increases the risk for adverse outcomes in patients recovering from laparoscopic cholecystectomy and may indicate that precautions should be taken and new COVID-19 infections even after surgery should be closely monitored.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"17 17","pages":"31348241248800"},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140660496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-24DOI: 10.1177/00031348241248783
Jaclyn Kliewer, Ilko Luque, Mariel A Javier, Amanda Moorefield, Hector Mendez, Zulmari Martinez, Jacob Oster, Alexis Rangel, Orlando Morejón
BACKGROUND Patients with emergency surgical conditions (ESCs) experience higher complication rates than those without emergency conditions. Our purpose was to improve time-based key performance indicators (KPIs) of care for ESC patients, including diagnostic workup, empiric stabilization, and referral to definitive care. METHODS A rapid response program (ESTAT) was developed to screen for and coordinate optimal, timely care for a spectrum of high-risk ESCs, from the patient's index clinical encounter up to definitive care. The Mann-Whitney test assessed whether any differences in KPIs were statistically significant (P < .05) before compared to after the implementation of ESTAT. RESULTS 98 patients were identified: 44 in ESTAT group (70% age ≥55, 57% male); 54 in control group (57% age ≥55, 44% male). There were significant decreases from time of index clinical encounter to resuscitation (5 min. vs 34 min., P < .001), to diagnostic imaging (52 min. vs 1 hr. 19 min., P = .004), and to definitive care (2 hr. 17 min. vs 3 hr. 51 min., P = .007) in the ESTAT group compared to the control group, respectively. DISCUSSION Improving time-based KPIs for delivery of clinical services is a common goal of medical emergency response systems (MERS) in numerous specialties. Implementation of an ESTAT program provides a screening tool for at-risk patients and reduces time to stabilize, diagnose and triage to definitive surgical intervention. These time benefits may ultimately translate to reduced complication rates for ESC patients. ESTAT may also represent a patient onboarding mechanism for surgical specialty verification programs promoted by quality improvement committees of various professional societies.
背景与非急诊患者相比，急诊手术患者的并发症发生率更高。我们的目的是改善急诊手术患者护理的基于时间的关键绩效指标（KPIs），包括诊断工作、经验性病情稳定和转诊至最终护理。方法我们开发了一项快速反应计划（ESTAT），用于筛查和协调从患者的首次临床就诊到最终护理的一系列高风险急诊手术患者的最佳及时护理。通过 Mann-Whitney 检验评估了实施 ESTAT 前与实施 ESTAT 后在关键绩效指标上的差异是否具有统计学意义（P < .05）：ESTAT组44人（70%年龄≥55岁，57%为男性）；对照组54人（57%年龄≥55岁，44%为男性）。与对照组相比，ESTAT 组患者从发病到复苏（5 分钟 vs 34 分钟，P < .001）、到影像诊断（52 分钟 vs 1 小时 19 分钟，P = .004）以及到最终治疗（2 小时 17 分钟 vs 3 小时 51 分钟，P = .007）的时间分别明显缩短。实施 ESTAT 计划可为高危患者提供筛查工具，并缩短稳定、诊断和分流至明确手术干预的时间。这些时间上的优势最终可能会降低 ESC 患者的并发症发生率。ESTAT还可作为患者入院机制，用于各专业学会质量改进委员会推广的外科专科验证计划。
{"title":"Emergency Surgical Treatment and Triage: Targeting Optimal Outcomes for Emergency Surgical Patients From Index Encounter Through Definitive Care.","authors":"Jaclyn Kliewer, Ilko Luque, Mariel A Javier, Amanda Moorefield, Hector Mendez, Zulmari Martinez, Jacob Oster, Alexis Rangel, Orlando Morejón","doi":"10.1177/00031348241248783","DOIUrl":"https://doi.org/10.1177/00031348241248783","url":null,"abstract":"BACKGROUND\u0000Patients with emergency surgical conditions (ESCs) experience higher complication rates than those without emergency conditions. Our purpose was to improve time-based key performance indicators (KPIs) of care for ESC patients, including diagnostic workup, empiric stabilization, and referral to definitive care.\u0000\u0000\u0000METHODS\u0000A rapid response program (ESTAT) was developed to screen for and coordinate optimal, timely care for a spectrum of high-risk ESCs, from the patient's index clinical encounter up to definitive care. The Mann-Whitney test assessed whether any differences in KPIs were statistically significant (P < .05) before compared to after the implementation of ESTAT.\u0000\u0000\u0000RESULTS\u000098 patients were identified: 44 in ESTAT group (70% age ≥55, 57% male); 54 in control group (57% age ≥55, 44% male). There were significant decreases from time of index clinical encounter to resuscitation (5 min. vs 34 min., P < .001), to diagnostic imaging (52 min. vs 1 hr. 19 min., P = .004), and to definitive care (2 hr. 17 min. vs 3 hr. 51 min., P = .007) in the ESTAT group compared to the control group, respectively.\u0000\u0000\u0000DISCUSSION\u0000Improving time-based KPIs for delivery of clinical services is a common goal of medical emergency response systems (MERS) in numerous specialties. Implementation of an ESTAT program provides a screening tool for at-risk patients and reduces time to stabilize, diagnose and triage to definitive surgical intervention. These time benefits may ultimately translate to reduced complication rates for ESC patients. ESTAT may also represent a patient onboarding mechanism for surgical specialty verification programs promoted by quality improvement committees of various professional societies.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"46 11","pages":"31348241248783"},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140665799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-24DOI: 10.1177/00031348241248691
Stephen Park, Sean M. Kim, Hye Kwang Kim, Emiliano Tabarsi, Brian Hom, Shea P. Gallagher, Chaiss Ugarte, Damon Clark, M. Schellenberg, Matthew Martin, Kenji Inaba, K. Matsushima
BACKGROUND The unhoused population is at high risk for traumatic injuries and faces unique challenges in accessing follow-up care. However, there is scarce data regarding differences in Emergency Department (ED) return rates and reasons for return between unhoused and housed patients. METHODS We conducted a 3-year retrospective cohort study at a level-1 trauma center in a large metropolitan area. All patients who presented to the ED with traumatic injuries and were discharged without hospital admission were included in the study. The primary outcome was ED returns for trauma-related complications or new traumatic events <6 months after discharge. Patient characteristics and study outcomes were compared between housed and unhoused groups. RESULTS A total of 4184 patients were identified, of which 20.3% were unhoused. Compared to housed, unhoused patients were more likely to return to the ED (18.8% vs 13.9%, P < .001), more likely to return for trauma-related complications (4.6% vs 3.1%, P = .045), more likely to return with new trauma (7.1% vs 2.8%, P < .001), and less likely to return for scheduled wound checks (2.5% vs 4.3%, P = .012). Of the patients who returned with trauma-related complications, unhoused patients had a higher proportion of wound infection (20.5% vs 5.7%, P = .008). In the regression analysis, unhoused status was associated with increased odds of ED return with new trauma and decreased odds of return for scheduled wound checks. CONCLUSIONS This study observed significant disparities between unhoused and housed patients after trauma. Our results suggest that inadequate follow-up in unhoused patients may contribute to further ED return.
背景无住房人群是创伤性损伤的高危人群，在获得后续治疗方面面临着独特的挑战。然而，关于无住所患者和有住所患者在急诊科（ED）复诊率和复诊原因方面的差异的数据却很少。所有在急诊室就诊的外伤患者均被纳入研究。研究的主要结果是患者在出院后 6 个月内因创伤相关并发症或新的创伤事件而重返急诊室。结果共确定了 4184 名患者，其中 20.3% 的患者无住房。与有住所的患者相比，无住所的患者更有可能返回急诊室（18.8% vs 13.9%，P < .001），更有可能因创伤相关并发症返回急诊室（4.6% vs 3.1%，P = .045），更有可能因新的创伤返回急诊室（7.1% vs 2.8%，P < .001），更不可能返回急诊室进行定期伤口检查（2.5% vs 4.3%，P = .012）。在因创伤相关并发症而复诊的患者中，无住房患者的伤口感染比例更高（20.5% 对 5.7%，P = .008）。在回归分析中，无住房患者因新创伤返回急诊室的几率增加，而返回急诊室接受预定伤口检查的几率降低。我们的研究结果表明，对无住房患者的随访不足可能会导致再次返回急诊室。
{"title":"Back on the Streets: Examining Emergency Department Return Rates for Unhoused Patients Discharged After Trauma.","authors":"Stephen Park, Sean M. Kim, Hye Kwang Kim, Emiliano Tabarsi, Brian Hom, Shea P. Gallagher, Chaiss Ugarte, Damon Clark, M. Schellenberg, Matthew Martin, Kenji Inaba, K. Matsushima","doi":"10.1177/00031348241248691","DOIUrl":"https://doi.org/10.1177/00031348241248691","url":null,"abstract":"BACKGROUND\u0000The unhoused population is at high risk for traumatic injuries and faces unique challenges in accessing follow-up care. However, there is scarce data regarding differences in Emergency Department (ED) return rates and reasons for return between unhoused and housed patients.\u0000\u0000\u0000METHODS\u0000We conducted a 3-year retrospective cohort study at a level-1 trauma center in a large metropolitan area. All patients who presented to the ED with traumatic injuries and were discharged without hospital admission were included in the study. The primary outcome was ED returns for trauma-related complications or new traumatic events <6 months after discharge. Patient characteristics and study outcomes were compared between housed and unhoused groups.\u0000\u0000\u0000RESULTS\u0000A total of 4184 patients were identified, of which 20.3% were unhoused. Compared to housed, unhoused patients were more likely to return to the ED (18.8% vs 13.9%, P < .001), more likely to return for trauma-related complications (4.6% vs 3.1%, P = .045), more likely to return with new trauma (7.1% vs 2.8%, P < .001), and less likely to return for scheduled wound checks (2.5% vs 4.3%, P = .012). Of the patients who returned with trauma-related complications, unhoused patients had a higher proportion of wound infection (20.5% vs 5.7%, P = .008). In the regression analysis, unhoused status was associated with increased odds of ED return with new trauma and decreased odds of return for scheduled wound checks.\u0000\u0000\u0000CONCLUSIONS\u0000This study observed significant disparities between unhoused and housed patients after trauma. Our results suggest that inadequate follow-up in unhoused patients may contribute to further ED return.","PeriodicalId":325363,"journal":{"name":"The American Surgeon","volume":"17 4","pages":"31348241248691"},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140660345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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