Background: Health care provider burnout worsened during the COVID-19 pandemic.
Objective: This qualitative study described general surgery residents' perceptions of burnout and the impact of the COVID-19 pandemic and their attitudes toward wellness initiatives.
Methods: General surgery residents at a large training program in Canada completed a 21-item survey focused on self-reported burnout, mental health, perceptions of wellness resources, and the effects of the COVID-19 pandemic. Free-text responses were extracted for qualitative thematic content analysis. A coding framework was established, and emergent themes were identified.
Results: A total of 62% (51/82) of the residents completed the survey. Most respondents were senior residents (21/51, 41%) and identified as male (32/51, 63%). In total, 65% (33/51) of the residents met the criteria for burnout. Three themes were identified: (1) the culture of general surgery does not promote wellness, (2) the COVID-19 pandemic worsened existing access to vacation days and rest, and (3) wellness education in general surgery is ineffective and onerous to complete. General surgery residents emphasized the rigid lifestyle and culture of the specialty. Residents said that the idea of wellness was poorly executed. COVID-19 protocols increased the acceptance of taking sick days, but this was offset by staff shortages during the pandemic. Finally, residents emphasized the inefficacy of wellness education. They felt that they did not lack knowledge on reaching wellness but simply lacked the adequate time and resources to improve their well-being.
Conclusions: There are persistent concerns within the culture of general surgery that were further impacted by workload and stress during the pandemic. These results may inform future programmatic efforts to decrease resident burnout.
Background: The perioperative environment is complex and may be challenging for patients and guardians to navigate. The emotional burden and stressors inherent to the perioperative process commonly result in preoperative anxiety. Many studies have demonstrated the usefulness of virtual reality (VR) in various patient populations.
Objective: The aim of this study is to evaluate the impact of a VR-based preoperative education tool on anxiety levels in pediatric patients undergoing ambulatory ear, nose, and throat surgery, as well as in their guardians.
Methods: We performed a single-center prospective randomized controlled trial including children 6-12 years of age, presenting for ambulatory tonsillectomy and/or adenoidectomy, with or without bilateral ear tube insertion. The patients were randomized to receive VR instruction of the perioperative workflow or standard preoperative experience (non-VR). The primary outcome was patient and guardian preoperative anxiety, as measured by the 6-item State-Trait Anxiety Inventory.
Results: The study cohort included 107 patient-guardian dyads-51 in the intervention (VR) group and 56 in the control (non-VR) group. Baseline characteristics between the study and control groups were comparable; however, patients in the control group were more likely to report feeling upset compared to the VR group. The VR intervention was associated with reduced preoperative anxiety in patients and guardians compared to the control group. Patients exposed to the VR intervention had higher odds of feeling calm (OR 4.95, 95% CI 2.32-10.61; P<.001) and lower odds of feeling worried (OR 0.25, 95% CI 0.12-0.53; P<.001) compared to the control group. Similarly, guardians in the VR group had higher odds of feeling calm (OR 3.55, 95% CI 1.69-7.49; P=.001) and lower odds of feeling worried (OR 0.45, 95% CI 0.22-0.93; P=.03) compared to the control group. Both patients and guardians exposed to VR were significantly less likely to have moderate or high levels of preoperative anxiety than the control group (patients: OR 0.15, 95% CI 0.05-0.41, P<.001; guardians: OR 0.14, 95% CI 0.06-0.38, P<.001).
Conclusions: VR exposure may be effective in reducing pediatric and guardian anxiety. VR may be a suitable alternative to pharmacologic anxiolysis and future studies should compare the effect to premedication techniques.
Background: Reducing the time to surgery for patients requiring cholecystectomy may lessen the risk of adverse outcomes. Dedicated day-surgery lists supported by out-of-hospital remote monitoring have been explored as a potential solution; however, the cost-effectiveness of such innovative care models remains largely unexplored.
Objective: This study presents a cost-effectiveness analysis comparing an acute day-surgery care model with remote patient monitoring to a conventional inpatient-centric care model for high-acuity cases of cholecystitis.
Methods: Post-surgical complications, effectiveness (measured by bed days saved and quality-adjusted life years [QALYs]), and health care costs associated with the two models of care were compared over a 1-year time horizon using a decision tree model. Health care costs were estimated from the Australian health care funder perspective and expressed in 2023 Australian dollars. Uncertainty was assessed using both deterministic and probabilistic sensitivity analyses.
Results: The acute day-surgery care model dominated the conventional inpatient-centric care model by saving a mean of 1.7 inpatient days per patient (3.2 days for the conventional model versus 1.5 days for the acute day-surgery model) and lowering net health care costs by a mean of AU $1,416 (US $935) per case over the 1-year time horizon. There was no meaningful difference in QALYs between the care models. These results remained robust in both deterministic and probabilistic sensitivity analyses.
Conclusions: An acute day-surgery care model with remote patient monitoring for individuals with acute cases of cholecystitis requiring cholecystectomy would likely free bed days and provide economic benefits to the health care system compared to inpatient-centric practice. Uncertainty in QALY estimates remains a limitation.
Background: Increasing arthroplasty volumes are testing health care system capacity, budgets, and workforce resilience. Clinical pathways (CPWs) provide a practical, evidence-based structure that aligns perioperative actions from preparation through follow-up. In this review, we treat three aims as coprimary: quality (patient outcomes and adherence to best practice); resource management and efficiency at the episode level (eg, length of stay, perioperative flow, direct costs); and sustainability, defined as the ability to maintain high-quality services over time by optimizing financial, human, and environmental resources while safeguarding equitable access.
Objective: This study aimed to describe the main CPW subtypes used in hip and knee arthroplasty and synthesize evidence on their effects on quality of care, resource management, and sustainability.
Methods: We conducted a narrative review of studies indexed in PubMed and Cochrane (2013-2024) that evaluated CPWs in total hip and knee arthroplasty. Screening and selection were documented with a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-style flow diagram for transparency, and findings were synthesized thematically.
Results: Across CPW models, consistent signals of benefit were identified. Enhanced Recovery After Surgery (ERAS) pathways accelerate recovery and enable earlier discharge without increasing complications, often reducing opioid exposure and time to mobilization. Integrated Clinical Pathways improve standardization and multidisciplinary coordination across settings, reducing unwarranted variability and supporting safer transitions of care. Fast-track programs emphasize early mobilization and streamlined perioperative processes, improving patient flow and satisfaction while decreasing length of stay. Outpatient arthroplasty pathways allow same-day discharge in carefully selected, low-risk patients, reducing bed occupancy and freeing inpatient capacity. Virtual clinics support remote follow-up, patient education, and complication surveillance, decreasing unnecessary in-person visits and optimizing clinician time. Collectively, these pathways align quality improvement with sustainability by lowering bed-days, improving adherence to evidence-based practices, and enabling more efficient use of operating rooms, wards, and workforce.
Conclusions: This review highlights the importance of CPWs in improving care delivery and patient outcomes in orthopedic surgery. Future efforts should refine CPWs, integrate digital tools and platforms, adopt standardized sustainability metrics, and stay flexible to evolving service demands.
[This corrects the article DOI: 10.2196/34453.].
Background: Social media has reshaped health care decision-making; however, its influence on maxillofacial surgeon selection in non-Western contexts such as Iran remains underexplored. Understanding how patients balance digital platforms (eg, Google, Instagram) with traditional referral networks can inform trust dynamics and patient-centered care strategies.
Objective: This study aimed to evaluate the impact of social media compared to personal recommendations on maxillofacial surgeon selection among Iranian patients, assessing decision-making factors, trust perceptions, accuracy concerns, and demographic influences.
Methods: A cross-sectional survey of 384 patients at maxillofacial surgery clinics in Isfahan, Iran (September-November 2023), was conducted using structured questionnaires to collect data on demographics, surgeon selection pathways, social media use, trust, and accuracy concerns. Descriptive statistics, χ2 tests, one-sample t tests, and multiple linear regression were conducted using SPSS Version 26 to analyze platform impact and predictive variables.
Results: Personal recommendations dominated surgeon selection (239/384, 62.2%), significantly outweighing Google (75/384, 19.5%) and Instagram (11/384, 2.9%; χ²=214.3, P<.001). Google and Instagram were used by 160 (41.7%) and 119 (31.0%) patients, respectively; however, their decision-making impact was low with (mean scores: Google 2.27 (0.82), Instagram 2.14 (SD 0.79) on a 1-5 scale; t tests: P<.001). Patient-generated content drove trust, with reviews valued by 144 (37.5%) for Google and 157 (40.9%) for Instagram, and testimonials by 174 (45.3%) for Instagram. Professional credentials influenced 116 (30.2%) participants for Google. Accuracy concerns were moderate; (means values of Google 2.84 (SD 0.91), Instagram 2.85 (SD) 0.88; P<.05). Regression identified recommendations (β=.42, P<.001), credential trust (β=.19, P=.002), and review authenticity (β=.14, P=.02) as predictors, while social media use was not a significant predictor (P=.32). Participants were predominantly female (233/384, 60.7%), aged 21-30 years (117/384, 30.5%), employed (159/384, 41.4%), with moderate income (201/384, 52.3%), and no prior surgery (205/384, 53.4%). Instagram use was higher among younger patients (21-30 years: 48/117, 41.0%; χ²=12.4, P=.006).
Conclusions: Social media plays a supplementary role in the selection of maxillofacial surgeons in Iran, with traditional networks prevailing due to cultural trust and low health literacy (adequacy in 43% patients). The emphasis on credible reviews and credentials underscores the need for verified digital content. Contrasting with the digital reliance on aesthetic surgery, these findings advocate for verified profiles, patient education portals, and culturally tailored strategies to enhance trust and patient-centered care.
Background: Large language models (LLMs) are revolutionizing natural language processing, increasingly applied in clinical settings to enhance preoperative patient education.
Objective: This study aimed to evaluate the effectiveness and applicability of various LLMs in preoperative patient education by analyzing their responses to superior capsular reconstruction (SCR)-related inquiries.
Methods: In total, 10 sports medicine clinical experts formulated 11 SCR issues and developed preoperative patient education strategies during a webinar, inputting 12 text commands into Claude-3-Opus (Anthropic), GPT-4-Turbo (OpenAI), and Gemini-1.5-Pro (Google DeepMind). A total of 3 experts assessed the language models' responses for correctness, completeness, logic, potential harm, and overall satisfaction, while preoperative education documents were evaluated using DISCERN questionnaire and Patient Education Materials Assessment Tool instruments, and reviewed by 5 postoperative patients for readability and educational value; readability of all responses was also analyzed using the cntext package and py-readability-metrics.
Results: Between July 1 and August 17, 2024, sports medicine experts and patients evaluated 33 responses and 3 preoperative patient education documents generated by 3 language models regarding SCR surgery. For the 11 query responses, clinicians rated Gemini significantly higher than Claude in all categories (P<.05) and higher than GPT in completeness, risk avoidance, and overall rating (P<.05). For the 3 educational documents, Gemini's Patient Education Materials Assessment Tool score significantly exceeded Claude's (P=.03), and patients rated Gemini's materials superior in all aspects, with significant differences in educational quality versus Claude (P=.02) and overall satisfaction versus both Claude (P<.01) and GPT (P=.01). GPT had significantly higher readability than Claude on 3 R-based metrics (P<.01). Interrater agreement was high among clinicians and fair among patients.
Conclusions: Claude-3-Opus, GPT-4-Turbo, and Gemini-1.5-Pro effectively generated readable presurgical education materials but lacked citations and failed to discuss alternative treatments or the risks of forgoing SCR surgery, highlighting the need for expert oversight when using these LLMs in patient education.
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