Surgery open science最新文献_第7页

Surgical trainee education in benign anorectal disease: a scoping review 良性肛肠疾病的外科培训生教育：范围综述

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-06-01 DOI: 10.1016/j.sopen.2025.05.001

Eleanor G.R. Watson BSc (Hons), MD , Tony Y. Zhang BBMed , Hwa Ian Ong MBChB, FRACS , David M. Proud MBBS (Hons), FRACS , Helen M. Mohan PhD, FRCSI

Background

Benign anorectal diseases such as haemorrhoids, perianal abscesses and fistulas are prevalent and disabling conditions that can be difficult to diagnose and treat.

This review aims to evaluate current education for training doctors around these diseases to inform the revision and development of surgical curricula.

Materials and methods

A literature search was conducted in MEDLINE, Embase and Google Scholar and data from included articles were charted in a semi-structured table. Quantitative outcomes were presented using simple descriptive statistics. Qualitative data were analysed using a reflexive thematic analysis framework.

Results

Ten studies were included. Most education was centred around haemorrhoids and delivered in the format of lectures and simulations. Harnessing the benefits of both on-demand and in-person content was key to optimising education delivery. In simulation studies, low-fidelity models were generally sufficient to meet educational objectives. There was universal agreement that the purpose of education was to supplement or prepare for clinical exposure, rather than to replace or ‘bridge gaps’ in experience. Education was found to be most useful and relevant when delivered to junior surgical or non-surgical cohorts.

Conclusions

This review elucidates gaps in current literature on benign anorectal disease education and provides recommendations for the development and implementation of future education for surgical trainees. There is a need for education that addresses a broader range of anorectal conditions and has a greater focus on the retention and clinical translation of acquired knowledge and skills. Interventions should be designed to enhance clinical exposure and maintain relevance throughout training progression.

背景：良性肛肠疾病如痔疮、肛周脓肿和瘘管是常见的致残性疾病，很难诊断和治疗。本综述旨在评价目前医生围绕这些疾病的培训教育，为外科课程的修订和发展提供信息。材料与方法在MEDLINE、Embase和谷歌Scholar中进行文献检索，并将纳入文章的数据用半结构化表格绘制。定量结果采用简单的描述性统计。使用反身性专题分析框架对定性数据进行分析。结果纳入10项研究。大多数教育以痔疮为中心，以讲座和模拟的形式进行。利用点播和现场内容的优势是优化教育交付的关键。在模拟研究中，低保真度模型通常足以满足教育目标。人们普遍认为，教育的目的是补充或准备临床接触，而不是取代或“弥合经验差距”。教育被发现是最有用的和相关的，当提供给初级外科或非手术队列。结论本文综述了目前关于肛肠良性疾病教育的文献空白，并对今后外科培训生教育的制定和实施提出了建议。有必要开展针对更广泛的肛肠疾病的教育，并更加注重已获得的知识和技能的保留和临床转化。干预措施的设计应加强临床暴露，并在整个培训过程中保持相关性。

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引用次数: 0

Prevalence of recurrent nerve injury among esophageal cancer patients undergoing esophagectomy: A systematic review and meta-analysis 食管癌切除术患者复发性神经损伤的发生率：系统回顾和荟萃分析

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-05-30 DOI: 10.1016/j.sopen.2025.05.009

Prakasini Satapathy , Abhay M. Gaidhane , Nasir Vadia , Soumya V. Menon , Kattela Chennakesavulu , Rajashree Panigrahi , Ganesh Bushi , Mahendra Singh , Sanjit Sah , Awakash Turkar , S. Govinda Rao , Khang Wen Goh , Muhammed Shabil

Background

Esophageal cancer remains a major cause of cancer-related mortality worldwide, and esophagectomy is a primary curative treatment for localized disease. However, recurrent laryngeal nerve (RLN) injury is a common and impactful complication that can impair vocal cord function, increase aspiration risk, and hinder postoperative recovery. To quantify its prevalence and explore contributing factors, we conducted a systematic review and meta-analysis including 24 studies and 6015 patients. The overall pooled prevalence of RLN injury was 18.36 % (95 % CI, 11.50 %–28.00 %), with substantial heterogeneity (I² = 95.8 %). Subgroup analysis revealed a lower pooled prevalence in robot-assisted minimally invasive esophagectomy (RAMIE) at 13.39 % (95 % CI, 9.28 %–18.95 %) compared to 21.89 % (95 % CI, 12.92 %–34.62 %) in minimally invasive esophagectomy (MIE). Among surgical techniques, the McKeown approach had the highest RLN injury prevalence (26.32 %; 95 % CI, 15.59 %–40.85 %), whereas the Ivor Lewis approach demonstrated a notably lower rate (5.77 %; 95 % CI, 1.00 %–100.00 %). RLN injury was more frequent in studies from low-volume or early-learning curve centers, while high-volume single-center RAMIE cohorts showed both lower prevalence and reduced heterogeneity. Sensitivity analyses supported the robustness of these findings, and publication bias assessment indicated only minor asymmetry (LFK index −1.81). These results highlight the clinical importance of RLN injury and support the role of robotic-assisted techniques, surgical experience, and intraoperative neuromonitoring in mitigating risk. Standardized definitions and procedural training are essential to improving outcomes and reducing the burden of this complication.

食管癌仍然是世界范围内癌症相关死亡的主要原因，食管癌切除术是局部疾病的主要治疗方法。然而，喉返神经（RLN）损伤是一种常见且有影响的并发症，可损害声带功能，增加误吸风险，阻碍术后恢复。为了量化其患病率并探讨影响因素，我们对24项研究和6015例患者进行了系统回顾和荟萃分析。RLN损伤的总总患病率为18.36 %(95 % CI, 11.50 % -28.00 %)，具有很大的异质性（I2 = 95.8 %）。亚组分析显示，机器人辅助微创食管切除术（RAMIE）的总患病率为13.39 %(95 % CI, 9.28 % -18.95 %)，而微创食管切除术（MIE）的总患病率为21.89 %（95 % CI, 12.92 % -34.62 %）。在手术技术中，McKeown入路的RLN损伤发生率最高(26.32 %；95% % CI, 15.59 % -40.85 %)，而Ivor Lewis方法的发生率明显较低(5.77 %；95 % ci, 1.00 % -100.00 %)。RLN损伤在小容量或早期学习曲线中心的研究中更为常见，而大容量的单中心RAMIE队列显示出更低的患病率和更低的异质性。敏感性分析支持这些发现的稳健性，发表偏倚评估显示只有轻微的不对称性（LFK指数- 1.81）。这些结果强调了RLN损伤的临床重要性，并支持机器人辅助技术、手术经验和术中神经监测在降低风险方面的作用。标准化的定义和程序性培训对于改善结果和减轻这种并发症的负担至关重要。

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引用次数: 0

Systematic review and meta-analysis of Transanal Opening of Intersphincteric Space (TROPIS) versus conventional treatments for anal fistula 经肛门括约肌间隙（TROPIS）与传统治疗肛瘘的系统回顾和荟萃分析

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-05-30 DOI: 10.1016/j.sopen.2025.05.010

Yang-Tao Chen , Zhao-Chu Wang, Ya-Meng Xie, Xun Wang, Xu-Xiong Wu, Yang Li, Rong Shi, Jing Wang

Transanal Opening of Intersphincteric Space (TROPIS) has emerged as a promising surgical approach for anal fistula management over recent years. This meta-analysis comprehensively evaluates the comparative efficacy and safety of TROPIS versus conventional treatments through systematic analysis of 24 clinical studies involving 2813 patients. Through systematic searches across 7 major biomedical databases (including PubMed, EMBASE, and Chinese repositories) from inception to March 2024, we identified comparative studies assessing TROPIS against six established interventions: incision-thread-drawing, seton placement, LIFT, EAFR, fistulotomy, and incision-suture techniques. Pooled analysis demonstrated TROPIS achieved superior clinical outcomes, with a 3.15-fold higher total efficacy rate (95 % CI 1.22–8.13, p = 0.02) and 64 % lower complication risk compared to conventional methods (OR 0.28, 95 % CI 0.18–0.42, p < 0.00001). Sensitivity analyses confirmed result stability across study designs, while publication bias assessment via funnel plots and Egger's test revealed no significant distortion. Importantly, TROPIS maintained its advantage across various complication subtypes including incontinence (OR 0.31), infection (OR 0.27), and recurrence (OR 0.19). These findings establish TROPIS as a clinically superior alternative that significantly improves therapeutic outcomes while reducing procedure-related risks, suggesting its potential to become the new reference standard in anal fistula management. The consistent results across diverse patient populations and comparator procedures underscore the robustness of this evidence synthesis.

近年来，经肛门括约肌间隙开放术（TROPIS）已成为肛瘘治疗的一种很有前途的手术方法。本荟萃分析通过对涉及2813例患者的24项临床研究的系统分析，综合评价了TROPIS与常规治疗的比较疗效和安全性。通过对7个主要生物医学数据库（包括PubMed、EMBASE和中文数据库）从成立到2024年3月的系统检索，我们确定了比较研究，评估了TROPIS与六种已建立的干预措施：切口线绘制、seton放置、LIFT、EAFR、瘘切开术和切口缝合技术。合并分析显示，与传统方法相比，TROPIS获得了更好的临床结果，总有效率提高3.15倍（95% CI 1.22-8.13, p = 0.02），并发症风险降低64% (OR 0.28, 95% CI 0.18-0.42, p <；0.00001)。敏感性分析证实了研究设计结果的稳定性，而通过漏斗图和Egger检验进行的发表偏倚评估显示没有显著的失真。重要的是，TROPIS在包括尿失禁（OR 0.31）、感染（OR 0.27）和复发（OR 0.19）在内的各种并发症亚型中保持了优势。这些研究结果表明，TROPIS在临床上是一种优越的选择，可以显著改善治疗结果，同时降低手术相关风险，这表明它有可能成为肛瘘治疗的新参考标准。不同患者群体和比较程序的一致结果强调了这一证据综合的稳健性。

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引用次数: 0

Searching for bacteria within acute cholecystitis using next-generation sequencers 使用新一代测序仪寻找急性胆囊炎中的细菌

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-05-26 DOI: 10.1016/j.sopen.2025.05.006

Tomohiro Otsuka , Yoichi Ishizaki , Jiro Yoshimoto , Kenji Takamori , Shin Watanabe

Introduction

A biliary microbiome comprising flora within normal gallbladders was recently uncovered through analyses targeting the bacterial 16S ribosomal RNA (16S rRNA) gene, despite the gallbladder previously being regarded as a sterile environment. In the present study, we subjected bile samples from patients with acute cholecystitis to gene analysis targeting bacterial flora.

Methods

We targeted patients diagnosed as having Grade I or Grade II acute cholecystitis (in accordance with the Tokyo Guidelines 2018 established by the Japanese Society of Hepato-Biliary-Pancreatic Surgery) who underwent laparoscopic cholecystectomy within 24 h of diagnosis at Juntendo University Urayasu Hospital between July 2021 and January 2024 for evaluation. We drew bile sample from the gallbladder of each patient to confirm the presence of biliary bacterial flora, using both standard bacteriology (culture test) and 16S rRNA gene sequence.

Results

Of the 29 samples, 15 yielded cultures positive for bacterial flora, and gene analysis revealed the presence of bacterial biliary flora in all 14 samples that had tested negative in standard bacteriology. Considering the bacterial flora of a normal gallbladder without lesions as “normal flora,” bacteria other than normal flora—Propionibacterium spp., Coprococcus spp., Prevotella spp., Sediminibacterium spp., and Collinesella spp.—were detected in 25 of the 29 cases (86 %).

Conclusions

Bacteria not detected in non-inflammatory gallbladders such as Propiobacterium spp., Coprococcus spp., Prevotella spp., Sediminibacterium spp., and Collinesella spp. may play a role in the mechanism underlying development of acute cholecystitis.

尽管胆囊以前被认为是无菌环境，但最近通过针对细菌16S核糖体RNA （16S rRNA）基因的分析，发现了正常胆囊中包含菌群的胆道微生物组。在本研究中，我们对急性胆囊炎患者的胆汁样本进行了针对细菌菌群的基因分析。方法：研究对象为诊断为I级或II级急性胆囊炎的患者（根据日本肝胆胰外科学会制定的2018年东京指南），这些患者于2021年7月至2024年1月在俊天道大学浦安医院诊断后24小时内行腹腔镜胆囊切除术进行评估。我们从每位患者的胆囊中抽取胆汁样本，使用标准细菌学（培养试验）和16S rRNA基因序列来确认胆道菌群的存在。结果29份样本中，15份培养菌群呈阳性，基因分析显示14份标准细菌学检测阴性的样本中均存在细菌胆道菌群。考虑到没有病变的正常胆囊的细菌菌群为“正常菌群”，29例患者中有25例（86%）检测到正常菌群以外的细菌——丙酸杆菌、粪球菌、普雷沃氏菌、沉积杆菌和Collinesella。结论非炎性胆囊中未检出的细菌如丙杆菌、粪原球菌、普雷沃氏菌、沉积杆菌和大肠杆菌可能在急性胆囊炎的发生机制中起作用。

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引用次数: 0

Pancreaticoduodenectomy on soft-embalmed human cadavers according to Dodge – a pilot feasibility report 根据道奇的试点可行性报告，对软防腐尸体进行胰十二指肠切除术

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-05-21 DOI: 10.1016/j.sopen.2025.05.005

Dariya Jaeger , Eric Hinrichs , Ralf Schoppe , Gebhard Reiss , Georg Feigl , Benno Mann

Objective

Pancreaticoduodenectomy (PD) is one of the most complex procedures in abdominal surgery. Nowadays, it is very difficult for novice surgeons to learn the procedure of PD on living patients. New concepts are needed to improve the surgical training of PD, comparable to education in the operating room.

Method

We investigated the feasibility of performing PD on a soft embalmed human cadaver using the Dodge preservation technique, considering all operative steps. Surgery was performed by a certified expert. The settings corresponded to the conditions of the operating room with the original surgical instruments and sutures. Upon completion of the PD, feedback in the form of a comprehensive questionnaire was obtained from the expert by evaluating all relevant operational steps in terms of realism using a 5 point Likert scale.

Results

PD was performed successfully by the expert. The results showed very good feasibility for PD on the used Dodge embalmed cadaver (DeC). The expert confirmed a realistic surgical performance similar to real-life conditions, with good color contrast, clearly visible tissue layers for a layered preparation, and a great result for the reconstruction part of the anastomoses.

Conclusions

New educational methods are needed to improve surgical training of PD. Hands-on training of PD performed on DeC enables a realistic surgical experience and offers a promising educational method for training in pancreatic surgery.

目的胰十二指肠切除术（PD）是腹部外科最复杂的手术之一。目前，新手外科医生学习活体PD的操作是非常困难的。需要新的理念来提高PD的手术培训，堪比手术室的教育。方法综合考虑各操作步骤，探讨采用Dodge保存技术对软防腐尸体进行PD的可行性。手术是由一位有资格的专家进行的。设置符合手术室条件，使用原始手术器械和缝合线。PD完成后，通过使用5分李克特量表评估所有相关操作步骤的真实性，从专家那里获得一份全面问卷的反馈。结果专家成功执行了spd。结果表明，在旧道奇防腐尸体（DeC）上应用PD具有良好的可行性。专家确认了与现实生活条件相似的逼真手术表现，具有良好的颜色对比度，分层准备时清晰可见的组织层，以及吻合器重建部分的良好效果。结论需要新的教育方法来提高PD的手术培训水平。在DeC上进行PD的实践培训可以提供真实的手术经验，并为胰腺手术培训提供了一种有前途的教育方法。

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引用次数: 0

Video-based learning for basic surgical skills - A randomized trial 基于视频的基本手术技能学习——一项随机试验

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-05-15 DOI: 10.1016/j.sopen.2025.05.003

I. Dantas , I. Jorge , A. Nicolau , M. Vales , C. Coutinho , S. Rodrigues , P. Febra , V.N. Lopes

Objective

The authors sought to evaluate how video-based learning compares to traditional learning method in basic surgical skills.

Design

Prospective, randomized and blinded case-control study.

Setting

Faculty of Medicine, University of Porto.

Participants and methods

Fifty medical students were randomized into two groups: traditional learning (in-person course) and video-based learning. Four sutures were taught to both groups: simple interrupted, cruciate mattress, horizontal mattress and vertical mattress sutures.

A first evaluation occurred following the learning sessions, and a retention evaluation was performed two weeks later.

Both groups were compared on performance quality (using a modified Objective Structured Assessment of Technical Skills scale (mOSATS)), time to complete the procedure, and participant satisfaction and self-evaluation (using a Likert-like questionnaire). The frequency and duration of autonomous training by the video-based learning group was documented.

Results

Performance quality was similar in the first evaluation, except for the horizontal [25.88 (SD (Standard Deviation) 3.58) vs 28.28 (SD 3.79), p = 0.04] and vertical mattress sutures [24.14 (SD 3.59) vs 28.44 (SD 3.69), p < 0.01], where the video-based learning group got higher mOSATS scores. In the retention evaluation, the video-based learning group demonstrated higher mOSATS ratings.

The time spent learning with videos was 45 min longer [median in hours: 2:15:30 (IQR (Interquartile Range) 2:17:44)] than the in-person course duration. Overall, the traditional learning group completed sutures faster (p < 0.01).

Conclusion

Video-based learning may be an effective alternative to traditional teaching of basic surgical skills, in performance quality and retention, offering better resource allocation and cost savings.

目的评价基于视频的外科基本技能学习方法与传统学习方法的比较。前瞻性、随机、盲法病例对照研究。波尔图大学医学院。参与者和方法50名医学生随机分为两组：传统学习（面对面课程）和基于视频的学习。两组分别教授四种缝合术：简单间断缝合术、十字缝合术、水平缝合术和垂直缝合术。第一次评估在学习课程之后进行，两周后进行记忆力评估。比较两组的表现质量（使用改进的客观结构化技术技能评估量表（mOSATS））、完成程序的时间、参与者满意度和自我评价（使用李克特式问卷）。记录了视频学习组自主训练的频率和持续时间。结果除水平缝[25.88 （SD (Standard Deviation) 3.58）对28.28 (SD 3.79), p = 0.04]和垂直缝[24.14 （SD 3.59）对28.44 (SD 3.69), p <；0.01]，其中视频学习组获得更高的mOSATS分数。在记忆评估中，视频学习组表现出更高的mOSATS评分。视频学习时间比现场学习时间长45分钟[小时中位数：2:15:30（四分位间距：2:17:44）]。总体而言，传统学习组完成缝合的速度更快(p <；0.01)。结论视频教学可有效替代传统的外科基本技能教学，提高教学效果，提高教学质量，节约教学成本。

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引用次数: 0

Importance of social ties in dissemination of Commission on Cancer's synoptic operative report 社会关系在传播癌症委员会天气性手术报告中的重要性

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-05-14 DOI: 10.1016/j.sopen.2025.05.004

Ko Un Park , Mary Brindle , Heather Neuman , Tasleem J. Padamsee , Sarah Birken

In 2020, the Commission on Cancer (CoC) launched templated synoptic element documentation in operative reports (SORs) as an accreditation standard to standardize and document surgical techniques for key portions of cancer operations. The study team identified multi-level factors influencing implementation of CoC's breast cancer SORs, including variations in surgeons' knowledge about the new SOR standard. One identified facilitator of SOR dissemination was social ties. To better understand mechanisms underlying social ties in disseminating breast SORs, we performed secondary analysis of key informant interviews in this study.

Social ties were identified by characterizing the surgeon's relationship to that program's Cancer Liaison Physician (CLP) or surgeon belonging to a CoC affiliate organization (e.g., Cancer Research Program). The CLP serving as each program's designated physician quality leader was also the central actor receiving information directly from the CoC. We found that both the CLP's direct ties to the CoC, and indirect ties (e.g., personal ties to someone with direct ties to the CoC), facilitated early dissemination of information about SORs. Leveraging interorganizational ties and providing guidance to CLPs about how and when to communicate with providers about new standards may facilitate dissemination.

2020年，癌症委员会（CoC）推出了手术报告模板化的概要要素文件（sor），作为一种认证标准，用于标准化和记录癌症手术关键部分的外科技术。研究小组确定了影响CoC乳腺癌SOR实施的多层次因素，包括外科医生对新SOR标准的认识差异。一个确定的促进SOR传播的因素是社会关系。为了更好地理解传播乳腺信息的社会联系机制，我们对本研究中的关键信息提供者访谈进行了二次分析。通过描述外科医生与该计划的癌症联络医师（CLP）或属于CoC附属组织（例如，癌症研究计划）的外科医生的关系来确定社会关系。CLP作为每个项目指定的医生质量领导者，也是直接从CoC接收信息的核心参与者。我们发现CLP与CoC的直接联系和间接联系（例如，与与CoC有直接联系的人的个人联系）都有助于有关sor的信息的早期传播。利用组织间联系，并就如何以及何时与供应商就新标准进行沟通向clp提供指导，可以促进传播。

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引用次数: 0

National Outcomes of Venoarterial Extracorporeal Life Support in Patients with Chronic Kidney Disease 慢性肾病患者静脉动脉体外生命支持的全国结果

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-05-10 DOI: 10.1016/j.sopen.2025.04.011

Oh Jin Kwon , Esteban Aguayo , Kevin Tabibian , Jeffrey Balian , Arjun Chaturvedi , Dariush Yalzadeh , Joseph Hadaya , Yas Sanaiha , Peyman Benharash

Background

Despite the increasing use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as advanced circulatory support for acute cardiac and circulatory failure, its high morbidity and mortality have necessitated the identification of risk factors. The prevalence of chronic kidney disease (CKD) in VA-ECMO patients remains unclear, and its relationship with outcomes is not well established.

Methods

A retrospective analysis was conducted on patients (≥18 years) undergoing VA-ECMO using the 2019–2021 Nationwide Readmissions Database. Patients were stratified into non-CKD, CKD 1–2, and CKD 3–5 based on renal disease severity. Those with end-stage renal disease requiring dialysis or prior renal transplant were excluded. The primary outcome was in-hospital mortality, while perioperative complications were secondarily assessed. Multivariable regression models were employed to assess the associations between CKD severity and outcomes across VA-ECMO indications.

Results

Of an estimated 15,432 included for analysis, 11.7 % had CKD, with 84.7 % categorized as CKD 3–5. Following risk adjustment, CKD 3–5 was independently associated with increased odds of in-hospital mortality (AOR 1.32, 95%CI 1.10–1.59) and overall complications (AOR 1.72, 95%CI 1.09–2.72) compared to non-CKD. Additionally, both CKD 1–2 and CKD 3–5 were linked to increased risks of cardiac and acute renal failure complications. When assessed across VA-ECMO indications, CKD 3–5 was associated with the highest risk-adjusted mortality when used for postcardiotomy shock, cardiogenic shock, and mixed cardiopulmonary support.

Conclusions

Advanced CKD is independently associated with increased mortality and perioperative complications in VA-ECMO patients, highlighting the association between preexisting renal dysfunction and adverse outcomes.

尽管越来越多地使用静脉体外膜氧合（VA-ECMO）作为急性心脏和循环衰竭的高级循环支持，但其高发病率和死亡率使其有必要确定危险因素。VA-ECMO患者中慢性肾脏疾病（CKD）的患病率尚不清楚，其与预后的关系也未得到很好的确定。方法使用2019-2021年全国再入院数据库对接受VA-ECMO的患者（≥18岁）进行回顾性分析。根据肾脏疾病严重程度将患者分为非CKD、CKD 1-2和CKD 3-5。需要透析或既往肾移植的终末期肾病患者被排除在外。主要结果是住院死亡率，其次评估围手术期并发症。采用多变量回归模型评估VA-ECMO适应症中CKD严重程度与预后之间的关系。结果在纳入分析的15,432例患者中，11.7%患有CKD，其中84.7%被归类为CKD 3-5。风险调整后，与非CKD相比，CKD 3-5与住院死亡率（AOR 1.32, 95%CI 1.10-1.59）和总并发症（AOR 1.72, 95%CI 1.09-2.72）的增加独立相关。此外，CKD 1-2和CKD 3-5都与心脏和急性肾功能衰竭并发症的风险增加有关。当对VA-ECMO适应症进行评估时，CKD 3-5在用于开心术后休克、心源性休克和混合心肺支持时与最高的风险调整死亡率相关。结论晚期CKD与VA-ECMO患者死亡率和围手术期并发症的增加独立相关，突出了先前存在的肾功能障碍和不良结局之间的关联。

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引用次数: 0

Dall-E in hand surgery: Exploring the utility of ChatGPT image generation 手外科中的Dall-E：探索ChatGPT图像生成的效用

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-05-10 DOI: 10.1016/j.sopen.2025.04.012

Daniel Soroudi , Daniel S. Rouhani , Alap Patel , Ryan Sadjadi , Reta Behnam-Hanona , Nicholas C. Oleck , Israel Falade , Merisa Piper , Scott L. Hansen

Background

Artificial intelligence (AI) has significantly influenced various medical fields, including plastic surgery. Large language model (LLM) chatbots such as ChatGPT and text-to-image tools like Dall-E and GPT-4o are gaining broader adoption. This study explores the capabilities and limitations of these tools in hand surgery, focusing on their application in patient and medical education.

Methods

Utilizing Google Trends data, common search terms were identified and queried on ChatGPT-4.5 and ChatGPT-3.5 from the following categories: “Hand Anatomy”, “Hand Fracture”, “Hand Joint Injury”, “Hand Tumor”, and “Hand Dislocation”. Responses were graded on a 1–5 scale for accuracy and evaluated using the Flesch-Kincaid Grade Level, Patient Education Materials Assessment Tool (PEMAT), and DISCERN instrument. GPT 4o, DALL-E 3, and DALL-E 2 illustrated visual representations of selected ChatGPT responses in each category, which were further evaluated.

Results

ChatGPT-4.5 achieved a DISCERN overall score of 3.80 ± 0.23. Its responses averaged 91.67 ± 0.29 for PEMAT understandability and 54.67 ± 0.55 for actionability. Accuracy was 4.47 ± 0.52, with a Flesch-Kincaid Grade Level of 9.26 ± 1.04. ChatGPT-4.5 consistently outperformed ChatGPT-3.5 across all evaluation metrics. For text-to-image generation, GPT-4o produced more accurate visuals compared to DALL-E 3 and DALL-E 2.

Conclusions

This study highlights the strengths and limitations of ChatGPT-4.5 and GPT-4o in hand surgery education. While combining accurate text generation with image creation shows promise, these AI tools still need further refinement before widespread clinical adoption.

人工智能（AI）已经对包括整形外科在内的各个医疗领域产生了重大影响。大型语言模型（LLM）聊天机器人（如ChatGPT）和文本到图像的工具（如Dall-E和gpt - 40）正在得到更广泛的采用。本研究探讨了这些工具在手外科手术中的能力和局限性，重点是它们在患者和医学教育中的应用。方法利用谷歌Trends数据，对ChatGPT-4.5和ChatGPT-3.5中“手部解剖”、“手部骨折”、“手部关节损伤”、“手部肿瘤”和“手部脱位”等类别的常用检索词进行识别和查询。回答的准确性分为1-5级，并使用Flesch-Kincaid等级水平、患者教育材料评估工具（PEMAT）和DISCERN仪器进行评估。GPT 40、DALL-E 3和DALL-E 2显示了每个类别中选择的ChatGPT反应的视觉表示，并对其进行进一步评估。结果schatgpt 4.5得分为3.80±0.23分。对PEMAT可理解性的平均反应为91.67±0.29，对可操作性的平均反应为54.67±0.55。准确率为4.47±0.52，Flesch-Kincaid分级水平为9.26±1.04。在所有评估指标上，ChatGPT-4.5始终优于ChatGPT-3.5。对于文本到图像的生成，与DALL-E 3和DALL-E 2相比，gpt - 40产生了更准确的视觉效果。结论本研究突出了ChatGPT-4.5和gpt - 40在手外科教育中的优势和局限性。虽然将准确的文本生成与图像创建相结合显示出前景，但在广泛应用于临床之前，这些人工智能工具仍需要进一步完善。

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引用次数: 0

National trends in utilization and readmission following intraoperative cholangiography in gallstone pancreatitis 胆结石性胰腺炎术中胆道造影后使用率和再入院率的全国趋势

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-05-10 DOI: 10.1016/j.sopen.2025.05.002

Ayesha P. Ng , Troy N. Coaston , Konmal Ali , Christian de Virgilio , Peyman Benharash

Background

In the absence of cholangitis, the role of intraoperative cholangiography (IOC) to exclude retained stones in mild gallstone pancreatitis (GSP) remains controversial. Using a nationally representative database, we examined the contemporary utilization of IOC and index outcomes and readmission following cholecystectomy for GSP.

Methods

All adults undergoing nonelective cholecystectomy for mild GSP in the 2017–2021 Nationwide Readmissions Database were identified. Patients were stratified based on the use of IOC. Multivariable regressions and Royston-Parmar analysis were used to evaluate the association of IOC use with outcomes of interest.

Results

Of 152,687 patients, 24.7 % underwent IOC. Utilization of IOC significantly decreased from 26.5 % to 20.7 % over the study period (p < 0.001). Compared to patients without IOC, IOC patients were older and more commonly treated at high-volume, private hospitals. Following risk adjustment, the odds of major adverse events, including mortality, complications, and bile duct injury repair were comparable between cohorts. Furthermore, length of stay and hospitalization costs were comparable between patients with and without IOC. Notably, IOC was significantly associated with 20 % decreased odds of 90-day readmission for recurrent pancreatitis or retained stone, which persisted over time (AOR 0.80 [95 % CI 0.74–0.86]).

Conclusions

IOC was associated with significantly reduced readmission and comparable resource use following cholecystectomy for GSP. Despite its decreasing utilization, IOC may be a cost-effective strategy to help reduce risk for recurrent biliary disease among patients with mild GSP.

在没有胆管炎的情况下，术中胆管造影（IOC）在轻度胆源性胰腺炎（GSP）中排除结石残留的作用仍然存在争议。使用一个具有全国代表性的数据库，我们检查了IOC的当代使用情况和指数结果以及胆囊切除术后GSP的再入院情况。方法选取2017-2021年全国再入院数据库中所有因轻度GSP接受非选择性胆囊切除术的成年人。根据IOC的使用对患者进行分层。使用多变量回归和Royston-Parmar分析来评估IOC使用与感兴趣的结果的关联。结果152,687例患者中，24.7%接受了IOC。在研究期间，IOC的利用率从26.5%显著下降到20.7% (p <；0.001)。与没有IOC的患者相比，IOC患者年龄较大，更常在大容量的私立医院接受治疗。经过风险调整后，主要不良事件（包括死亡率、并发症和胆管损伤修复）的发生率在队列之间具有可比性。此外，住院时间和住院费用在有和没有IOC的患者之间具有可比性。值得注意的是，IOC与复发性胰腺炎或结石潴留的90天再入院率降低20%显著相关（AOR 0.80 [95% CI 0.74-0.86]）。结论sioc与GSP胆囊切除术后再入院率显著降低和资源利用率相当相关。尽管其使用率下降，但IOC可能是一种具有成本效益的策略，有助于降低轻度GSP患者复发性胆道疾病的风险。

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引用次数: 0