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.
{"title":"Searching for bacteria within acute cholecystitis using next-generation sequencers","authors":"Tomohiro Otsuka , Yoichi Ishizaki , Jiro Yoshimoto , Kenji Takamori , Shin Watanabe","doi":"10.1016/j.sopen.2025.05.006","DOIUrl":"10.1016/j.sopen.2025.05.006","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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—<em>Propionibacterium</em> spp., <em>Coprococcus</em> spp., <em>Prevotella</em> spp., <em>Sediminibacterium</em> spp., and <em>Collinesella</em> spp.—were detected in 25 of the 29 cases (86 %).</div></div><div><h3>Conclusions</h3><div>Bacteria not detected in non-inflammatory gallbladders such as <em>Propiobacterium</em> spp., <em>Coprococcus</em> spp., <em>Prevotella</em> spp., <em>Sediminibacterium</em> spp., and <em>Collinesella</em> spp. may play a role in the mechanism underlying development of acute cholecystitis.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 113-118"},"PeriodicalIF":1.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144147269","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 : 2025-05-21DOI: 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.
{"title":"Pancreaticoduodenectomy on soft-embalmed human cadavers according to Dodge – a pilot feasibility report","authors":"Dariya Jaeger , Eric Hinrichs , Ralf Schoppe , Gebhard Reiss , Georg Feigl , Benno Mann","doi":"10.1016/j.sopen.2025.05.005","DOIUrl":"10.1016/j.sopen.2025.05.005","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Method</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 107-112"},"PeriodicalIF":1.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124752","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 : 2025-05-15DOI: 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。
{"title":"Video-based learning for basic surgical skills - A randomized trial","authors":"I. Dantas , I. Jorge , A. Nicolau , M. Vales , C. Coutinho , S. Rodrigues , P. Febra , V.N. Lopes","doi":"10.1016/j.sopen.2025.05.003","DOIUrl":"10.1016/j.sopen.2025.05.003","url":null,"abstract":"<div><h3>Objective</h3><div>The authors sought to evaluate how video-based learning compares to traditional learning method in basic surgical skills.</div></div><div><h3>Design</h3><div>Prospective, randomized and blinded case-control study.</div></div><div><h3>Setting</h3><div>Faculty of Medicine, University of Porto.</div></div><div><h3>Participants and methods</h3><div>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.</div><div>A first evaluation occurred following the learning sessions, and a retention evaluation was performed two weeks later.</div><div>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.</div></div><div><h3>Results</h3><div>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), <em>p</em> = 0.04] and vertical mattress sutures [24.14 (SD 3.59) vs 28.44 (SD 3.69), <em>p</em> < 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.</div><div>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 (<em>p</em> < 0.01).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 94-106"},"PeriodicalIF":1.4,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144107461","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 : 2025-05-14DOI: 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.
{"title":"Importance of social ties in dissemination of Commission on Cancer's synoptic operative report","authors":"Ko Un Park , Mary Brindle , Heather Neuman , Tasleem J. Padamsee , Sarah Birken","doi":"10.1016/j.sopen.2025.05.004","DOIUrl":"10.1016/j.sopen.2025.05.004","url":null,"abstract":"<div><div>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.</div><div>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.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 61-63"},"PeriodicalIF":1.4,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070060","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 : 2025-05-10DOI: 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.
{"title":"National Outcomes of Venoarterial Extracorporeal Life Support in Patients with Chronic Kidney Disease","authors":"Oh Jin Kwon , Esteban Aguayo , Kevin Tabibian , Jeffrey Balian , Arjun Chaturvedi , Dariush Yalzadeh , Joseph Hadaya , Yas Sanaiha , Peyman Benharash","doi":"10.1016/j.sopen.2025.04.011","DOIUrl":"10.1016/j.sopen.2025.04.011","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on patients (≥18 years) undergoing VA-ECMO using the 2019–2021 Nationwide Readmissions Database. Patients were stratified into <em>non-CKD</em>, <em>CKD 1–2</em>, and <em>CKD 3–5</em> 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.</div></div><div><h3>Results</h3><div>Of an estimated 15,432 included for analysis, 11.7 % had CKD, with 84.7 % categorized as <em>CKD 3–5</em>. Following risk adjustment, <em>CKD 3–5</em> 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 <em>non-CKD</em>. Additionally, both <em>CKD 1–2</em> and <em>CKD 3–5</em> were linked to increased risks of cardiac and acute renal failure complications. When assessed across VA-ECMO indications, <em>CKD 3–5</em> was associated with the highest risk-adjusted mortality when used for postcardiotomy shock, cardiogenic shock, and mixed cardiopulmonary support.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 87-93"},"PeriodicalIF":1.4,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070059","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 : 2025-05-10DOI: 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.
{"title":"Dall-E in hand surgery: Exploring the utility of ChatGPT image generation","authors":"Daniel Soroudi , Daniel S. Rouhani , Alap Patel , Ryan Sadjadi , Reta Behnam-Hanona , Nicholas C. Oleck , Israel Falade , Merisa Piper , Scott L. Hansen","doi":"10.1016/j.sopen.2025.04.012","DOIUrl":"10.1016/j.sopen.2025.04.012","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 64-78"},"PeriodicalIF":1.4,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070057","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 : 2025-05-10DOI: 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。
{"title":"National trends in utilization and readmission following intraoperative cholangiography in gallstone pancreatitis","authors":"Ayesha P. Ng , Troy N. Coaston , Konmal Ali , Christian de Virgilio , Peyman Benharash","doi":"10.1016/j.sopen.2025.05.002","DOIUrl":"10.1016/j.sopen.2025.05.002","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>Of 152,687 patients, 24.7 % underwent IOC. Utilization of IOC significantly decreased from 26.5 % to 20.7 % over the study period (<em>p</em> < 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]).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 79-86"},"PeriodicalIF":1.4,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070058","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 : 2025-04-30DOI: 10.1016/j.sopen.2025.04.008
Zeyu Liu BS , Saad Mallick MD , Nam Yong Cho BS , Esteban Aguayo MD , Mahima Chillakanti BS , Giselle Porter BS , Konmal Ali , Joseph Song BS , Areti Tillou MD , Peyman Benharash MD
Background
With advances in imaging and interventional techniques, traumatic injuries are increasingly managed non-operatively. However, the impact of frailty on outcomes of non-operatively managed traumatic injuries remains generally unexplored. Using a national cohort, we characterized the association of frailty with clinical and financial outcomes of non-operative trauma hospitalizations.
Methods
We identified all adult (≥18 years) hospitalizations for traumatic injuries using the 2019–2021 Nationwide Readmissions Database. Only patients who did not undergo major operations were considered. Patients were then stratified into three frailty groups based on the validated Hospital Frailty Risk Score. Multivariable models were subsequently developed to assess the association of frailty with various clinical and financial outcomes.
Results
Of an estimated 2,818,070 hospitalizations for non-operative trauma, 18.6 % were classified as low frailty (LF), 57.0 % as intermediate frailty (IF), and 24.4 % as high frailty (HF). Following risk adjustment, compared to LF, IF (Adjusted Odds Ratio [AOR] 2.4; 95 % Confidence Interval [CI], 2.0–3.0) and HF (AOR 3.3; 95 % CI, 2.7–4.1) were associated with greater odds of in-hospital mortality. Similarly, risks of major complications and non-home discharge elevated in a stepwise fashion. Furthermore, IF patients experienced an incremental increase in LOS of 1.3 days (95%CI, 1.2–1.4 days) and costs of $3200 (95 % CI, $3100–$3400) while HF patients had a prolonged LOS by 5.1 days (95 % CI, 4.8–5.2 days) and higher costs by $11,300 (95 % CI, $11,000-11,600).
Conclusion
Our findings showed frailty status to be associated with adverse clinical outcomes and increase resource utilization among hospitalizations for non-operative trauma.
{"title":"Association of frailty with clinical and financial outcomes of hospitalization for non-operative trauma","authors":"Zeyu Liu BS , Saad Mallick MD , Nam Yong Cho BS , Esteban Aguayo MD , Mahima Chillakanti BS , Giselle Porter BS , Konmal Ali , Joseph Song BS , Areti Tillou MD , Peyman Benharash MD","doi":"10.1016/j.sopen.2025.04.008","DOIUrl":"10.1016/j.sopen.2025.04.008","url":null,"abstract":"<div><h3>Background</h3><div>With advances in imaging and interventional techniques, traumatic injuries are increasingly managed non-operatively. However, the impact of frailty on outcomes of non-operatively managed traumatic injuries remains generally unexplored. Using a national cohort, we characterized the association of frailty with clinical and financial outcomes of non-operative trauma hospitalizations.</div></div><div><h3>Methods</h3><div>We identified all adult (≥18 years) hospitalizations for traumatic injuries using the 2019–2021 Nationwide Readmissions Database. Only patients who did not undergo major operations were considered. Patients were then stratified into three frailty groups based on the validated Hospital Frailty Risk Score. Multivariable models were subsequently developed to assess the association of frailty with various clinical and financial outcomes.</div></div><div><h3>Results</h3><div>Of an estimated 2,818,070 hospitalizations for non-operative trauma, 18.6 % were classified as low frailty (LF), 57.0 % as intermediate frailty (IF), and 24.4 % as high frailty (HF). Following risk adjustment, compared to LF, IF (Adjusted Odds Ratio [AOR] 2.4; 95 % Confidence Interval [CI], 2.0–3.0) and HF (AOR 3.3; 95 % CI, 2.7–4.1) were associated with greater odds of in-hospital mortality. Similarly, risks of major complications and non-home discharge elevated in a stepwise fashion. Furthermore, IF patients experienced an incremental increase in LOS of 1.3 days (95%CI, 1.2–1.4 days) and costs of $3200 (95 % CI, $3100–$3400) while HF patients had a prolonged LOS by 5.1 days (95 % CI, 4.8–5.2 days) and higher costs by $11,300 (95 % CI, $11,000-11,600).</div></div><div><h3>Conclusion</h3><div>Our findings showed frailty status to be associated with adverse clinical outcomes and increase resource utilization among hospitalizations for non-operative trauma.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 47-53"},"PeriodicalIF":1.4,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143903636","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 : 2025-04-29DOI: 10.1016/j.sopen.2025.04.010
Saad Mallick MD , Sara Sakowitz MS MPH , Syed Shahyan Bakhtiyar MD MBE , Nam Yong Cho BS , Troy Coaston BS , Esteban Aguayo MD , Peyman Benharash MD
Background
Racial health disparities are responsible for ∼$50 billion in excess annual healthcare expenditures, driven in part by unequal access to preventive services. We thus studied cost differences in abdominal aortic aneurysm repair (AAA), coronary artery bypass graft (CABG), and colon resection for malignancy (COL), as the elective status of these procedures suggest greater access to preventive care and screening.
Methods
All adult hospitalizations for AAA, CABG, and COL were identified using the 2011–2020 National Inpatient Sample. Generalized linear models were developed to assess cost differences for emergent versus elective surgeries across different racial groups.
Results
Of an estimated 3,069,339 patients, 1,300,717 (42.4%) underwent an emergent operation. The proportion of procedures performed emergently increased from 39.4 in 2011 to 44.5% in 2020 (p < 0.001). After risk adjustment, emergent procedures were associated with a $13,645 (95%CI 13,470-13,820) increment in per-patient hospitalization costs compared with elective, representing a 33% relative difference. The overall adjusted cost difference of emergent surgery was higher for Black ($15,552), Hispanic ($14,525), and Asian/Pacific Islanders ($16,887) patients as compared to White patients ($13,086; all p < 0.001). Emergent surgery was associated with increased adjusted odds of experiencing in-hospital mortality and all major examined postoperative complications, as well as being linked with increased length of stay.
Conclusions
Over a decade, the conversion of only 10% of such procedures to planned elective cases would be associated with $1,774,882,977 in cost savings nationally. With racial minorities experiencing the maximal detriment both clinically and financially, implementing proven strategies can help reduce race-based disparities and annual healthcare expenditures.
{"title":"Race based disparities in clinical and financial outcomes associated with major elective and emergent surgery","authors":"Saad Mallick MD , Sara Sakowitz MS MPH , Syed Shahyan Bakhtiyar MD MBE , Nam Yong Cho BS , Troy Coaston BS , Esteban Aguayo MD , Peyman Benharash MD","doi":"10.1016/j.sopen.2025.04.010","DOIUrl":"10.1016/j.sopen.2025.04.010","url":null,"abstract":"<div><h3>Background</h3><div>Racial health disparities are responsible for ∼$50 billion in excess annual healthcare expenditures, driven in part by unequal access to preventive services. We thus studied cost differences in abdominal aortic aneurysm repair (AAA), coronary artery bypass graft (CABG), and colon resection for malignancy (COL), as the elective status of these procedures suggest greater access to preventive care and screening.</div></div><div><h3>Methods</h3><div>All adult hospitalizations for AAA, CABG, and COL were identified using the 2011–2020 National Inpatient Sample. Generalized linear models were developed to assess cost differences for emergent versus elective surgeries across different racial groups.</div></div><div><h3>Results</h3><div>Of an estimated 3,069,339 patients, 1,300,717 (42.4%) underwent an emergent operation. The proportion of procedures performed emergently increased from 39.4 in 2011 to 44.5% in 2020 (<em>p</em> < 0.001). After risk adjustment, emergent procedures were associated with a $13,645 (95%CI 13,470-13,820) increment in per-patient hospitalization costs compared with elective, representing a 33% relative difference. The overall adjusted cost difference of emergent surgery was higher for Black ($15,552), Hispanic ($14,525), and Asian/Pacific Islanders ($16,887) patients as compared to White patients ($13,086; all <em>p</em> < 0.001). Emergent surgery was associated with increased adjusted odds of experiencing in-hospital mortality and all major examined postoperative complications, as well as being linked with increased length of stay.</div></div><div><h3>Conclusions</h3><div>Over a decade, the conversion of only 10% of such procedures to planned elective cases would be associated with $1,774,882,977 in cost savings nationally. With racial minorities experiencing the maximal detriment both clinically and financially, implementing proven strategies can help reduce race-based disparities and annual healthcare expenditures.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 39-46"},"PeriodicalIF":1.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143900356","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 : 2025-04-29DOI: 10.1016/j.sopen.2025.04.009
Mesut Kocaman , Stephen Johnston , Mosadoluwa Afolabi , Walter Danker , Fiona Adshead
Background
Minimizing avoidable healthcare resource use can support a move towards more sustainable healthcare systems. Few studies have sought to evaluate the environmental impact of complications associated with specific surgical procedures. The aim of this study was to assess the environmental impact associated with disruptive surgical bleeding across a broad range of procedures.
Methods
The environmental impact assessment was performed using clinical and healthcare resource use data from a retrospective database analysis of patients with disruptive bleeding across nine procedures. Emissions data from the Sustainable Healthcare Coalition were sourced for the relevant resource use activities and used to calculate the climate, water and waste impact associated with disruptive surgical bleeding.
Results
Across the procedures of interest, surgical bleeding was shown to incur a mean environmental impact of 167 kg CO2e, 267 m3 water use and 20 kg waste. Considering the incidence of disruptive bleeding per 1000 procedures, treatment of bleeding during valve procedures was associated with the highest environmental impact due to the high proportion of patients in which this complication occurs (44 %). Achieving effective and timely control of surgical bleeding events and reducing their incidence by 50 % could save up to 49 tons of CO₂e, 77,082 m3 of water use, and 6.3 tons of waste per 1000 surgical procedures.
Conclusions
Surgical bleeding is associated with a substantial environmental impact. This study demonstrates the potential to use existing resource use data associated with specific healthcare activities to assess their environmental impact, helping to identify key areas for improvement in the sustainability of surgical departments.
{"title":"Assessing the environmental impact associated with disruptive surgical bleeding","authors":"Mesut Kocaman , Stephen Johnston , Mosadoluwa Afolabi , Walter Danker , Fiona Adshead","doi":"10.1016/j.sopen.2025.04.009","DOIUrl":"10.1016/j.sopen.2025.04.009","url":null,"abstract":"<div><h3>Background</h3><div>Minimizing avoidable healthcare resource use can support a move towards more sustainable healthcare systems. Few studies have sought to evaluate the environmental impact of complications associated with specific surgical procedures. The aim of this study was to assess the environmental impact associated with disruptive surgical bleeding across a broad range of procedures.</div></div><div><h3>Methods</h3><div>The environmental impact assessment was performed using clinical and healthcare resource use data from a retrospective database analysis of patients with disruptive bleeding across nine procedures. Emissions data from the Sustainable Healthcare Coalition were sourced for the relevant resource use activities and used to calculate the climate, water and waste impact associated with disruptive surgical bleeding.</div></div><div><h3>Results</h3><div>Across the procedures of interest, surgical bleeding was shown to incur a mean environmental impact of 167 kg CO<sub>2</sub>e, 267 m<sup>3</sup> water use and 20 kg waste. Considering the incidence of disruptive bleeding per 1000 procedures, treatment of bleeding during valve procedures was associated with the highest environmental impact due to the high proportion of patients in which this complication occurs (44 %). Achieving effective and timely control of surgical bleeding events and reducing their incidence by 50 % could save up to 49 tons of CO₂e, 77,082 m<sup>3</sup> of water use, and 6.3 tons of waste per 1000 surgical procedures.</div></div><div><h3>Conclusions</h3><div>Surgical bleeding is associated with a substantial environmental impact. This study demonstrates the potential to use existing resource use data associated with specific healthcare activities to assess their environmental impact, helping to identify key areas for improvement in the sustainability of surgical departments.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"26 ","pages":"Pages 54-60"},"PeriodicalIF":1.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143907793","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号