American Surgeon最新文献

ObjectiveOur study aims to compare the performance of different large language model chatbots on surgical questions of different topics and categories.Materials and MethodsFour different chatbots (ChatGPT 4.0, Medical Chat, Google Bard, and Copilot Ai) were used for our study. 114 multiple-choice surgical questions covering 9 different topics were entered into each chatbot, and their answers were recorded.ResultsThe performance of ChatGPT was significantly better than Bard (P < 0.0001) and Medical Chat (P = 0.0013) but not significantly better than Copilot (P = 0.9663). We also found a statistically significant difference in ENT (P = 0.0199) and GI (P = 0.0124) questions between each chatbot when we assessed their performances per surgical specialty. Finally, the mean scores of Bard, Copilot, Medical Chat, and ChatGPT 4.0 on the diagnosis questions were higher than those in the management questions. The difference was only statistically significant, however, for Bard (P = 0.0281).ConclusionOur study offers insight into the performance of different chatbots on surgery-related questions and topics. The strengths and shortcomings of each can provide us with a better understanding of how to use Chatbots in the surgical field, including surgical education.

Introduction: Peritoneal mesothelioma (PM) is a rare cancer associated with high mortality. No studies exist using the National Cancer Database (NCDB) that have examined factors associated with long-term survival (LTS). Methods: NCDB 2006-2019 was queried for patients with PM. Primary objective was to determine the characteristics of LTS among patients with peritoneal mesothelioma. Secondary objective: identified predictors of LTS were then used to develop and internally validate a nomogram to predict the probability of LTS among patients. LTS was defined as 5 or more years of survival after diagnosis. Univariate and multivariate logistic analyses were performed. Results: The study included 3,636 patients with PM, 17.8% had LTS. The median survival time was 17.7 months. For LTS, the median survival time was ∼92 months while the median survival time of non-long-term survivors (NLTS) was 11.7 months. Following factors were common with LTS patients compared to the NLTS: female, younger, privately insured, treatment at academic/research institutions and treatment at high case volume institutions, Charlson-Deyo comorbidity score of 0, receiving radical surgery, receiving chemotherapy, greater proportion of grade 1 disease, negative lymph nodes, and lower rates of lymphovascular invasion (P < .001). The nomogram included age, gender, and surgical margins. Conclusion: A subset of PM patients can be long-term survivors with effective patient selection and appropriate care. This study highlights critical factors that influence LTS, paving the way for personalized treatment strategies and enhanced prognostication. Further research is needed to improve patient selection and ensure patients likely to be LTS receive adequate care.

ObjectiveThis study aimed to examine the effect of surgical approach on the incidence of early asymptomatic deep vein thrombosis (DVT) following inguinal hernia surgery and to evaluate additional factors influencing postoperative asymptomatic DVT formation. The study seeks to provide guidance and support for the diagnosis and treatment of early postoperative asymptomatic DVT.MethodsThe present study is a retrospective study. Our study finally included 565 patients with inguinal hernia divided into laparoscopic and open surgery groups. Bilateral lower extremity venous Doppler ultrasonography was performed on the second postoperative day to document the occurrence of asymptomatic DVT in the early postoperative period. A 1:1 matching was performed using propensity score matching (PSM). Independent factors affecting early postoperative asymptomatic DVT were determined using multivariate binary logistic regression analysis.ResultsThere were 565 patients, in which 317 underwent laparoscopic surgery and 248 underwent open surgery. Propensity score matching yielded 102 matched pairs for further analysis. In multivariate analysis, bilateral hernias (OR = 50.546, 95% CI 2.277-1122.159, P = 0.013) and total length of stay (OR = 1.807, 95% CI 1.239-2.634, P = 0.002) were identified as independent risk factors for early postoperative asymptomatic DVT, whereas preoperative length of stay (OR = 0.341, 95% CI 0.162-0.719, P = 0.005) and operation time (OR = 0.965, 95% CI 0.936-0.995, P = 0.021) served as protective factors. There was no significant impact of laparoscopic or open surgery on the incidence of early postoperative asymptomatic DVT (OR = 1.808, 95% CI: 0.288-11.361, P = 0.528).ConclusionThe choice of laparoscopic vs open inguinal hernia repair did not significantly affect the incidence of early postoperative asymptomatic DVT. In this study, effective perioperative management, whether through preoperative admission to manage significant comorbidities or a reduced overall length of stay, lowered the incidence of early postoperative asymptomatic DVT, particularly in patients with bilateral inguinal hernias.

IntroductionThe burden of traumatic injury in the United States continues to outpace the rate of trauma surgeons entering practice within a larger surgical workforce crisis. Furthermore, a trauma length of stay can be prolonged by many nonsurgical factors, including nonsurgical procedures, medical comorbidities, and socioeconomic barriers to discharge. We hypothesize that using a time-series analysis to predict the likelihood of surgeon-directed procedures can aid trauma centers in redesigning the trauma workflow and more efficiently deploying surgical resources.MethodsWe performed a single-institution, retrospective cohort study, including adult (≥18 years) trauma patients admitted to a level 1 trauma center between 2018 and 2022. Hospital billing and charge data were collected to determine procedure-level data. Procedures were classified as surgeon-directed or non-surgeon-directed. Probabilities were generated based on the likelihood of patients remaining hospitalized and requiring a surgeon-directed procedure.Results7382 patients underwent 3138 unique procedures. Of these patients, 6095 (82.6%) had at least one surgeon-directed procedure; 1287 (17.4%) had no surgeon-directed procedure. The length of stay was marginally longer in patients who underwent surgeon-directed procedures. For all patients, the likelihood of needing a surgeon-directed procedure declines each day of admission but stabilizes after day 5.ConclusionsIn our population, the surgical to nonsurgical transition during a trauma admission occurs after day 5. However, this may vary across institutions and not apply to patients requiring complex surgical intervention. Our methods can be used to structure and optimize the deployment of surgical resources only during the period with the highest surgical need.

BackgroundLaparoscopic common bile duct exploration (LCBDE) is underutilized by surgeons to treat choledocholithiasis. We hypothesized that fellowship training in acute care surgery (ACS) vs minimally invasive surgery (MIS) results in different LCBDE practices and perceptions, thus producing unique barriers to implementation.MethodsA survey was distributed by email to members of Society of American Gastrointestinal and Endoscopic Surgeons and the American Association for the Surgery of Trauma to assess surgeon demographics, surgeon-specific perceptions, practice patterns, and barriers to LCBDE utilization. Categorical data were compared with Pearson's chi-square, and continuous parametric data were compared with a t test.Results543 US surgeons who perform laparoscopic cholecystectomy completed the survey. Of all, 124 survey respondents were ACS trained and 175 were MIS trained. Similar proportions of MIS and ACS surgeons prefer to manage choledocholithiasis with LCBDE (28% vs 27%, P = 0.79). The most utilized LCBDE technique was choledochoscopy (71% vs 69%, P = 0.17). MIS surgeons more frequently perform intraoperative cholangiogram (IOC) compared to ACS surgeons (P = 0.02). A third of MIS surgeons felt that LCBDE is too time consuming to be of value, vs 25% of ACS surgeons (P = 0.37). When asked if LCBDE is difficult to master, 56% of MIS surgeons agreed compared to 32% of ACS surgeons (P < 0.01).DiscussionBoth MIS and ACS surgeons utilize LCBDE infrequently despite responding that choledocholithiasis should be managed by surgeons. Compared to MIS, fewer ACS surgeons consider time to perform LCBDE and difficulty as barriers. Understanding these barriers can influence education and efforts toward increasing adoption in both groups.

Ineffective esophageal motility (IEM) related to gastroesophageal reflux disease (GERD) presents unique treatment challenges. Our study evaluates symptom outcomes in patients with IEM due to GERD undergoing laparoscopic anti-reflux surgery (LARS) to determine the incidence of subjective symptomatic improvement and evidence of worsened dysphagia. Following institutional review board (IRB) approval, we retrospectively evaluated patients who underwent LARS for GERD who demonstrated IEM on pre-operative high-resolution manometry (HRM) based on the Chicago 3 classification and evaluated symptom resolution at post-operative visits. 29 patients with IEM underwent LARS with the most frequent presenting complaints being regurgitation (24/29, 83%) and dysphagia (21/29, 72%). In patients presenting with dysphagia, 70.8% reported resolution at the first post-operative visit. The mean rate of resolution of dysphagia and regurgitation by the last follow-up was 78% and 85.7%, respectively. Laparoscopic anti-reflux surgery for IEM due to GERD resulted in subjective improvement in presenting symptoms including dysphagia and regurgitation with minimal complications and no generation of new post-operative dysphagia.

Through new and astonishing capabilities of artificial intelligence, the editors of The American Surgeon have been able to step back in time and conduct a virtual interview with the most eponymous surgeon in history: Allen Oldfather Whipple. We caught up with Dr. Whipple on September 2nd, 1946, shortly after completing the final operation of his surgical career; not surprisingly, a pancreaticoduodenectomy.

BackgroundTo evaluate comparative outcomes of wound infusion catheter (WC) vs epidural analgesia (EP) for analgesia following midline laparotomy for abdominal surgery.MethodsA systematic search of PubMed, Cochrane Library, and Scopus was conducted, and all randomised controlled trials (RCTs) comparing WC vs EP for analgesia after midline laparotomy were included. Overall pain scores, total morphine consumption, respiratory depression, catheter-related complications, time of first bowel movement, and length of hospital stay (LOS) were set as outcome parameters for the meta-analysis. Subgroups of catheter positions, including preperitoneal, rectus sheath and transversus abdominis plane block as deep WC and subcutaneous WC, were examined for pain scores superiority.ResultsTwelve RCTs were pooled in a meta-analysis, involving a total of 778 patients who received WC (n = 390) or EP (n = 388). There was no significant difference in pain scores at rest and movement between WC and EP groups at 24 hours [P = .85 and P = .30, respectively] and 48 hours [P = .33 and P = .06, respectively]. However, subgroup analysis, excluding subcutaneous catheters, showed favourable pain scores on movement at 48 hours of use (mean difference [MD] -0.97, P = .03). The LOS was notably shorter in the WC group [MD, -0.50; P < .001]. There were no significant differences between both groups in cumulative morphine consumption [P = .33], return of bowel function [P = .13], respiratory depression [P = .43], or catheter-related complications [P = .16].ConclusionWC generally provides a comparable postoperative analgesia to EP; however, it is associated with shorter LOS and a slight superiority of analgesia of deep catheters. Comparing different types of nerve blocks and positions of catheters in future research may optimise the use of WC.

Sex-based differences in rib fracture presentation and recovery may influence surgical stabilization of rib fractures (SSRF) outcomes. Greater chest wall muscle mass in males may necessitate higher-energy trauma to cause rib fractures, increasing the risk of respiratory complications.

Objective: We compared the rates of SSRF in male and female blunt trauma patients (BTPs) with rib fractures, hypothesizing that males would undergo SSRF at a higher rate and experience increased respiratory complications following SSRF.

Methods: TQIP (2017-2022) was queried for adult BTPs with multiple rib fractures and/or flail segment. Male SSRF BTPs were compared to female SSRF BTPs. Multivariable logistic regression analysis was performed to determine if sex was associated with an increased risk of respiratory complications [unplanned intubation, acute respiratory distress syndrome (ARDS), and ventilator-associated pneumonia (VAP)].

Results: The rate of SSRF in males was 3.1% and 2.3% in females (P < .001). From 20 487 SSRF patients, 15 086 (74%) were male. Both groups had similar median injury severity scores (ISS) of 17; however, males had higher rates of severe thoracic injury (34.7% vs 31.1%, P < .001). Males had higher rates of overall respiratory complications (13.0% vs 10.3%) including ARDS (1.9% vs 1.3%), VAP (3.9% vs 2.4%), and unplanned intubation (7.8% vs 6.8%) (all P < .05). On multivariable analysis, males had an increased risk of respiratory complications (OR 1.37, CI 1.24-1.52, P < .001) and mortality (OR 1.33, CI 1.07-1.65, P = .01).

Conclusion: Despite comparable ISS, males more frequently underwent SSRF and had increased risk of respiratory complications and mortality post-operatively. These disparities may reflect underlying anatomical/physiological factors.

ObjectiveTo evaluate the impact of metabolic and bariatric surgery (MBS) on plasma Fetuin-A expression, body mass index (BMI), and glucose levels in patients with obesity.MethodsA systematic literature search was performed in PubMed, Cochrane Library, Web of science, and Embase following the PRISMA guidelines. A total of 5 studies (n = 298 participants) were included, reporting pre- and post-surgery plasma Fetuin-A levels, BMI, and glucose levels. Two independent reviewers extracted data, with discrepancies resolved by a third reviewer. Pooled standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated for each outcome. Heterogeneity was assessed using the I² statistic.ResultsThe pooled results revealed a significant reduction in plasma Fetuin-A levels post-surgery (SMD = -0.43, 95% CI = -0.73 to -0.14, P < .05, I² = 60.7%). BMI also decreased significantly following MBS (SMD = -1.74, 95% CI = -2.28 to -1.19, P < .05, I² = 84.2%). Additionally, glucose levels showed a marked reduction post-surgery (SMD = -0.94, 95% CI = -1.12 to -0.76, P < .05, I² = 16.2%).ConclusionMBS is associated with significant reductions in plasma Fetuin-A levels, BMI, and glucose levels. These findings indicate that changes in Fetuin-A may accompany the metabolic improvements observed after MBS, although causal mechanisms cannot be established from the available evidence.