Surgical Innovation最新文献

{"title":"Evaluation of Veress Needle as a Liver Retraction Technique in Laparoscopic Sleeve Gastrectomy.","authors":"Suleyman Caglar Ertekin, Gökhan Akbulut, Emre Turgut, Hüseyin Akyol, Muhammer Ergenç, Cumhur Yeğen","doi":"10.1177/15533506241305894","DOIUrl":"10.1177/15533506241305894","url":null,"abstract":"<p><p>BackgroundLiver retraction management in laparoscopic sleeve gastrectomy (LSG) is challenging for surgeons, especially in patients with enlarged livers. Traditional methods, such as the Nathanson retractor (NR), often necessitate additional incisions, potentially increasing liver enzymes and increasing the risk of complications. The aim of this study was to evaluate the efficacy of the use of a Veress needle (VN), an alternative liver retraction technique, in LSG surgery compared with NR.Materials and MethodsThis study was conducted at a university-affiliated hospital between May 2022 and December 2022. Patients who underwent LSG were divided into two groups: one utilizing the NR and the other employing the VN for liver retraction. Parameters such as operation duration, retraction time, liver laceration, trocar-induced hemorrhage, subxiphoid trocar site infections, pain scores measured via the visual analog scale (VAS) at various time points, pre- and postoperative liver enzyme levels (AST, ALT, GGT, ALP) and CRP levels were analyzed.ResultsData from 151 patients were analyzed. The AST/ALT elevations (<i>P</i> < 0.001) were significantly lower in the VN group (73 patients) than in the NR group (78 patients), while there was no significant difference in GGT/ALP levels. Retraction-related bleeding was significantly greater in the NR group than in the VN group (6.4% vs 0%, <i>P</i> = 0.035). Postoperative infection rate was lower in the VN group but not statistically significant (0% vs 3.8%, <i>P</i> = 0.135). CRP differences were significant on the first postoperative day (<i>P</i> < 0.001). Postoperative VAS scores were significantly lower in the VN group at all measured time points except at the 48th hour and 10th day.ConclusionsThe VN technique in LSG significantly reduces liver enzyme elevation and the need for an extra trocar and incision, potentially lowering complication risk and enhancing patient outcomes.</p>","PeriodicalId":22095,"journal":{"name":"Surgical Innovation","volume":" ","pages":"85-93"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First Experience with the NPseal®: A Novel Mechanically Powered Negative Pressure Dressing Applied to Colorectal Surgery Wounds.","authors":"Johnny Wang, Brian Williams, Jordan R Wlodarczyk, Abhinav Gupta, Debora Kim, Kyle G Cologne, Sarah E Koller, Christine Hsieh, Marjun P Duldulao, Joongho Shin","doi":"10.1177/15533506241307729","DOIUrl":"10.1177/15533506241307729","url":null,"abstract":"<p><p>BackgroundThe use of prophylactic closed-incisional negative pressure wound therapy after colorectal procedures has been shown to reduce postoperative wound complications and surgical site infection. We present our experience with a novel, closed-incision, mechanically powered negative pressure (MP-NPD) dressing after colorectal procedures.MethodsThis was a prospective, single-center, single-arm observational study assessing patient reported and wound healing outcomes of colorectal surgical incisions dressed with a MP-NPD. Consecutive patients, 18 years and older, that met inclusion criteria were enrolled between May 2021 and December 2021.ResultsThirty patients were included (13 male/17 female) with a mean age of 62.7 ± 11.8 years and mean body mass index of 25.5 ± 4.4 kg/m². The mean incision length covered was 3.0 ± 1.8 cm. The median number of manual pinches required to initially activate the dressing with negative pressure within -75 to -125 mmHg was 12 (range 7-20). Four dressings were changed (13.3%) after drainage was noted inside the pump; not including these, 88.5% (23/26) of dressings held pressure consistently without any re-pinching during the 72-h period since they were first applied in the operating room. 75.9% of patients reported the dressing was \"very comfortable\" and none reported the dressing restricted mobility. 79.3% of patients reported the dressing was \"very easy\" to use. There were no cases of major wound complication or surgical site infection within 30 days.ConclusionThe use of MP-NPD appears to be feasible on primarily-closed colorectal incisions. Further randomized controlled study is warranted to ascertain its clinical efficacy.</p>","PeriodicalId":22095,"journal":{"name":"Surgical Innovation","volume":" ","pages":"127-140"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the Use of Virtual Pointers in Laparoscopic Surgery Training Activities.","authors":"Javier Jiménez-Ruescas, Fco J Celdrán, Lucía Salazar, Juan A Sánchez-Margallo, Francisco M Sánchez-Margallo, Pascual González","doi":"10.1177/15533506241292854","DOIUrl":"10.1177/15533506241292854","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic surgery has advanced significantly; however, effective communication within the surgical team remains challenging, particularly in training scenarios where misinterpretation of instructions can lead to errors. Virtual pointers, indicating the instructor's gaze through eye-tracking devices and overlaying it onto the screen using augmented reality (AR), can enhance understanding and reduce errors.</p><p><strong>Methods: </strong>In a study involving 10 participants divided into experts and novices in laparoscopic surgery, various pointers (differing in shape, size and colour) were analysed in an AR environment using the HoloLens2 device. The aim was to assess the acceptance of these pointers by both groups, understand how their characteristics affect perception, and evaluate the AR device's usefulness.</p><p><strong>Results: </strong>Initial results showed an 80% acceptance rate. After analysing the pointers, this decreased to 60%, as some experts changed their opinion from positive to neutral. The study revealed that the characteristics of the pointers significantly affect their perception, with large, thick-rimmed pointers being preferred. Orange was the best-performing colour. The device used also influenced perception, as experts who changed their perception criticised certain aspects of the head-mounted display.</p><p><strong>Conclusions: </strong>The study highlights the potential of virtual pointers to improve communication in laparoscopic training, particularly when their size, shape, and colour are optimised. Further research with a larger sample size is needed to confirm these results and explore the HoloLens2's influence on users' perceptions. These insights could guide the development of more effective training tools for minimally invasive surgery.</p>","PeriodicalId":22095,"journal":{"name":"Surgical Innovation","volume":" ","pages":"54-61"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Enhanced Recovery after Surgery (ERAS): The Effect of a Patient-Centred Mobile Application and an Activity Tracker on Patient Engagement in Colorectal Surgery.","authors":"Sebastiaan L van der Storm, Marilou Jansen, Malou D Mulder, Hendrik A Marsman, Esther C J Consten, Frank C den Boer, Hans D de Boer, Willem A Bemelman, Christianne J Buskens, Marlies P Schijven","doi":"10.1177/15533506241299888","DOIUrl":"10.1177/15533506241299888","url":null,"abstract":"<p><strong>Background: </strong>The Enhanced Recovery After Surgery (ERAS) protocol improved perioperative colorectal care. Although the protocol is firmly implemented across hospital settings, there are benefits to gain by actively involving patients in their recovery. The main objective of this study was to investigate whether compliance with selected items in the ERAS protocol could further improve by using a patient-centred mobile application.</p><p><strong>Method: </strong>This multicentre, randomised controlled trial was conducted between October 2019 and September 2022. Patients aged 18 years or older who underwent elective colorectal surgery, and in possession of a smartphone were included. The intervention group used a mobile application combined with an activity tracker to be guided and supported through the ERAS pathway. The control group received standard care and wore an activity tracker to monitor their daily activities. The primary outcome was overall compliance with selected active elements of the ERAS protocol.</p><p><strong>Results: </strong>In total, 140 participants were randomised to either the intervention (n = 72) or control group (n = 68). The use of the ERAS App demonstrated a significant improvement in overall compliance by 10%, particularly in early solid food intake by 42% and early mobilization by 27%. Postoperative or patient reported outcomes did not differ between groups.</p><p><strong>Conclusion: </strong>The smartphone application 'ERAS App' is able to improve adherence to the active elements of the ERAS protocol for colorectal surgery. This is an important step towards optimizing perioperative care for colorectal surgery patients and enabling patients to optimize being in control of their own recovery. Trial registration: ERAS APPtimize, NTR7314 (https://trialsearch.who.int/Trial2.aspx?TrialID=NL-OMON29410).</p>","PeriodicalId":22095,"journal":{"name":"Surgical Innovation","volume":" ","pages":"5-15"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11736976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolving Methods and Application of a 3D Printed Model in the Current Deep Inferior Epigastric Perforator Flap Elevation.","authors":"Soo Jin Woo, Su Yong Kim, Il Young Ahn, Ki Yong Hong, Jinil Choi, Se Yeon Lee, Woo Ju Kim, Sun Joo Kim, Shin Hyuk Kang, Hak Chang","doi":"10.1177/15533506241299147","DOIUrl":"10.1177/15533506241299147","url":null,"abstract":"<p><strong>Background: </strong>The choice of the deep inferior epigastric perforator (DIEP) flap for breast reconstruction has increased. Three-dimensional (3D) models of DIEP flaps have been introduced with advances in 3D technology to assist the tedious intramuscular dissection of the pedicle. This study presents the process of creating an ideal 3D model for a DIEP flap.</p><p><strong>Methods: </strong>Collaboration among various professionals, including surgeons, radiologists, and 3D-printing model makers, is essential for manufacturing suitable 3D-printing DIEP models. Our team facilitated the collaboration process by sharing the virtual 3D model via a uniform resource locator (URL) using an online platform accessible on mobile devices.</p><p><strong>Results: </strong>During collaboration in 3D DIEP model-making, we continuously upgraded the model to a better version. The model was modified according to the surgeon's preference from a 1:1 ratio size to a handheld size. Additionally, we achieved significant advancements over conventional methods, including improved visualization of detailed vessel pathways with separation of arteries and veins, tissue transparency, and superficial inferior epigastric vein (SIEV).</p><p><strong>Conclusions: </strong>Through 3D model-making collaborations, our team successfully developed a 3D DIEP model with translucency and visualized arteries and veins separately with accentuation of the perforators, including SIEV tracing, which is more accurate. This ideal 3D model for the DIEP flap enables the selection of a perforator vessel that is safe and easy to dissect to lower complications and procedure time and will be of great help to less experienced surgeons.</p>","PeriodicalId":22095,"journal":{"name":"Surgical Innovation","volume":" ","pages":"16-24"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent Gastroesophageal Reflux Disease After RYGB: What Shall we do Next?","authors":"Dimitra V Peristeri, Sai Sandeep Singh Rowdhwal","doi":"10.1177/15533506241292707","DOIUrl":"10.1177/15533506241292707","url":null,"abstract":"<p><strong>Background: </strong>Roux-en-Y gastric bypass (RYGB) is considered the weight loss procedure of choice for obese patients with gastroesophageal reflux disease (GORD). The long-term prevalence of GORD after RYGB for obesity is underestimated as many post-RYGB patients can still complain of severe reflux symptoms, refractory to medications.</p><p><strong>Methods: </strong>This is a narrative review using the patient, intervention, comparison, outcome and study strategy. The literature search was undertaken using PubMed, Medline, and Google Scholar databases with the following MeSH terms: Gastroesophageal reflux disease, GORD, Obesity, Gastric bypass, Roux-en-Y gastric bypass, complication, and fundoplication.</p><p><strong>Results: </strong>Twelve original papers and case report studies on 57 patients who met the inclusion criteria were suitable for the present review. Reporting styles on successful treatment outcomes were heterogeneous. Treatment options for these patients are limited but include further surgical or endoscopic interventions. Careful follow-up and appropriate management are paramount for this population.</p><p><strong>Conclusion: </strong>There is significant paucity in the available evidence on managing GORD after RYGB. This narrative review provides a detailed overview of the underlying causes, discusses the various endoscopic and surgical therapy options, and suggests strategies to provide tailored and appropriate therapy for this complex group of patients.</p>","PeriodicalId":22095,"journal":{"name":"Surgical Innovation","volume":" ","pages":"62-71"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urgent Versus Elective Laparoscopic Cholecystectomy Following Percutaneous Transhepatic Gallbladder Drainage for Moderate Acute Cholecystitis: A Meta-Analysis.","authors":"Musa Yaermaimaiti, Abudukeremu Miersalijiang, Xue-Jun Wang, Jian-Kang Zhu, Hong-Cheng Wang","doi":"10.1177/15533506241300735","DOIUrl":"10.1177/15533506241300735","url":null,"abstract":"<p><strong>Background: </strong>There is still controversy regarding the treatment strategy for moderate acute cholecystitis (AC). Percutaneous transhepatic gallbladder drainage (PTGBD) followed laparoscopic cholecystectomy (LC) has shown advantages compared to emergency LC (ELC). However, the results are controversial. Therefore, we conducted this updated meta-analysis to clarify this issue.</p><p><strong>Materials and methods: </strong>A comprehensive literature search for relevant studies comparing the PTGBD + LC and ELC for moderate AC was performed. The statistical analysis was conducted using Stata.</p><p><strong>Results: </strong>A total of 14 studies were included. The pooled analysis revealed that PTGBD + LC group had a shorter operation time (SMD = -1.07, 95%CI = -1.19 to -0.95), lower amount of intraoperative bleeding (SMD = -0.93, 95%CI = -1.07 to -0.79), lower conversion rate (OR = 0.28, 95% CI = 0.17-0.44), lower postoperative complications (OR = 0.45, 95% CI = 0.23-0.88) shorter postoperative hospital stay (SMD = -1.20, 95%CI = -1.33 to -1.07), lower wound infection rate (OR = 0.41, 95%CI = 0.23-0.74) and higher hospitalization expenses (SMD = 1.13, 95%CI = 0.96 to 1.29) compared with ELC group. There was no significant difference in the incidence of bile leak, bile duct injury and total hospital stay.</p><p><strong>Conclusion: </strong>This meta-analysis suggested that PTGBD + LC has significant advantages over ELC for moderate AC patients, including lower surgical difficulty, lower conversion rate, fewer postoperative complications, and shorter hospital stay.</p>","PeriodicalId":22095,"journal":{"name":"Surgical Innovation","volume":" ","pages":"25-35"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Surgical Competences for Neck Dissection and Total Laryngectomy on Revascularized Cadaver Models: Onco-Neck-Score and Onco-Larynx-Score.","authors":"Anne Rullière, Jérôme Danion, Xavier Dufour, Denis Oriot, Jean-Pierre Faure, Valentin Favier, Florent Carsuzaa","doi":"10.1177/15533506241292698","DOIUrl":"10.1177/15533506241292698","url":null,"abstract":"<p><strong>Background: </strong>In surgical simulation, evaluation tools are necessary to allow the overall and specific level of each gesture to be assessed for learners, to allow active feedback and follow-up. The aim of this study was to create and validate a scale for the assessment of competences for neck dissection (ND) and total laryngectomy (TL) in head and neck surgical oncology simulation specific for revascularized cadavers' models.</p><p><strong>Methods: </strong>Two independent scales were created for ND and TL based on a two-round Delphi method. The scales were used during ND and TL simulation sessions on SimLife® (Symedis, Poitiers, France) model. Surgical steps were scored by 2 independent observers. To assess its ease of use, a questionnaire was answered by senior surgeons (SS) at the end of the sessions.</p><p><strong>Results: </strong>Fifteen items were included in the final version for ND scale and 20 for TL scale. The results of 14 lateral ND and 8 TL were included. The mean score was higher for SS (69 ± 6.4; 87.5 ± 8.5) than for residents (36.5 ± 11; 57.5 ± 13.2) for ND (<i>P</i> = 0.0006) and TL (<i>P</i> = 0.028) respectively. Six SS strongly agreed that this tool had a positive impact on resident training with stepwise feedback and accurately represented their competences.</p><p><strong>Conclusion: </strong>We developed a pedagogic tool built to assess surgical competence for head and neck surgical oncology on revascularized cadaver models. This tool has a good construct validity thanks to the expert reviewing with Delphi method and appears to have fine acceptability by the SS.</p>","PeriodicalId":22095,"journal":{"name":"Surgical Innovation","volume":" ","pages":"46-53"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Augmented Reality Versus Freehand Spinopelvic Fixation in Spinal Deformity: A Case-Control Study.","authors":"Tej D Azad, Melanie Alfonzo Horowitz, Jovanna A Tracz, Jawad M Khalifeh, Connor J Liu, Liam P Hughes, Brendan F Judy, Majid Khan, Ali Bydon, Timothy F Witham","doi":"10.1177/15533506241299887","DOIUrl":"10.1177/15533506241299887","url":null,"abstract":"<p><strong>Purpose: </strong>This study sought to compare screw placement accuracy and outcomes between freehand (FH) and AR-guided pelvic fixation. While pelvic fixation is a critical technique in spinal deformity surgery, S2-alar iliac (S2AI) screw placement poses challenges.</p><p><strong>Methods: </strong>We conducted a case-control study of 50 consecutive patients who underwent spinopelvic fixation at a single institution. AR guidance was performed using a head-mounted display (Xvision, Augmedics). Patient demographics, surgical characteristics, spinopelvic parameters, and screw breach grade were compared using univariate and multivariate statistics.</p><p><strong>Results: </strong>Pelvic fixation was performed FH in 21 patients (median age, 64; female, 38.1%; median BMI 32.3 kg/m²) and AR-guided in 29 patients (median age, 66; female, 51.7%; median BMI 28.4 kg/m²). Mean follow-up was longer in the FH group (28 mos vs 11 mos, <i>P</i> < 0.001). Pelvic fixation in the FH group was performed using either S2AI (90.5%) or dual S2AI (9.5%) screws. There were no significant differences in length of surgery (FH, 439 minutes; AR, 490 minutes; <i>P</i> = 0.1) or estimated blood loss (FH, 2.1L; AR, 1.9L; <i>P</i> = 0.7). Accuracy of FH pelvic fixation was 95.6% (43/45 screws) and accuracy of AR pelvic fixation was 96.5% (55/57 screws). Multivariable logistic regression for screw breach revealed no significant association with AR guidance when controlling for age, BMI, osteoporosis, and smoking.</p><p><strong>Conclusions: </strong>We present the first case-control study of AR-guided spinopelvic fixation, with findings suggesting parity between FH and AR-guidance, serving as foundation for prospective controlled studies with longitudinal follow-up to interrogate the benefits of AR-guidance in spinal deformity surgery.</p>","PeriodicalId":22095,"journal":{"name":"Surgical Innovation","volume":" ","pages":"36-45"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing Emergency Department Triage Prediction With Machine Learning to Optimize Triage for Abdominal Pain Surgery Patients.","authors":"Chen Chai, Shu-Zhen Peng, Rui Zhang, Cheng-Wei Li, Yan Zhao","doi":"10.1177/15533506241273449","DOIUrl":"10.1177/15533506241273449","url":null,"abstract":"<p><strong>Background: </strong>The development of emergency department (ED) triage systems remains challenging in accurately differentiating patients with acute abdominal pain (AAP) who are critical and urgent for surgery due to subjectivity and limitations. We use machine learning models to predict emergency surgical abdominal pain patients in triage, and then compare their performance with conventional Logistic regression models.</p><p><strong>Methods: </strong>Using 38 214 patients presenting with acute abdominal pain at Zhongnan Hospital of Wuhan University between March 1, 2014, and March 1, 2022, we identified all adult patients (aged ≥18 years). We utilized routinely available triage data in electronic medical records as predictors, including structured data (eg, triage vital signs, gender, and age) and unstructured data (chief complaints and physical examinations in free-text format). The primary outcome measure was whether emergency surgery was performed. The dataset was randomly sampled, with 80% assigned to the training set and 20% to the test set. We developed 5 machine learning models: Light Gradient Boosting Machine (Light GBM), eXtreme Gradient Boosting (XGBoost), Deep Neural Network (DNN), and Random Forest (RF). Logistic regression (LR) served as the reference model. Model performance was calculated for each model, including the area under the receiver-work characteristic curve (AUC) and net benefit (decision curve), as well as the confusion matrix.</p><p><strong>Results: </strong>Of all the 38 214 acute abdominal pain patients, 4208 underwent emergency abdominal surgery while 34 006 received non-surgical treatment. In the surgery outcome prediction, all 4 machine learning models outperformed the reference model (eg, AUC, 0.899 [95%CI 0.891-0.903] in the Light GBM vs. 0.885 [95%CI 0.876-0.891] in the reference model), Similarly, most machine learning models exhibited significant improvements in net reclassification compared to the reference model (eg, NRIs of 0.0812[95%CI, 0.055-0.1105] in the XGBoost), with the exception of the RF model. Decision curve analysis shows that across the entire range of thresholds, the net benefits of the XGBoost and the Light GBM models were higher than the reference model. In particular, the Light GBM model performed well in predicting the need for emergency abdominal surgery with higher sensitivity, specificity, and accuracy.</p><p><strong>Conclusions: </strong>Machine learning models have demonstrated superior performance in predicting emergency abdominal pain surgery compared to traditional models. Modern machine learning improves clinical triage decisions and ensures that critically needy patients receive priority for emergency resources and timely, effective treatment.</p>","PeriodicalId":22095,"journal":{"name":"Surgical Innovation","volume":" ","pages":"583-597"},"PeriodicalIF":1.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}