American Surgeon最新文献_第10页

Development of an Acute Femoral Hernia Treatment Algorithm: Insights From the ACHQC National Database. 急性股疝治疗算法的发展：来自ACHQC国家数据库的见解。

IF 1 4区医学

American Surgeon Pub Date : 2025-06-28 DOI: 10.1177/00031348251353074

Ian Kim, Galinos Barmparas, Shirin Towfigh

{"title":"Development of an Acute Femoral Hernia Treatment Algorithm: Insights From the ACHQC National Database.","authors":"Ian Kim, Galinos Barmparas, Shirin Towfigh","doi":"10.1177/00031348251353074","DOIUrl":"https://doi.org/10.1177/00031348251353074","url":null,"abstract":"BackgroundDue to the rarity of femoral hernias (FH), mastery of surgical decision-making can be challenging. Current guidelines address only elective treatment of FH, without guidance for the acute setting.ObjectiveTo review current surgical management of FH, and to determine a modern-day treatment algorithm for FH in the acute setting.MethodsThe Abdominal Core Health Quality Collaborative (ACHQC) was surveyed for adult patients undergoing elective (EFH) or acute (AFH) FH repair from 2016 to 2023.ResultsOf 2563 FH repairs, 61 (2.4%) were AFH. Patients with AFH were more likely to be female (68.9% vs 31.1%, P < 0.01), older (median age 76 vs 64.5 years, P < 0.01), have greater comorbidity (ASA III or higher, 58% vs 30%, P < 0.01), and larger hernia defects (≥1.5 cm, 51% vs 34%, P < 0.01). Open surgery was the predominant approach for AFH (61% vs 14%, P < 0.01), while EFH was mostly repaired robotically (54% vs 10%, P < 0.01). Over time, robotic surgery increased for both AFH and EFH. AFH were less likely to have mesh implanted (72% vs 97%, P < 0.01), though permanent synthetic mesh remained the dominant choice in both groups (89% vs 98%, P < 0.01).DiscussionOpen surgery with mesh dominates for AFH, but robotic techniques are increasingly utilized. A treatment algorithm is proposed to optimize management of patients with AFH to determine the safest approach based on clinical scenarios.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251353074"},"PeriodicalIF":1.0,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526100","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}

引用次数: 0

Outcomes After Implementation of an Enhanced Recovery Protocol for Minimally Invasive Repair of Pectus Excavatum. 微创修复漏斗胸的增强恢复方案实施后的结果。

IF 1 4区医学

American Surgeon Pub Date : 2025-06-28 DOI: 10.1177/00031348251353807

Lisa Ngo, Chelsea Spector, Monique Motta, Danielle Katz, Shenae Samuels, Carrie Laituri, Tamar Levene

{"title":"Outcomes After Implementation of an Enhanced Recovery Protocol for Minimally Invasive Repair of Pectus Excavatum.","authors":"Lisa Ngo, Chelsea Spector, Monique Motta, Danielle Katz, Shenae Samuels, Carrie Laituri, Tamar Levene","doi":"10.1177/00031348251353807","DOIUrl":"https://doi.org/10.1177/00031348251353807","url":null,"abstract":"Background: Surgical repair of pectus excavatum is commonly associated with significant post-operative pain requiring prolonged hospital stays and critical care admission for sedative and analgesic infusions. By implementing an enhanced recovery after surgery (ERAS) protocol for patients undergoing minimally invasive pectus repair, we aimed to reduce length of hospital stay, need for higher level monitored care, and opioid utilization. Methods: A retrospective chart review was performed for all patients under the age of 25 years who underwent Nuss bar insertion at our institution between January 2011 and May 2021. The primary outcomes were hospital length of stay, intensive care unit (ICU) utilization, and opioid consumption before and after the implementation of the ERAS protocol in December 2017. Results: A total of 86 patients underwent Nuss repair of pectus excavatum, including 14 patients in the ERAS cohort. Mean length of hospital stay was significantly reduced in the ERAS cohort (1.9 vs. 4.9 days, P < 0.001). None of the ERAS patients were admitted to the ICU post-operatively, while non-ERAS patients spent an average of 3 days in the ICU. Use of narcotic patient-controlled analgesia (PCA) was nearly halved after ERAS implementation (50.0% vs. 97.2%), and total oxycodone, Percocet, and Dilaudid dosages were significantly reduced. Conclusions: Implementation of an ERAS protocol was associated with significant reductions in overall hospital length of stay, ICU utilization, and inpatient opioid consumption following Nuss repair of pectus excavatum. These changes in post-op management are expected to reduce costs and promote earlier return to school and activities.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251353807"},"PeriodicalIF":1.0,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526102","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}

引用次数: 0

Identifying the Surgical to Nonsurgical Care Transition for Trauma Patients: Time to Redesign Trauma Workflow. 确定创伤患者从手术到非手术护理的过渡：重新设计创伤工作流程的时间。

IF 1 4区医学

American Surgeon Pub Date : 2025-06-27 DOI: 10.1177/00031348251353804

Ursula Adams, William Yu Luo, Kevin Chen Wang, Didong Li, Pascal Osita Udekwu, Anthony Charles

{"title":"Identifying the Surgical to Nonsurgical Care Transition for Trauma Patients: Time to Redesign Trauma Workflow.","authors":"Ursula Adams, William Yu Luo, Kevin Chen Wang, Didong Li, Pascal Osita Udekwu, Anthony Charles","doi":"10.1177/00031348251353804","DOIUrl":"https://doi.org/10.1177/00031348251353804","url":null,"abstract":"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.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251353804"},"PeriodicalIF":1.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504538","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}

引用次数: 0

Less is More: A Cost and Environmental Waste Analysis in Nonadherence to Antibiotic Prophylaxis Guidelines in Clean Ambulatory Surgical Procedures. 少即是多：清洁门诊手术过程中不遵守抗生素预防指南的成本和环境浪费分析。

IF 1 4区医学

American Surgeon Pub Date : 2025-06-26 DOI: 10.1177/00031348251355936

Isabela Sandigo-Saballos, Stefania Montero, Pamela Lee, Hanjoo Lee, Kathryn T Chen

{"title":"Less is More: A Cost and Environmental Waste Analysis in Nonadherence to Antibiotic Prophylaxis Guidelines in Clean Ambulatory Surgical Procedures.","authors":"Isabela Sandigo-Saballos, Stefania Montero, Pamela Lee, Hanjoo Lee, Kathryn T Chen","doi":"10.1177/00031348251355936","DOIUrl":"https://doi.org/10.1177/00031348251355936","url":null,"abstract":"BackgroundAntibiotic misuse extends beyond clinical outcomes, imposing significant financial, operational, and environmental burdens on health care systems. Despite guidelines advising against antibiotic prophylaxis for elective low-risk laparoscopic operations, clean head and neck, and soft tissue procedures, many surgeons continue to use them. We performed a cost and environmental waste analysis at our institution resulting from nonadherence to guidelines.MethodsA retrospective chart review was performed at a single institution between January 2022 and March 2023. All patients undergoing elective diagnostic laparoscopy, soft tissue excisions for presumed benign disease, thyroid, and parathyroidectomy operations were included. Antibiotic costs were obtained from the hospital charge pharmacy. Waste was estimated by weighing the bottles and syringes used to administer the antibiotics.ResultsFrom January 2022 to March 2023, 137 patients who underwent the defined operations were identified. 38% (n = 52) underwent lipoma excisions, 33% (n = 46) thyroidectomy, 11% (n = 15) parathyroidectomy, 9% (n = 12) diagnostic laparoscopy, and 9% (n = 12) other soft tissue excision. 94% (n = 129) of cases were classified as clean and 6% (n = 8) were classified as clean-contaminated in the operative report. Prophylactic antibiotics were administered to 92% (n = 126) of patients, with 6% (n = 8) receiving an additional intraoperative dose. Cefazolin was used in 90% (n = 119) of cases, followed by Cefoxitin 1% (n = 1) and Clindamycin 1% (n = 1). Adherence to guidelines could have saved US$3279 and prevented £23 of waste.DiscussionA significant number of clean cases received prophylactic antibiotics, reflecting poor adherence to clinical practice guidelines. Improving antibiotic stewardship can reduce costs and environmental waste.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251355936"},"PeriodicalIF":1.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504539","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}

引用次数: 0

Prognostic Significance of Preoperative Serum CA19-9-to-CEA Ratio in Stage I-III Colorectal Cancer Post-Resection. I-III期结直肠癌切除术后术前血清ca19 -9 / cea比值的预后意义

IF 1 4区医学

American Surgeon Pub Date : 2025-06-26 DOI: 10.1177/00031348251356745

Takashi Aida, Teppei Kamada, Junji Takahashi, Daisuke Yamagishi, Eisaku Ito, Norihiko Suzuki, Taigo Hata, Masashi Yoshida, Hironori Ohdaira, Yutaka Suzuki

{"title":"Prognostic Significance of Preoperative Serum CA19-9-to-CEA Ratio in Stage I-III Colorectal Cancer Post-Resection.","authors":"Takashi Aida, Teppei Kamada, Junji Takahashi, Daisuke Yamagishi, Eisaku Ito, Norihiko Suzuki, Taigo Hata, Masashi Yoshida, Hironori Ohdaira, Yutaka Suzuki","doi":"10.1177/00031348251356745","DOIUrl":"https://doi.org/10.1177/00031348251356745","url":null,"abstract":"Background: During colorectal cancer (CRC) surveillance, tumor markers, such as carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9), play important roles in the diagnosis, prediction, and monitoring of tumors. Herein, we devised a novel combined index comprising the CA19-9-to-CEA ratio and investigated its prognostic value in patients with stage I-III CRC after resection. Methods: This retrospective study included 306 patients who underwent radical resection between 2011 and 2020. CA19-9 and CEA levels were evaluated preoperatively. The CA19-9-to-CEA ratio cutoff value was determined via receiver-operating characteristic analysis using the survival status at the 5-year follow-up evaluation. Multivariate Cox proportional hazard models were used to assess disease-free survival (DFS) and overall survival (OS). Results: According to the multivariate analysis, T3 or T4 tumor (P = 0.041; hazard ratio [HR], 2.54), pathological stage III (P = 0.001; HR, 3.07), serum CEA level ≥5.0 ng/mL (P = 0.018; HR, 2.11), and high CA19-9-to-CEA ratio (P = 0.015; HR, 2.89) were independently associated with DFS. Age 65≥ years (P = 0.03; HR, 2.86), pathological stage III (P = 0.001; HR, 2.00), high neutrophil-to-lymphocyte ratio (P = 0.003; HR, 2.27), and high CA19-9-to-CEA ratio (P = 0.009; HR, 3.16) were independent prognostic factors for OS. Patients with high CA19-9-to-CEA ratios had significantly worse DFS (P < 0.001) and OS (P < 0.001). Discussion: A high CA19-9-to-CEA ratio can be used for detailed risk prediction in patients with CRC.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251356745"},"PeriodicalIF":1.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504540","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}

引用次数: 0

Developing a Post-surgical Nomogram for Patients With Poorly Differentiated Adenocarcinoma of the Rectosigmoid Junction. 直肠乙状结肠结低分化腺癌的术后影像学研究。

IF 1 4区医学

American Surgeon Pub Date : 2025-06-26 DOI: 10.1177/00031348251355930

Hoi-Bor Chan, Chao-Yu Hsu

{"title":"Developing a Post-surgical Nomogram for Patients With Poorly Differentiated Adenocarcinoma of the Rectosigmoid Junction.","authors":"Hoi-Bor Chan, Chao-Yu Hsu","doi":"10.1177/00031348251355930","DOIUrl":"https://doi.org/10.1177/00031348251355930","url":null,"abstract":"BackgroundThe study of poorly differentiated adenocarcinoma of the rectosigmoid junction (RSJ) remains underexplored. This study aims to develop a postoperative nomogram to accurately predict cancer-specific survival (CSS) in patients afflicted with this form of cancer.MethodsThe study utilized data from the Surveillance, Epidemiology, and End Results database, focusing on patients diagnosed with RSJ cancer between 2004 and 2017. Participants were divided into a training cohort and a validation cohort at a 7:3 ratio. Initially, the training cohort was analyzed using Cox univariate analysis to identify significantly impactful factors. These factors were then examined through Cox multivariate analysis to isolate the best predictors for CSS, which were used to construct the nomogram. The validity of this nomogram was subsequently tested using the validation cohort.ResultsThe study enrolled a total of 2668 patients, with 1867 in the training cohort and 801 in the validation cohort. The 1-, 3-, and 5-year CSS rates were 86.5%, 67.9%, and 57.8%, respectively. Significant predictors identified included race, age, and stage. The constructed nomogram was validated through receiver operating characteristic analysis, calibration, and decision curve analysis, confirming its reliability and accuracy in predicting CSS.ConclusionRace, age, and staging have been affirmed as significant prognostic indicators for CSS. This study has successfully developed a postoperative nomogram that effectively predicts the 1-, 3-, and 5-year CSS for these patients. This predictive model holds substantial clinical value, providing essential guidance for therapeutic decision-making and patient counseling.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251355930"},"PeriodicalIF":1.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144493469","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}

引用次数: 0

Ten-Year Analysis of Mastectomy in Stage IV Breast Cancer: Practice Patterns and Outcomes. 四期乳腺癌乳房切除术的十年分析：实践模式和结果。

IF 1 4区医学

American Surgeon Pub Date : 2025-06-26 DOI: 10.1177/00031348251355933

Anup Y Parikh, Daniil Sokolov, Hadley D Freeman, Jukes P Namm, Naveenraj Solomon, Sharon Lum, Halley Vora

{"title":"Ten-Year Analysis of Mastectomy in Stage IV Breast Cancer: Practice Patterns and Outcomes.","authors":"Anup Y Parikh, Daniil Sokolov, Hadley D Freeman, Jukes P Namm, Naveenraj Solomon, Sharon Lum, Halley Vora","doi":"10.1177/00031348251355933","DOIUrl":"https://doi.org/10.1177/00031348251355933","url":null,"abstract":"BackgroundCurrently no level 1 data clearly demonstrates a survival benefit from operative therapy in patients with de novo metastatic breast cancer (dnMBC); thus, NCCN guidelines reserve mastectomy for palliation only. However, as multimodal therapies improve, disease management over a longer period may benefit certain patients who are on the continuum between curative and palliative intent.MethodsA retrospective review was performed of all female patients with dnMBC treated between 2014-2024 at our institution. The cohort was divided into 2 groups: those patients who underwent mastectomy and those who did not. Clinicopathologic factors and patient outcomes of both groups were analyzed.ResultsOf the 92 patients meeting inclusion criteria, total mastectomy was performed in 37 (40%) patients. Surgical resection was more commonly associated with oligometastatic bone disease (11.5% vs 0%, P < .01) and not with widespread metastasis involving multiple systems (24.3% vs 50.9%, P = 0.02). Surgical patients had significantly higher rates of complete response and stable disease after upfront systemic therapy (32.4% vs 12.7% and 18.9% vs 3.6%, respectively) while nonsurgical patients had a significantly higher rate of disease progression (32.7% vs 2.7%). The median OS was higher in surgical patients (NR vs 3.95 years, P < .01).DiscussionPrimary site surgery played an important role as part of a multimodal disease management paradigm in dnMBC patients at our institution. Future studies should evaluate which patients on the continuum between curative and palliative intent may benefit the most from this strategy, which may help standardize surgical care in these clinically challenging patients.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251355933"},"PeriodicalIF":1.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504541","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}

引用次数: 0

Risk Factors for Significant Injury After Inpatient Falls. 住院病人跌倒后重大损伤的危险因素。

IF 1 4区医学

American Surgeon Pub Date : 2025-06-25 DOI: 10.1177/00031348251354900

Paige Kmetz-Cutrone, Story Bernstein, Alison Muller, Catie Sweeney, Christopher Butts, Eugene Reilly, Thomas Geng, Adrian W Ong

{"title":"Risk Factors for Significant Injury After Inpatient Falls.","authors":"Paige Kmetz-Cutrone, Story Bernstein, Alison Muller, Catie Sweeney, Christopher Butts, Eugene Reilly, Thomas Geng, Adrian W Ong","doi":"10.1177/00031348251354900","DOIUrl":"https://doi.org/10.1177/00031348251354900","url":null,"abstract":"Inpatient (IP) falls present substantial challenges to health care institutions. We aimed to characterize injuries after IP falls and evaluate if there were risk factors for these injuries. Adult inpatients who fell in an acute care hospital from 2018 to 2023 were studied. Severity of injury were retroactively assigned using the Abbreviated Injury Scale (AIS) for each of nine body regions and calculating the Injury Severity Score (ISS). The primary outcome was any significant injury (SI), which was defined as an ISS of ≥2. Patients with SI were matched 1:2 for age and whether the fall was witnessed to those without SI (controls). The risk of SI was estimated for each plausible variable using conditional logistic regression, with P < .05 considered significant. There were 2617 IP falls with 53 (2%) having SI. SI was associated with greater age (median, 73 vs 65 years, P = .002) but not with witnessed falls (2% vs 2%, P = .99). In the matched groups (n = 53 vs n = 106), signs of injury in the head, neck, back and extremities and new complaints after the fall were associated with SI. SI patients were more likely to require surgical intervention for injuries (36% vs 10%, P = .0001), and to die (9% vs 2%, P = .03). SI is uncommon after IP falls but portends increased resource utilization. Evaluation for SI requires a careful history and examination by providers at the time of the fall. Signs of injury on physical exam and new complaints should raise suspicion for SI.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251354900"},"PeriodicalIF":1.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144482893","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}

引用次数: 0

A Comparative Analysis of the Accuracy and Readability of Popular Artificial Intelligence-Chat Bots for Inguinal Hernia Management. 流行人工智能聊天机器人治疗腹股沟疝的准确性和可读性对比分析。

IF 1 4区医学

American Surgeon Pub Date : 2025-06-25 DOI: 10.1177/00031348251353065

Thisun Udagedara, Ashley Tran, Sumaya Bokhari, Sharon Shiraga, Stuart Abel, Caitlin Houghton, Katie Galvin, Kamran Samakar, Luke R Putnam

{"title":"A Comparative Analysis of the Accuracy and Readability of Popular Artificial Intelligence-Chat Bots for Inguinal Hernia Management.","authors":"Thisun Udagedara, Ashley Tran, Sumaya Bokhari, Sharon Shiraga, Stuart Abel, Caitlin Houghton, Katie Galvin, Kamran Samakar, Luke R Putnam","doi":"10.1177/00031348251353065","DOIUrl":"https://doi.org/10.1177/00031348251353065","url":null,"abstract":"BackgroundArtificial intelligence (AI), particularly large language models (LLMs), has gained attention for its clinical applications. While LLMs have shown utility in various medical fields, their performance in inguinal hernia repair (IHR) remains understudied. This study seeks to evaluate the accuracy and readability of LLM-generated responses to IHR-related questions, as well as their performance across distinct clinical categories.MethodsThirty questions were developed based on clinical guidelines for IHR and categorized into four subgroups: diagnosis, perioperative care, surgical management, and other. Questions were entered into Microsoft Copilot®, Google Gemini®, and OpenAI ChatGPT-4®. Responses were anonymized and evaluated by six fellowship-trained, minimally invasive surgeons using a validated 5-point Likert scale. Readability was assessed with six validated formulae.ResultsGPT-4 and Gemini outperformed Copilot in overall mean scores for response accuracy (Copilot: 3.75 ± 0.99, Gemini: 4.35 ± 0.82, and GPT-4: 4.30 ± 0.89; P < 0.001). Subgroup analysis revealed significantly higher scores for Gemini and GPT-4 in perioperative care (P = 0.025) and surgical management (P < 0.001). Readability scores were comparable across models, with all responses at college to college-graduate reading levels.DiscussionThis study highlights the variability in LLM performance, with GPT-4 and Gemini producing higher-quality responses than Copilot for IHR-related questions. However, the consistently high reading level of responses may limit accessibility for patients. These findings underscore the potential of LLMs to serve as valuable adjunct tools in surgical practice, with ongoing advancements expected to further enhance their accuracy, readability, and applicability.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251353065"},"PeriodicalIF":1.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144482891","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}

引用次数: 0

Lung Cancer Screening Disparities in Asian American Subgroups in a Large Integrated Health System. 大型综合医疗系统中亚裔美国人亚群肺癌筛查差异

IF 1 4区医学

American Surgeon Pub Date : 2025-06-24 DOI: 10.1177/00031348251353073

Seth J Tivakaran, Julia L Raghu, Jeff C K Leung, King Sum Tong, Nicholas L Panyanouvong, Carmen Javier, Sheng-Fang Jiang, Lester Andrew V Uy, Armaan Jamal, Malathi Srinivasan, Nitya Rajeshuni, Gloria S Kim, Robert J Huang, Latha Palaniappan, Jeffrey B Velotta

{"title":"Lung Cancer Screening Disparities in Asian American Subgroups in a Large Integrated Health System.","authors":"Seth J Tivakaran, Julia L Raghu, Jeff C K Leung, King Sum Tong, Nicholas L Panyanouvong, Carmen Javier, Sheng-Fang Jiang, Lester Andrew V Uy, Armaan Jamal, Malathi Srinivasan, Nitya Rajeshuni, Gloria S Kim, Robert J Huang, Latha Palaniappan, Jeffrey B Velotta","doi":"10.1177/00031348251353073","DOIUrl":"https://doi.org/10.1177/00031348251353073","url":null,"abstract":"BackgroundLung cancer is the leading cause of cancer-related deaths worldwide in Asian Americans (AsA), yet AsA lung cancer screening (LCS) rates are unknown. We examined LCS rates in AsA within Kaiser Permanente Northern California (KPNC), a large integrated healthcare system where LCS is a member benefit. The California LCS rate is 0.7%.MethodsThis cohort study analyzed KPNC 2015-2022 electronic health records. Lung cancer screening rates were compared among AsA subgroups, controlling for sociodemographics, considering both more restrictive 2013 (n = 2,273) and more inclusive 2021 (n = 5,823) United States Preventive Services Task Force (USPSTF) LCS guidelines, which differ by age range and years post-smoking cessation.ResultsOverall KPNC LCS rates for eligible AsA patients were 4.3% and 2.7% using USPSTF 2013 and 2021 guidelines, respectively. Lung cancer screening rates varied by AsA subgroup. Under 2021 guidelines, Chinese (4.0%) were screened more than Korean (3.57%), Southeast Asian (3.52%), Japanese (3.19%), Asian (Other) (2.28%), Pacific Islander (1.91%), and Filipino (1.55%). Under 2013 guidelines, Southeast Asian (6.54%) were screened more than Chinese (6.51%), Japanese (5.36%), Asian (Other) (3.95%), and Filipino (1.93%).DiscussionThis is the first study to demonstrate significant heterogeneity in LCS rates for disaggregated AsA subgroups. Kaiser Permanente Northern California LCS rates were 4× California rates. When payment alone is not a care barrier, systemic and culturally sensitive interventions are necessary to increase overall LCS screening rates and address population-specific disparities.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251353073"},"PeriodicalIF":1.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473814","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}

引用次数: 0