American Surgeon最新文献

{"title":"Staged Thyroidectomy After First-Side Recurrent Laryngeal Nerve Injury or Loss of Signal: An Evidence-Based Operative Framework.","authors":"Tucker Bettis, Logan D Glosser, Quynh Tran, Neil Saunders, Thomas Yamashita, Loreski Collado, Anee Jackson, Collin Weber, Joe Sharma, Snehal G Patel","doi":"10.1177/00031348261496605","DOIUrl":"https://doi.org/10.1177/00031348261496605","url":null,"abstract":"<p><p>Bilateral recurrent laryngeal nerve (RLN) injury after thyroidectomy is uncommon but catastrophic, producing airway compromise, tracheostomy dependence, and permanent disability. The 2025 American Thyroid Association guideline and the International Neural Monitoring Study Group guidelines both recommend deferring contralateral resection when first-side RLN injury or persistent loss of signal is recognized, and prospective monitoring series show that terminating bilateral surgery in this setting reduces bilateral vocal cord paralysis without compromising patient satisfaction. What existing recommendations do not supply is an operative pathway: what should trigger the pause, how loss of signal should be troubleshot, what recovery threshold permits same-session completion, when laryngoscopy should occur, and how completion thyroidectomy should be reconsidered. This review synthesizes contemporary guideline language, prospective monitoring data, and published thyroidectomy malpractice decisions retrieved from Westlaw into a practical two-track intraoperative framework. Track A addresses visualized transection or a clearly nonviable nerve; Track B addresses persistent loss of signal without visualized injury, where amplitude recovery to at least half of baseline, confirmed by vagal stimulation, supports same-session completion. Published case law is used illustratively rather than epidemiologically and shows that adjudicated operative criticism has clustered around extent of resection and the decision to complete the second side rather than around the occurrence of nerve injury, while defense outcomes more often reflected accepted-risk anatomy, specific consent documentation, and adequate expert proof. Evidence favoring selective immediate completion is presented alongside the case for staging. The framework operationalizes rather than replaces existing guidance and supplies concrete troubleshooting, consent, and operative-note elements.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261496605"},"PeriodicalIF":1.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164026","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":"Increasing Detection of Early-Onset Rectal Neuroendocrine Neoplasms in the Era of Earlier Colorectal Cancer Screening.","authors":"Maher Al Khaldi, Zubair Bayat, Noam Kahana, Michal Perets, Sameh Hany Emile","doi":"10.1177/00031348261495992","DOIUrl":"https://doi.org/10.1177/00031348261495992","url":null,"abstract":"<p><p>BackgroundThis study aimed to evaluate contemporary national trends in the presentation, management, and outcomes of early-onset rectal neuroendocrine neoplasms (EORNETs).MethodsA retrospective cohort analysis of patients <50 years who underwent surgery for rectal neuroendocrine neoplasms was performed using the National Cancer Database (NCDB) (2004-2023). Patients undergoing surgery were categorized as local tumor excision or radical resection. Five-year overall survival (OS) was estimated using Kaplan-Meier analysis, and multivariable Cox proportional hazards analysis was used to identify factors associated with OS. A sensitivity analysis was also performed in the well-differentiated neuroendocrine tumor subgroup.Results7285 patients were included; 6638 (91.1%) underwent local excision and 647 (8.9%) radical resection. The annual number of surgically treated cases increased from 234 in 2004 to 778 in 2023. 83.0% of tumors with known grade were low grade, and 90.6% of tumors with known clinical stage were stage I. Radical resection was associated with larger tumors, higher grade, more advanced stage, lymphovascular invasion, and liver metastases (all <i>P</i> < .001). Five-year OS was higher after local excision than radical resection (97.5% vs 85.7%, <i>P</i> < .001). In the full multivariable model, radical resection was associated with worse OS (HR 3.43, 95% CI 1.60-7.36; <i>P</i> = .002); however, this association was no longer statistically significant in the well-differentiated tumor subgroup (HR 2.52, 95% CI 0.97-6.54; <i>P</i> = .057).ConclusionsThe number of surgically treated EORNET cases substantially increased over time. Local excision was the predominant treatment. These findings are compatible with increased detection of indolent lesions through greater endoscopic evaluation.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261495992"},"PeriodicalIF":1.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164200","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":"From Anatomy to Biology: Tumor Location has Limited Independent Value in Predicting Pathological Complete Response After Neoadjuvant Chemoradiotherapy.","authors":"Omer Akay, Abdullah Gunes, Mert Guler, Ibrahim Unlu, Murat Burc Yazicioglu, Feyyaz Adasiroglu, Husnu Ozan Sevik, Ozan Can Tatar, Ufuk Oguz Idiz","doi":"10.1177/00031348261497817","DOIUrl":"https://doi.org/10.1177/00031348261497817","url":null,"abstract":"<p><p>BackgroundNeoadjuvant therapy is the standard treatment for locally advanced rectal cancer; however, treatment response remains heterogeneous, and research has increasingly shifted from isolated anatomical predictors toward biologically integrated response assessment. This study evaluated whether anatomical tumor location was independently associated with pathological response to neoadjuvant therapy.Materials and MethodsThis multicenter retrospective study included 179 patients with stages II-III rectal adenocarcinoma undergoing long-course neoadjuvant chemoradiotherapy followed by total mesorectal excision between January 2023 and January 2026. Tumor location was categorized as upper (>10 cm), mid (5-10 cm), or low (<5 cm) rectum. Pathological response was assessed using the modified Ryan system, and major response was defined as TRG 0-1. Multivariable binary logistic regression evaluated factors associated with major pathological response, with multinomial regression as a secondary exploratory analysis.ResultsIn the primary multivariable analysis, tumor location was not independently associated with major pathological response (global <i>P</i> = .358). Major response occurred in 47.5% of patients without lymphovascular invasion but in only 3.3% of those with lymphovascular invasion, which was associated with lower odds of major response (OR 0.05, 95% CI 0.01-0.15; <i>P</i> < .001).ConclusionAnatomical tumor location was not independently associated with pathological response following neoadjuvant chemoradiotherapy. These findings suggest that response assessment should extend beyond simple anatomical variables and be interpreted within the broader context of tumor biology and integrated clinicopathological assessment.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261497817"},"PeriodicalIF":1.0,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164904","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":"Early Observations From the Adoption of Robotic Cholecystectomy by an Acute Care Surgery Service.","authors":"Bethany O Ekeh, Stephen B Vinczi, Yee M Wong, Ann Cardosi, Akpofure Peter Ekeh","doi":"10.1177/00031348261493532","DOIUrl":"https://doi.org/10.1177/00031348261493532","url":null,"abstract":"<p><p>BackgroundLaparoscopic cholecystectomy (LC) is the standard procedure for gallbladder disease. Robotic cholecystectomy (RC) has been increasingly adopted; its role within Acute Care Surgery (ACS) services remains undefined. We evaluated early outcomes following the adoption of RC by an ACS service at a Level I trauma center and compared perioperative outcomes with LC.MethodsA retrospective study revealed all adult patients undergoing LC or RC, emergently or electively, by ACS surgeons at a verified Level I trauma center between January 2024 and 2025. Demographic characteristics, operative indications, body mass index (BMI), operative duration, conversion to open surgery, length of stay (LOS), complications, and 30-day readmission were collected. Categorical variables used Fisher's exact test and continuous variables utilized Welch's t-test.Results416 cholecystectomies were performed, including 305 LC (73.3%) and 111 RC (26.7%). Mean patient age was 50.3 years and 33.4% were male, with no demographic differences between groups. Robotic cholecystectomy patients had a higher mean BMI (36.0 vs 32.1 kg/m²; <i>P</i> = 0.002). Operative duration, conversion to open surgery (4.1%), and overall complication rates (10.8%) were similar between LC and RC. Robotic cholecystectomy was associated with shorter LOS (3.02 vs 3.96 days; <i>P</i> = 0.031) and lower 30-day readmission rate (4.5% vs 11.5%; <i>P</i> = 0.038).ConclusionsInitial experience with RC by ACS surgeons demonstrated modest reduction in hospital LOS, lower 30-day readmission rates, comparable complication rates relative to LC, and preferential use among patients with higher BMI. Larger prospective studies need to further define RC's clinical outcomes and value-based implications in the ACS setting.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261493532"},"PeriodicalIF":1.0,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164175","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":"Delayed Multi-Compartment Traumatic Hernias After Blunt Abdominal Trauma: A Case-Based Review of Diagnosis and Staged Management.","authors":"Colton M Moore, Miranda Smith, Benjamin Koppman, Jana Sacco, Ruchir Puri","doi":"10.1177/00031348261496610","DOIUrl":"https://doi.org/10.1177/00031348261496610","url":null,"abstract":"<p><p>BackgroundTraumatic diaphragmatic hernias (TDHs) and traumatic abdominal wall hernias (TAWHs) are uncommon sequelae of blunt abdominal trauma (BAT) and may be missed during the initial evaluation. Delayed presentation can occur months to years later, resulting in incarceration, obstruction, or respiratory compromise.Case PresentationA 61-year-old woman presented 1 year after a motor vehicle collision with abdominal pain, nausea, constipation, and dyspnea. Computed tomography demonstrated an incarcerated left diaphragmatic hernia containing colon and omentum, along with a right flank hernia containing ascending colon. Review of prior imaging revealed a flank hematoma and subtle abdominal wall disruption at the time of initial injury. The patient underwent urgent laparoscopic repair of the diaphragmatic hernia followed by elective robotic transabdominal preperitoneal repair of the flank hernia 2 months later.DiscussionThis case illustrates a pattern of delayed multi-compartment traumatic herniation resulting from thoracoabdominal force transmission. Diagnostic delays may occur because of competing priorities during polytrauma management, limitations of initial imaging, and delayed development of herniation, especially when the injuries are subtle. Findings such as rib fractures, pneumothorax, abdominal wall hematoma, and persistent symptoms should prompt continued surveillance.ConclusionDelayed multi-compartment traumatic hernias represent a diagnostic challenge requiring a high index of suspicion, longitudinal surveillance, and individualized management. A staged operative approach based on symptom severity and anatomic location can effectively address differing levels of clinical urgency.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261496610"},"PeriodicalIF":1.0,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147264","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":"Crossing the Threshold to Emergency Surgery: Robot-Assisted Adrenalectomy for Refractory Pheochromocytoma Crisis.","authors":"Mario Annecchiarico, Giuseppe Loiaco, Francesco Carafa, Claudia Cirillo, Antonio Antonino, Giulio Argenio, Antonio Varricchio, Giuseppe Esposito, Pellegrino Gambardella, Angela Romano","doi":"10.1177/00031348261497804","DOIUrl":"https://doi.org/10.1177/00031348261497804","url":null,"abstract":"<p><p>Pheochromocytoma crisis can make conventional adrenergic preparation impossible and force consideration of adrenalectomy before physiologic recovery. This narrative review synthesizes the evidence that informs the transition from continued stabilization to nondeferrable tumor removal. Emergency presentation alone does not constitute an operative indication. When hemorrhage is controlled and cardiovascular and extracardiac organ function improved, surgery should be deferred until preparation is completed. Uncontrolled bleeding, expanding hematoma, or life-threatening compression requires immediate source-control assessment. Transcatheter arterial embolization may provide a bridge to elective adrenalectomy in selected hemorrhagic presentations. In nonhemorrhagic crisis, rescue adrenalectomy may be considered only when serial multidisciplinary reassessment shows persistent tumor-driven deterioration despite appropriate support, conventional preparation cannot be advanced safely, the lesion is localized and resectable, and organ injury remains potentially reversible. Mechanical circulatory support usually serves as a bridge to myocardial recovery and later surgery rather than as a routine platform for adrenalectomy. No validated temporal, hemodynamic, biochemical, or organ-failure threshold defines the point at which surgery becomes preferable to continued support. Operative access should therefore be selected only after the indication for surgery has been established and should reflect anatomy, physiologic tolerance, institutional expertise, and immediate conversion capability.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261497804"},"PeriodicalIF":1.0,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149163808","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":"Lack of Primary Care Continuity Predicts Readmission Risk Among Socially Vulnerable Trauma Populations.","authors":"Jennifer H Lowell, Paul R Scott, Seth A Battad, Caleb W Brown, Hannah Tan, Derek C Wenger, Hannah E Collins, Sarah A King, Lou M Smith, J Bracken Burns","doi":"10.1177/00031348261495998","DOIUrl":"https://doi.org/10.1177/00031348261495998","url":null,"abstract":"<p><p>IntroductionEarly unplanned trauma readmission (UR-30) is not well-understood. Social vulnerability indices (SVIs) and primary care access were postulated as contributing factors to discharge outcomes.MethodsRetrospective propensity-matched analysis at a Level I Trauma Center compared readmitted patients (UR-30, n = 85) to those without (NoReadmission-30, n = 85). Established PCP relationship and five social vulnerability indices (SVIs) were evaluated.Results170 total patients had average age 56.6, 71.8% male, and 95.3% Caucasian. Average ISS = 9. Average LOS was 6.44 ± 6.71 days. LOS was longer in readmissions (5 vs 3 days, <i>P</i> = 0.03). UR-30 had 2.908X more patients with >3 comorbidities (<i>P</i> < 0.001). No SVI (CDC SVI Quality, ARC, FORHP, CBSA, and PLACES; <i>P</i> = 0.303, 0.882, 0.916, 0.721, and 1.000, respectively) was significant. 49.4% of UR-30 and 72.9% of NoReadmission-30 patients had a documented PCP, conferring a 0.371 [0.137-1.007] times lower odds of readmission (<i>P</i> = 0.047).ConclusionOur findings suggest that lack of PCP access/continuity of routine medical care contributes to UR-30 among trauma patients when high levels of social vulnerability are routinely present. Social vulnerability indices did not identify readmission risk in this predominantly rural, underserved patient population.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261495998"},"PeriodicalIF":1.0,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164148","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":"Prehospital Variables Do Not Reliably Identify Pelvic Fracture Morphologies Amenable to Pelvic Binder Application: A Retrospective Imaging Review.","authors":"Maximilian P Forssten, Hayder Saleh Al Saadi, Amin El Helw, Vettikkattil Joseph Simon, Marcelo Af Ribeiro, Neev Trehan, Sebastian P Forssten, Ravi Trehan, Shahin Mohseni","doi":"10.1177/00031348261494137","DOIUrl":"https://doi.org/10.1177/00031348261494137","url":null,"abstract":"<p><p>BackgroundPelvic binders are used in prehospital settings for early stabilization when pelvic fractures are suspected. Although a rapid and cost-effective tool, uncertainties persist regarding their use prior to radiological confirmation of pelvic fracture.MethodsA review of adult patients with a pelvic fracture requiring trauma team activation who were admitted to a tertiary trauma center between 2020 and 2023 was conducted. The radiological studies were reviewed by four consultant orthopedic surgeons and were classified according to whether the application of a pelvic binder would be mechanically favorable, neutral, or potentially unfavorable. The area under the curve (AUC) was calculated to evaluate the ability of specific physiologic and injury-related variables (hypotension, tachycardia, shock index, Injury Severity Score (ISS), Glasgow Coma Scale, and mechanism of injury) to discriminate pelvic fracture morphologies for which pelvic binder application would be favorable.ResultsA total of 298 patients were included in the current investigation. Of these patients, applying a pelvic binder was favorable in 17% of cases (95% CI: 13%-22%, N = 50), would be mechanically neutral in 28% of cases (95% CI: 23%-33%, N = 82), and was potentially unfavorable in 56% of cases (95% CI: 50%-61%, N = 166) (<i>P</i> < .001). All investigated variables demonstrated limited discriminatory ability for identifying patients for whom pelvic binder application was favorable, with most AUCs <0.60. The highest predictive performance was observed for the ISS [AUC (95% CI): 0.65 (0.58-0.73)].ConclusionIn trauma patients with CT-confirmed pelvic ring injuries, readily available prehospital variables such as hemodynamic instability, associated injury patterns, and mechanism of injury appear to be insufficient for reliably identifying patients with a fracture morphology that could be amenable to pelvic binder application.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261494137"},"PeriodicalIF":1.0,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147199","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":"From Resection to Transplantation: Rethinking Training and Certification for the Modern HPB Surgeon.","authors":"Dimitrios Moris, Ioannis A Ziogas, Emmanouil Giorgakis, Yuri S Genyk","doi":"10.1177/00031348261496615","DOIUrl":"https://doi.org/10.1177/00031348261496615","url":null,"abstract":"<p><p>Hepatopancreatobiliary (HPB) surgery has evolved beyond the confines of traditional liver and pancreatic resection. Contemporary practice increasingly encompasses advanced vascular reconstruction, extended hepatectomy in compromised livers, transplantation for malignancy, and complex operations following multimodality therapy. These developments have fundamentally altered the technical and cognitive demands placed upon HPB surgeons, raising an important question: which training pathway best prepares surgeons for the future of the specialty? Dedicated HPB, surgical oncology, and integrated transplant-HPB fellowships each provide valuable but distinct expertise. Surgical oncology emphasizes tumor biology, multidisciplinary cancer care, and clinical investigation. Dedicated HPB fellowships focus on advanced liver and pancreatic resection. In contrast, integrated transplant-HPB training uniquely combines these competencies with mastery of hepatic physiology, complex vascular reconstruction, management of portal hypertension and liver failure, transplantation, and operative rescue under extreme physiologic conditions. We contend that integrated transplant-HPB training now represents the most comprehensive preparation for modern HPB surgery. This argument is not intended to promote territorial ownership of the specialty but rather to advocate for competency-based training that reflects the realities of current practice. As transplant oncology, living donor liver transplantation, machine perfusion, and increasingly aggressive surgical strategies continue to redefine operability, developments now supported by randomized and large-registry data rather than qualitative impression alone, certification pathways should evolve accordingly. Rather than existing outside mainstream HPB training, integrated transplant-HPB fellowships should be fully embraced within HPB certification frameworks, ensuring that future surgeons are equipped to offer the complete spectrum of operative strategies available to patients with complex HPB disease.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261496615"},"PeriodicalIF":1.0,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164413","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":"Large Language Models as a Clinical Interface for Predictive Modeling: A Feasibility Study in Pediatric Appendicitis.","authors":"Jesse P Caron, Oscar Rodriguez, Leila Raden, William Cobb, Jeffrey Lu, Shelby Harris, Daniel Rozefort, Scott W Bloom, Lindsey Armstrong","doi":"10.1177/00031348261480836","DOIUrl":"https://doi.org/10.1177/00031348261480836","url":null,"abstract":"<p><p>PurposeLarge language models (LLMs) are increasingly used in clinical data workflows, but most clinicians lack the time, training, or support to build predictive models. We evaluated whether a ChatGPT-assisted workflow could enable clinicians to independently construct and execute a basic predictive model using routine perioperative data, using postoperative length of stay (LOS) in pediatric appendicitis as a feasibility use case.MethodsWe conducted a retrospective study of 228 children undergoing laparoscopic appendectomy. Ten routinely available preoperative variables were used. ChatGPT guided preprocessing and generated code for linear regression and random forest models using naïve and structured prompting. Models were trained using an 80/20 split and evaluated using MAE, RMSE, r, and R².ResultsNaïve prompting performed poorly, while structured prompting improved model performance (MAE 0.34, RMSE 0.85, r 0.85). On the test set, linear regression achieved MAE 1.00 and random forest 0.77. Identified variables reflected expected clinical patterns. These findings demonstrate internal consistency of the workflow rather than new predictive insight.ConclusionsA structured ChatGPT workflow enabled clinicians to construct standard predictive models using routine data. These findings support feasibility of clinician-directed model development, but not clinical utility, of LLM-enabled workflows.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261480836"},"PeriodicalIF":1.0,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134589","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}