Impact of Operative Approach on Acute Kidney Injury Risk Prediction Models for Colectomy.

INTRODUCTION: Acute kidney injury (AKI) is a serious postoperative complication associated with increased morbidity and mortality. Identifying patients at risk for AKI is important for risk stratification and management. This study aimed to develop an AKI risk prediction model for colectomy and determine if the operative approach (laparoscopic versus open) alters the influence of predictive factors through an interaction term analysis. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was analyzed from 2005 to 2019. Patients undergoing laparoscopic and open colectomy were identified and propensity score matched. Multivariable logistic regression identified significant preoperative demographic, comorbidity, and laboratory value predictors of AKI. The predictive ability of a baseline model consisting of these variables was compared to a proposed model incorporating interaction terms between operative approach and predictor variables using the likelihood ratio test, c-statistic, and Brier score. Shapley Additive Explanations values assessed relative importance of significant predictors. RESULTS: 252,372 patients were included in the analysis. Significant AKI predictors were hypertension, age, sex, race, body mass index, smoking, diabetes, preoperative sepsis, Congestive heart failure, preoperative creatinine, preoperative albumin, and operative approach (P < 0.001). The proposed model with interaction terms had improved predictive ability per the likelihood ratio test (P < 0.05) but had no statistically significant interaction terms. C-statistic and Brier scores did not improve. Shapley Additive Explanations analysis showed hypertension had the highest importance. The importance of age and diabetes showed some variation between operative approaches. CONCLUSIONS: While the inclusion of interaction terms collectively improved AKI prediction, no individual operative approach interaction terms were significant. Including operative approach interactions may enhance predictive ability of AKI risk models for colectomy.

Is Program Director Gender Associated With Gender Diversity Among Orthopaedic Surgery Residency Programs?

BACKGROUND: Women remain underrepresented in leadership roles, faculty roles, and among residents in orthopaedic surgery. It has been suggested that having women in leadership positions in orthopaedic surgery may help to increase the gender diversity of residency programs. However, to our knowledge, no study has explored the relationship, if any, between the gender of the residency program director and the percentage of women in the residency program. QUESTIONS/PURPOSES: (1) Is the program director's gender associated with differences in the percentage of women orthopaedic surgery residents? (2) Do women and men differ in the time to appointment of program director? METHODS: A list of 207 orthopaedic surgery residencies was obtained from the Accreditation Council for Graduate Medical Education (ACGME) website for the academic year 2021 to 2022. The study excluded 6% (13) of programs; 4% (8) were those without ACGME accreditation and those with initial accreditation, and 2% (5) did not have updated 2021 to 2022 resident lists. Descriptive information on 194 programs was obtained from publicly accessible resources from July 2021 through July 2022. The institution's website and the American Medical Association's (AMA) Fellowship and Residency Electronic Interactive Database (FREIDA) was used to collect residency program characteristics and resident demographics [2]. Doximity, Healthgrades, and LinkedIn were used to further collect current orthopaedic surgery residency program director demographics, including gender, age, and education/training history. To determine gender, photographs and pronouns (she/her/hers or he/him/hers) used in their biographies were used first. To confirm this, secondary sources were used including their NPI profile, which lists gender; Doximity; and their LinkedIn profile. Scopus was used to analyze research output by the program directors-using the Hirsch index (h-index) as the primary bibliometric metric. A total of 194 program directors were identified, of whom of 12% (23) were women and 88% (171) were men. Of the 4421 total residents among these programs, 20% (887) were women and 80% (3534) were men. A univariate analysis comparing program directors was conducted, with continuous variables analyzed using an independent-sample t-test and categorical variables analyzed using a Pearson chi-square test. With the numbers available, a post hoc statistical power calculation indicated that we could detect an 32% difference in the percentage of women in a program as significant with 80% power at the p < 0.05 level, whereas we might have been underpowered to discern smaller differences than that. RESULTS: With the numbers available, we found no difference in the percentage of women in residency programs run by women program directors than in programs in which the program director was a man (22% [125 of 558] versus 20% [762 of 3863], mean difference 2% [95% CI -1.24% to 7.58%]; p = 0.08). Comparing women to men program directors, women had fewer years between residency completion and appointment to the position of program director (8 ± 2 years versus 12 ± 7 years, mean difference 4 years [95% CI 2.01 to 7.93 years]; p = 0.02) and had a lower mean h-index (7 ± 4 versus 11 ± 11, mean difference 4 [95% CI 1.70 to 6.56]; p = 0.03) and number of publications (24 ± 23 versus 41 ± 62, mean difference 17 [95% CI 3.98 to 31.05]; p = 0.01), although they did not differ in terms of their advanced degrees, duration of training, or likelihood of having taken a fellowship. CONCLUSION: Orthopaedic residency programs that were run by women did not contain a higher percentage of women residents, suggesting that the gender of the individual in that role may not be as important as has been speculated by others. Future studies should investigate the intersectionality of gender, race, and ethnicity of residents, program directors, and current faculty. CLINICAL RELEVANCE: The fact that women were placed in program director roles earlier in career may also carry special jeopardy for them. Those roles are difficult and can impair a faculty member's ability to conduct individual research, which often is key to further academic promotions. Given that and the fact that the gender of the program director was not associated with differences in gender composition of residency programs, we believe that increasing mentorship and access to pipeline programs will help promote diversity in residency programs.

Is YouTube Propagating Concerns About Breast Implant Illness?

BACKGROUND: An increasing number of patients who underwent breast implant surgery are reporting a cluster of concerning physical and psychological symptoms-newly coined term breast implant illness (BII). YouTube is a popular educational tool for plastic surgery patients. OBJECTIVES: The purposes of this study were to assess the quality and reliability of YouTube videos on BII, compare the quality and reliability of different video categories and publishers, and determine the frequencies of reported BII symptoms. METHODS: On YouTube, videos were searched for the term breast implant illness , and the first 100 results were collected. Engagement parameters and symptoms of BII mentioned in each video were recorded. Video power index, a modified DISCERN instrument, and the Global Quality Scale (GQS) were used to assess popularity, reliability, and quality, respectively. RESULTS: Ninety videos met the inclusion criteria. More than half mentioned fatigue (66%), cognitive dysfunction (59%), or muscle and/or joint pain (57%). Videos with a plastic surgeon present had higher DISCERN ( P = 0.001) and GQS ( P = 0.002) scores than those without. Educational videos had higher DISCERN and GQS scores than patient experience ( P < 0.0001, P = 0.001) and entertainment and advertisement videos ( P = 0.014, P = 0.022). Videos published by plastic surgeons had higher Video power index ( P = 0.033), DISCERN ( P < 0.0001), and GQS scores ( P < 0.0001) than those by nonmedical publishers. CONCLUSIONS: The top YouTube videos for BII are generally of low reliability and low-to-moderate quality. Patients unaware of YouTube's limited quality control measures for health education videos are susceptible to misinformation. Additional social media content created by plastic surgeons can improve the quality and accuracy of videos viewed by patients.

Malnutrition in Head and Neck Free Flap Reconstruction as a Predictor of Adverse Outcomes.

INTRODUCTION: Malnutrition is associated with increased mortality in patients with head and neck (H&N) cancer. Because albumin levels are used as a surrogate for nutritional status, the purpose of this study is to assess whether malnutrition is associated with adverse postoperative outcomes in H&N free flap reconstruction. MATERIALS AND METHODS: The 2006-2018 National Surgical Quality Improvement Program Database was queried for patients undergoing flap procedures of the H&N based on Current Procedure Terminology codes. Patients were included if they were operated on by an otolaryngologist or when the primary surgical site was H&N. Nutritional status was categorized as malnourished (preoperative albumin level <3.5 g/dL) or normal (preoperative albumin level ≥3.5 g/dL). Major complications included pulmonary complications, cardiac complications, deep vein thrombosis/pulmonary embolism, and sepsis/septic shock. Minor complications included surgical infection, urinary tract infection, bleeding, and dehiscence. Data were analyzed via univariate chi-square and multivariate regression analyses. RESULTS: Of the patients, 2532 (83.3%) had normal albumin and 506 (16.7%) had hypoalbuminemia. Patients with hypoalbuminemia were more likely to have smoking history (P = 0.008), pulmonary comorbidity (P < 0.001), renal comorbidity (P = 0.018), disseminated cancer (P < 0.001), steroid use (P < 0.001), recent weight loss (P < 0.001), bleeding disorder (P = 0.023), and preoperative transfusion (P < 0.001). After adjustment for preoperative variance, malnourished patients were more likely to experience death (P < 0.001), return to operating room (P < 0.001), free flap failure (P = 0.008), pulmonary complication (P < 0.001), deep vein thrombosis/pulmonary embolism (P = 0.019), wound disruption (P = 0.042), intraoperative transfusion (P < 0.001), minor complication (P < 0.001), major complication (P < 0.001), and extended length of stay (P < 0.001). Of the patients with normal albumin, 2.1% experienced flap failure compared with 6.3% of patients with hypoalbuminemia. It should be noted that malnourished patients were 3.370 times more likely to experience flap failure (95% confidence interval, 1.383-8.212; P = 0.008) and 3.975 times more likely to experience death (95% confidence interval, 1.700-9.626; P = 0.001) than those with normal albumin. CONCLUSION: Malnutrition is associated with death, flap failure, minor complications, and other major complications following H&N free flap surgery, even after controlling for preoperative variance. Optimizing preoperative nutrition status before free flap procedures may ameliorate morbidity and mortality in H&N patients.

Utilization of the gastrocnemius flap for post-traumatic knee reconstruction: a systematic review.

PURPOSE: High-energy injuries to the knee may lead to extensive soft tissue loss, fractures, and potential loss of extensor function. The gastrocnemius flap is a prominent reconstructive option for patients with injuries involving the knee and proximal third of the lower extremity. To the best of our knowledge, there has not been an informative review that has evaluated outcomes of patients who have undergone post-traumatic knee reconstruction with a pedicled medial or lateral gastrocnemius flap. The goal of this study is to assess outcomes in patients who have undergone gastrocnemius flap reconstruction after traumatic injuries to the knee. METHODS: The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) methodology. Four databases were utilized including PubMed, Cochrane Reviews, Embase, and CINAHL. Our search criteria consisted of the following keywords: gastrocnemius, flap, knee, and traum*. RESULTS: A total of 204 studies were imported for screening, from which five papers met our final inclusion/exclusion criteria. The most common studies utilized in this review were case series followed by retrospective chart reviews. In total, 43 patients with traumatic soft tissue knee defects were included with an average patient age of 27.28 years. All patients had successful and clinical viable flaps post-operatively, and there were a total of five patients who had complications. CONCLUSION: The gastrocnemius flap has demonstrated to be an effective option for individuals undergoing post-traumatic knee reconstruction. Infection rates, loss of mobility, and scarring represent a minority of complications that may be seen when this reconstructive technique is utilized. Still, additional randomized controlled trials and retrospective studies are required in order to further evaluate for other potential complications that may occur in this patient population.

Assessing the Impact of COVID-19 on Facial Aesthetic Surgery Search Interest.

ABSTRACT: The global COVID-19 pandemic reshaped many components of modern health care practice. Before the pandemic, research was beginning to demonstrate the impact of self-facing cameras, selfie images, and webcams on patient interest in head and neck (H&N) aesthetic surgery. We sought to determine temporal changes in patient interest in aesthetic surgery of the H&N as compared with the rest of the body because of COVID-19, and the subsequent surge in Web-conferencing and telecommunication. The 2020 Plastic Surgery Trends Report produced by the American Society of Plastic Surgeons was used to identify the 5 most common aesthetic surgical procedures performed on the H&N and the rest of the body for 2019: blepharoplasty, face lift, rhinoplasty, neck lift, cheek implant, and breast lift, liposuction, tummy tuck, breast augmentation, and breast reduction, respectively. Google Trends filters, which provide relative search interest for greater than 85% of Internet searches, were applied to gauge interest from January 2019 to April 2022. Relative search interest and mean interest were plotted as a function of time for each term. Our findings demonstrate a sharp decline in online aesthetic surgery interest in March 2020, coinciding with the beginning of the COVID-19 pandemic for both the H&N and the rest of the body. Search interest increased shortly after March 2020 and reached values greater than those of the prepandemic year (2019) in 2021 for rest of the body procedures. After March 2020, there was a brief, sharp increase in search interest for rhinoplasty, neck lift, and facelift, whereas patient interest in blepharoplasty increased more gradually. There was no increase in search interest for H&N procedures as a result of COVID-19 when using the mean values of the included procedures, although current interest has returned to prepandemic levels. The COVID-19 pandemic caused a disruption of normal trends in aesthetic surgery interest, with a sharp decline in search interest in March 2020. Afterward, there was a sharp increase in rhinoplasty, face lift, neck lift, and blepharoplasty interest. Patient interest in blepharoplasty and neck lift has remained elevated compared with 2019. Interest in rest of the body procedures has returned to and even surpassed prepandemic levels.

Performance of ChatGPT on the Plastic Surgery Inservice Training Examination.

BACKGROUND: Developed originally as a tool for resident self-evaluation, the Plastic Surgery Inservice Training Examination (PSITE) has become a standardized tool adopted by Plastic Surgery residency programs. The introduction of large language models (LLMs), such as ChatGPT (OpenAI, San Francisco, CA), has demonstrated the potential to help propel the field of Plastic Surgery. OBJECTIVES: The authors of this study wanted to assess whether or not ChatGPT could be utilized as a tool in resident education by assessing its accuracy on the PSITE. METHODS: Questions were obtained from the 2022 PSITE, which was present on the American Council of Academic Plastic Surgeons (ACAPS) website. Questions containing images or tables were carefully inspected and flagged before being inputted into ChatGPT. All responses by ChatGPT were qualified utilizing the properties of natural coherence. Responses that were found to be incorrect were divided into the following categories: logical, informational, or explicit fallacy. RESULTS: ChatGPT answered a total of 242 questions with an accuracy of 54.96%. The software incorporated logical reasoning in 88.8% of questions, internal information in 95.5% of questions, and external information in 92.1% of questions. When stratified by correct and incorrect responses, we determined that there was a statistically significant difference in ChatGPT's use of external information (P < .05). CONCLUSIONS: ChatGPT is a versatile tool that has the potential to impact resident education by providing general knowledge, clarifying information, providing case-based learning, and promoting evidence-based medicine. With advancements in LLM and artificial intelligence (AI), it is possible that ChatGPT may be an impactful tool for resident education within Plastic Surgery.

Expanding Cosmetic Plastic Surgery Research With ChatGPT.

BACKGROUND: In the past 3 months, OpenAI, a San Francisco-based artificial intelligence (AI) research laboratory, has released ChatGPT, a conversation large language model. ChatGPT has the ability to answer user questions, admit to mistakes, and learn from users that are accessing the program. OBJECTIVES: Due to the importance of producing evidence-based research in plastic surgery, the authors of this study wanted to determine how accurate ChatGPT could be in creating novel systematic review ideas that encompass the diverse practice of cosmetic surgery. METHODS: ChatGPT was given commands to produce 20 novel systematic review ideas for 12 different topics within cosmetic surgery. For each topic, the system was told to give 10 general and 10 specific ideas that were related to the concept. To determine the accuracy of ChatGPT, a literature review was conducted with PubMed, CINAHL, EMBASE, and Cochrane. RESULTS: A total of 240 "novel" systematic review ideas were constructed by ChatGPT. We determined that the system had an overall accuracy of 55%. When topics were stratified by general and specific ideas, we found that ChatGPT was 35% accurate for general ideas and 75% accurate for specific ideas. CONCLUSIONS: ChatGPT is an excellent tool that should be utilized by plastic surgeons. ChatGPT is versatile and has uses beyond research, including patient consultation, patient support, and marketing. As advancements in AI continue to be made, it is important for plastic surgeons to consider the utilization of AI in their clinical practice.

Assessing the potential role of ChatGPT in spine surgery research.

Purpose: Since its release in November 2022, Chat Generative Pre-Trained Transformer 3.5 (ChatGPT), a complex machine learning model, has garnered more than 100 million users worldwide. The aim of this study is to determine how well ChatGPT can generate novel systematic review ideas on topics within spine surgery. Methods: ChatGPT was instructed to give ten novel systematic review ideas for five popular topics in spine surgery literature: microdiscectomy, laminectomy, spinal fusion, kyphoplasty and disc replacement. A comprehensive literature search was conducted in PubMed, CINAHL, EMBASE and Cochrane. The number of nonsystematic review articles and number of systematic review papers that had been published on each ChatGPT-generated idea were recorded. Results: Overall, ChatGPT had a 68% accuracy rate in creating novel systematic review ideas. More specifically, the accuracy rates were 80%, 80%, 40%, 70% and 70% for microdiscectomy, laminectomy, spinal fusion, kyphoplasty and disc replacement, respectively. However, there was a 32% rate of ChatGPT generating ideas for which there were 0 nonsystematic review articles published. There was a 71.4%, 50%, 22.2%, 50%, 62.5% and 51.2% success rate of generating novel systematic review ideas, for which there were also nonsystematic reviews published, for microdiscectomy, laminectomy, spinal fusion, kyphoplasty, disc replacement and overall, respectively. Conclusions: ChatGPT generated novel systematic review ideas at an overall rate of 68%. ChatGPT can help identify knowledge gaps in spine research that warrant further investigation, when used under supervision of an experienced spine specialist. This technology can be erroneous and lacks intrinsic logic; so, it should never be used in isolation. Level of Evidence: Not applicable.

Hypoalbuminemia improves the ACS-NSQIP surgical risk calculator for gastrectomy.

BACKGROUND: The ACS-NSQIP Surgical Risk Calculator (SRC) is used to predict surgical outcomes, but its accuracy in gastrectomy has been questioned.1,2 We investigated if adding hypoalbuminemia enhances its predictive ability in gastrectomy. METHODS: We identified gastrectomy patients from the ACS-NSQIP database from 2005 to 2019. We constructed pairs of logistic regression models: one with the existing 21 preoperative risk factors from the SRC and another with the addition of hypoalbuminemia. We evaluated improvement using Likelihood Ratio Test (LRT), Brier scores, and c-statistics. RESULTS: Of 18,070 gastrectomy patients, 34.5 â€‹% had hypoalbuminemia. Hypoalbuminemia patients had 2.34 higher odds of mortality and 1.79 higher odds of morbidity. Adding hypoalbuminemia to the RC model statistically improved predictions for mortality, cumulative morbidity, pulmonary, renal, and wound complications (LRT p â€‹< â€‹0.001). It did not improve predictions for cardiac complications (LRT p â€‹= â€‹0.11) CONCLUSION: Hypoalbuminemia should be considered as an additional variable to the ACS-NSQIP SRC for gastrectomy.

The Relative Citation Ratio: An Impartial Assessment of Productivity in Academic Otolaryngologists.

OBJECTIVES: Quantification of academic productivity relies on bibliometric measurements, such as the Hirsch index (h-index). The National Institutes of Health (NIH) recently developed the relative citation ratio (RCR), an article-level, citation-driven metric that compares researchers with others within their respective fields. Our study is the first to compare the usage of RCR in academic otolaryngology. STUDY DESIGN: Retrospective Database Review. METHODS: Academic otolaryngology residency programs were identified using the 2022 Fellowship and Residency Electronic Interactive Database. Demographic and training data were collected for surgeons using institutional websites. RCR was calculated using the NIH iCite tool, and h-index was calculated using Scopus. Mean RCR (m-RCR) is the average score of the author's articles. Weighted RCR (w-RCR) is the sum of all article scores. These derivatives are a measure of impact and output, respectively. The career duration of a physician was categorized into the following cohorts: 0-10, 11-20, 21-30, and 31+ years. RESULTS: A total of 1949 academic otolaryngologists were identified. Men had higher h-indices and w-RCRs than women (both p less than 0.001). m-RCR was not different between genders (p = 0.083). There was a difference in h-index and w-RCR (both p less than 0.001) among the career duration cohorts, but there was no difference in m-RCR among the cohorts (p = 0.416). The faculty rank professor was the greatest for all metrics (p < 0.001). CONCLUSION: Critics of the h-index argue that it is reflective of the time a researcher has spent in the field, instead of impact. The RCR may reduce historic bias against women and younger otolaryngologists. LEVEL OF EVIDENCE: NA Laryngoscope, 134:592-599, 2024.

"Top 20" residency-trained academic orthopaedic surgeons have higher academic productivity and funding in their careers.

"Top 20" status on Doximity, an online networking service for medical professionals, is an indicator of the reputation of a residency program. The study assesses how training at a Top 20 (T20) orthopaedic residency program impacts career productivity and funding. Fellowship and Residency Electronic Interactive Database was used in 2022 to identify active orthopaedic residency programs. Demographic and training data was collected for each orthopaedic surgeon using institutional websites and Doximity. The Residency Navigator feature on Doximity was used to rank residency programs by "reputation." Programs were categorized as either T20 or non-T20. The relative citation ratio (RCR) was calculated using the NIH iCite tool and Hirsch index (h-index) was calculated using Scopus. Industry funding was collected from the Centers for Medicare & Medicaid Services Open Payments Program (CMS) for all available years (2014-2020). A total of 2812 academic orthopaedic surgeons were included in the study. Among academic orthopaedic surgeons in the United States, T20 trained orthopedists had more publications and citations (p < 0.001), along with higher h-indices (p < 0.001), RCR (p < 0.001), and industry funding (p = 0.043). Additionally, T20 trained orthopedists were 1.375 times more likely to obtain professor status (95% confidence interval: 1.150-1.645, p < 0.001). Even after propensity-matched analysis, T20 trained orthopedists maintained these differences. Training at a T20 residency program is associated with promotion, productivity, and funding. These findings are especially of concern to medical students who must consider the importance of a residency program's reputation when deciding where to apply for residency.

Retainment of U.S. Orthopaedic Surgeons in Academia from 2016 to 2022.

Background: Academic medical centers greatly benefit from retaining their physicians; that ensures continuity in patient care, enhances resident education, and maintains a pool of experienced clinicians and researchers. Despite its importance, little research has been published on the retainment of academic faculty in orthopaedics. To address this gap, this study investigates the demographic trends of academic orthopaedic surgeons from 2016 to 2022. By analyzing data pertaining to gender distribution, years of practice, research productivity, and institutional rankings, we aimed to gain insights into the factors influencing faculty retainment, institution changes, and new entrants into academic orthopaedics. Methods: A retrospective cross-sectional analysis of U.S. academic orthopaedic surgeons affiliated with programs under the Accreditation Council for Graduate Medical Education (ACGME) in 2016 and 2022 was performed. Faculty present in both the 2016 and the 2022 data were classified as being "retained" in academia; those present only in 2016, as having "left" academia; and those present only in 2022, as being "new" to academia. The retained group was then divided into movers (those who moved to other institutions) and non-movers. Results: Retained orthopaedists had fewer years of practice, a higher h-index (Hirsch index), and more publications. Non-fellowship-trained orthopaedists had less retainment in academia, and orthopaedists with fellowships in oncology had more retainment in academia. Additionally, movers also had fewer years in practice but an equal level of scholarly productivity when compared with non-movers. Lastly, higher-ranked academic programs retained a greater proportion of orthopaedic surgeons. Conclusions: Over the study period, a majority of orthopaedists (56.99%) chose to remain in academia. Those retained tended to be in the earlier stages of their careers, yet demonstrated higher research output. Notably, the representation of female orthopaedists in academic orthopaedics is on the rise. Conversely, lower-ranked programs faced higher turnover rates, highlighting the challenges that they encounter in retaining faculty members. Clinical Relevance: Academic medical centers benefit from retaining orthopaedic surgeons by maintaining patient relationships, having consistency in resident education, and building on clinical and research expertise. Likewise, orthopaedists benefit from understanding the trends in current academic employment, in order to optimize career planning decisions.

Targeted Muscle Reinnervation in the Setting of Traumatic Bilateral Above-Knee Amputations: A Case Report.

CASE: We present the case of a 20-year-old man who was pedestrian struck and sustained bilateral traumatic above-knee amputations. Targeted muscle reinnervation (TMR) was performed with nerve transfers, including tibial nerve to semitendinosus (bilateral), superficial peroneal nerve to biceps femoris (left), deep peroneal nerve to biceps femoris (left), and common peroneal nerve to biceps femoris (right). CONCLUSIONS: Less than 1 year postoperatively, the patient was ambulating on his myoelectric prosthesis and experienced no Tinel or neuroma-type pain. This case is a testament to the impact TMR, an innovative surgical technique, can have on the quality of life of patients sustaining devastating limb injuries.

EQIP Quality Assessment of Refractive Surgery Resources on YouTube.

PURPOSE: To evaluate the utility of EQIP as a novel tool for determining the quality of patient information on YouTube regarding refractive eye surgery. METHODS: Three searches were conducted on YouTube using "PRK eye surgery", "LASIK eye surgery", and "SMILE eye surgery". 110 relevant videos were evaluated using the Ensuring Quality Information for Patients (EQIP) criteria. RESULTS: The average EQIP score was 15.1 (moderate quality). On average, physician-authored videos scored significantly higher on questions 17 (p = .01), 18 (p = .001), 26 (p = .008), relating to author transparency and use of graphs/figures. Patient-authored videos scored significantly higher on questions 8 (p < .001), 9 (p < .001), 12 (p = .008), 16 (p = .02), and 21 (p = .0350). These questions addressed risks/benefits, quality of life and alert signs, date and video revisions, and personally addressing viewers. CONCLUSION: EQIP was useful in identifying specific strengths and deficits in online refractive surgery patient education resources that were not evident from other screening tools. The quality of information on YouTube videos on refractive surgeries is average. Physician-authored videos could be improved by clarifying risks and quality of life issues. Quality evaluation of medical information is important for comprehensive online surgical education.

Utilization of ChatGPT for Plastic Surgery Research: Friend or Foe?

On November 20, 2022, ChatGPT was made available to the general public free of charge. As a large language model (LLM), the software was able to process inquiries by users and generate text based on compiled datasets in a humanist manner. Due to the importance of research in the Plastic Surgery community, we set out to determine if ChatGPT could be utilized to produce novel systematic review ideas relevant to Plastic Surgery. Out of 80 systematic review ideas generated by ChatGPT, we found that the software was highly accurate in creating novel systematic review ideas. Beyond aiding in Plastic Surgery research, ChatGPT has the potential to be used for virtual consultations, pre-operative planning, patient education, and post-operative care for patients. ChatGPT may be a simple solution for the complex problems encountered in Plastic Surgery.

Use of the Relative Citation Ratio in Conjunction With H-Index to Promote Equity in Academic Orthopaedics.

INTRODUCTION: Quantification of a researcher's productivity relies on objective bibliometric measurements, such as the Hirsch index (h-index). However, h-index is not field and time-normalized and possesses bias against newer researchers. Our study is the first to compare the relative citation ratio (RCR), a new article-level metric developed by the National Institutes of Health, with h-index in academic orthopaedics. METHODS: Academic orthopaedic programs in the United States were identified using the 2022 Fellowship and Residency Electronic Interactive Database. Available demographic and training data for surgeons were collected. RCR was calculated using the National Institutes of Health iCite tool, and h-index was calculated using Scopus. RESULTS: Two thousand eight hundred twelve academic orthopaedic surgeons were identified from 131 residency programs. H-index, weighted RCR (w-RCR), and mean RCR (m-RCR) all significantly differed by faculty rank and career duration. However, while h-index and w-RCR varied between sexes (P < 0.001), m-RCR did not (P = 0.066), despite men having a longer career duration (P < 0.001). DISCUSSION: We propose that m-RCR be used in conjunction with w-RCR or h-index to promote a fairer, comprehensive depiction of an orthopaedic surgeon's academic effect and productivity. Use of m-RCR may reduce the historic bias against women and younger surgeons in orthopaedics, which has implications in employment, promotion, and tenure.

Applying GPT-4 to the Plastic Surgery Inservice Training Examination.

BACKGROUND: The recent introduction of Generative Pre-trained Transformer (GPT)-4 has demonstrated the potential to be a superior version of ChatGPT-3.5. According to many, GPT-4 is seen as a more reliable and creative version of GPT-3.5. OBJECTIVE: In conjugation with our prior manuscript, we wanted to determine if GPT-4 could be exploited as an instrument for plastic surgery graduate medical education by evaluating its performance on the Plastic Surgery Inservice Training Examination (PSITE). METHODS: Sample assessment questions from the 2022 PSITE were obtained from the American Council of Academic Plastic Surgeons website and manually inputted into GPT-4. Responses by GPT-4 were qualified using the properties of natural coherence. Incorrect answers were stratified into the consequent categories: informational, logical, or explicit fallacy. RESULTS: From a total of 242 questions, GPT-4 provided correct answers for 187, resulting in a 77.3% accuracy rate. Logical reasoning was utilized in 95.0% of questions, internal information in 98.3%, and external information in 97.5%. Upon separating the questions based on incorrect and correct responses, a statistically significant difference was identified in GPT-4's application of logical reasoning. CONCLUSION: GPT-4 has shown to be more accurate and reliable for plastic surgery resident education when compared to GPT-3.5. Users should look to utilize the tool to enhance their educational curriculum. Those who adopt the use of such models may be better equipped to deliver high-quality care to their patients.