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INTRODUCTION: Large language models (LLM) have revolutionized the way humans interact with artificial intelligence (AI) technology, with marked potential for applications in esthetic surgery. The present study evaluates the performance of Bard, a novel LLM, in identifying and managing postoperative patient concerns for complications following body contouring surgery. METHODS: The American Society of Plastic Surgeons' website was queried to identify and simulate all potential postoperative complications following body contouring across different acuities and severity. Bard's accuracy was assessed in providing a differential diagnosis, soliciting a history, suggesting a most-likely diagnosis, appropriate disposition, treatments/interventions to begin from home, and red-flag signs/symptoms indicating deterioration, or requiring urgent emergency department (ED) presentation. RESULTS: Twenty-two simulated body contouring complications were examined. Overall, Bard demonstrated a 59% accuracy in listing relevant diagnoses on its differentials, with a 52% incidence of incorrect or misleading diagnoses. Following history-taking, Bard demonstrated an overall accuracy of 44% in identifying the most-likely diagnosis, and a 55% accuracy in suggesting the indicated medical dispositions. Helpful treatments/interventions to begin from home were suggested with a 40% accuracy, whereas red-flag signs/symptoms, indicating deterioration, were shared with a 48% accuracy. A detailed analysis of performance, stratified according to latency of postoperative presentation (<48hours, 48hours-1month, or >1month postoperatively), and according to acuity and indicated medical disposition, is presented herein. CONCLUSIONS: Despite promising potential of LLMs and AI in healthcare-related applications, Bard's performance in the present study significantly falls short of accepted clinical standards, thus indicating a need for further research and development prior to adoption. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Body Contouring , Surgery, Plastic , Humans , Artificial Intelligence , Postoperative Complications/diagnosis , LanguageABSTRACT
BACKGROUND: Despite increasing demand for breast capsular surgery to treat various benign and malignant implant-related pathologies, high-quality evidence elucidating complication profiles of capsulectomy and capsulotomy is lacking. OBJECTIVES: The aim of this study was to provide the largest-scale analysis of associated outcomes and complications using the Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database, and to investigate clinical scenarios that may subject patients to increased risks for complications, most notably extent of capsular surgery (complete vs partial) and index indication of implantation (aesthetic vs reconstructive). METHODS: An analysis of the TOPS database from 2008 to 2019 was performed. CPT codes were used to identify complete capsulectomy and partial capsulectomy/capsulotomy cases. Breast implant exchange procedures constituted procedural controls. RESULTS: In total, 7486 patients (10,703 breasts) undergoing capsulectomy or capsulotomy were assessed. Relative to controls, capsulectomy (4.40% vs 5.79%), but not capsulotomy (4.40% vs 4.50%), demonstrated higher overall complication rates. Both capsulectomies (0.83% vs 0.23%) and capsulotomies (0.56% vs 0.23%) also had greater rates of seroma relative to controls. Subgroup analyses demonstrated that reconstructive patients, relative to aesthetic patients, experienced greater overall complications (6.76% vs 4.34%), and increased risks for seroma (1.06% vs 0.47%), dehiscence (0.46% vs 0.14%), surgical site infections (1.03% vs 0.23%), and implant loss (0.52% vs 0.23%). A detailed synthesis of 30-day outcomes, including all patient- and breast-specific complications, for both capsulectomy and capsulotomy, stratified according to all potential confounders, is presented herein. CONCLUSIONS: Surgeries on the breast capsule are safe overall, although complete capsulectomies and reconstructive patients are associated with significantly increased operative risks. The present findings will enhance patient selection, counseling, and informed consent.
Subject(s)
Breast Implantation , Breast Implants , Databases, Factual , Postoperative Complications , Humans , Female , Breast Implants/adverse effects , Breast Implantation/adverse effects , Breast Implantation/methods , Breast Implantation/instrumentation , Middle Aged , Adult , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Aged , Seroma/etiology , Seroma/epidemiology , United States/epidemiology , Treatment Outcome , Esthetics , Young AdultABSTRACT
BACKGROUND: While there exists ample evidence on the impact of perioperative blood pressure on hematoma incidence following facelift; the association of elevated or labile intraoperative blood pressure with postoperative hematoma remains to be explored. OBJECTIVES: The authors evaluate the association of elevated or labile intraoperative systolic blood pressure (SBP) with postoperative hematoma, using the senior author's single surgeon experience of 118 consecutive facelifts. METHODS: A multivariate logistic regression was conducted using complete demographic, procedure-related, blood pressure-related, and outcomes-related data, with the outcome of interest representing postoperative hematoma. One-way ANOVA and linear regression analyses were used to assess for significant associations between a preoperative history of hypertension and a tendency to demonstrate elevated or labile intraoperative SBP. A Fisher's Exact test was subsequently used to assess for specific intraoperative SBP measurement cut-offs significantly associated with postoperative hematoma, including maximum recorded intraoperative SBP, and specific degree of intraoperative SBP fluctuations. RESULTS: Multivariate logistic regression demonstrated no statistically significant patient- or procedure-related demographic predictors of postoperative hematoma. With aggressive treatment of preoperative hypertension, high preoperative SBP was not found to be a significant predictor of postoperative hematoma following facelift, although this approached statistical significance (p=0.05). In contrast, labile intraoperative SBP (maximum recorded intraoperative SBP - minimum recorded intraoperative SBP; p=0.026), as well as high immediate postoperative SBP (p=0.002), were both independent and statistically significant predictors of postoperative hematoma. Patients with a preoperative history of hypertension, and more specifically those with elevated SBP measurements in the preoperative clinic, were more likely to demonstrate labile (p=0.007) or elevated (p=0.005) intraoperative SBP during facelift surgery. Specifically, maximum recorded intraoperative SBP ≥155mmHg (p=0.045), as well as maximum intraoperative SBP fluctuations ≥80mmHg (p=0.036) were found to be significantly associated with hematoma. CONCLUSIONS: A multimodal approach is necessary to control perioperative systolic blood pressure within the strict <120mmHg target demonstrated to significantly decrease hematoma incidence. The senior author's preference is for intraoperative SBP to remain within a strict 90-100mmHg range. In contrast to hypertension that is aggressively treated and successfully controlled, hypertension that is difficult to control intraoperatively, may be a predictor of systolic blood pressure that is difficult to control postoperatively, and thus a significant risk factor for postoperative hematoma following facelift.
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BACKGROUND: Social media platforms have come to represent integral components of the professional marketing and advertising strategy for plastic surgeons. Effective and consistent content development, however, remains technically demanding and time consuming, prompting most to employ, at non-negligible costs, social media marketing specialists for content planning and development. OBJECTIVES: In the present study, we aimed to investigate the ability of presently available artificial intelligence (AI) models to assist plastic surgeons in their social media content development and sharing plans. METHODS: An AI large language model was prompted on the study's objectives through a series of standardized user interactions. Social media platforms of interest, on which the AI model was prompted, included Instagram, TikTok, and X (formerly Twitter). RESULTS: A 1-year, entirely AI-generated social media plan, comprising a total of 1091 posts for the 3 aforementioned social media platforms, is presented. Themes of the AI-generated content proposed for each platform were classified in 6 categories, including patient-related, practice-related, educational, "uplifting," interactive, and promotional posts. Overall, 91 publicly recognized holidays and observant and awareness days were incorporated into the content calendars. The AI model demonstrated an ability to differentiate between the distinct formats of each of the 3 social media platforms investigated, generating unique ideas for each, and providing detailed content development and posting instructions, scripts, and post captions, leveraging features specific to each platform. CONCLUSIONS: By providing detailed and actionable social media content creation and posting plans to plastic surgeons, presently available AI models can be readily leveraged to assist in and significantly alleviate the burden associated with social media account management, content generation, and potentially patient conversion.
Subject(s)
Artificial Intelligence , Social Media , Surgeons , Surgery, Plastic , Humans , Marketing of Health Services/methodsABSTRACT
BACKGROUND: Large language models (LLMs) have revolutionized the way plastic surgeons and their patients can access and leverage artificial intelligence (AI). OBJECTIVES: The present study aims to compare the performance of 2 current publicly available and patient-accessible LLMs in the potential application of AI as postoperative medical support chatbots in an aesthetic surgeon's practice. METHODS: Twenty-two simulated postoperative patient presentations following aesthetic breast plastic surgery were devised and expert-validated. Complications varied in their latency within the postoperative period, as well as urgency of required medical attention. In response to each patient-reported presentation, Open AI's ChatGPT and Google's Bard, in their unmodified and freely available versions, were objectively assessed for their comparative accuracy in generating an appropriate differential diagnosis, most-likely diagnosis, suggested medical disposition, treatments or interventions to begin from home, and/or red flag signs/symptoms indicating deterioration. RESULTS: ChatGPT cumulatively and significantly outperformed Bard across all objective assessment metrics examined (66% vs 55%, respectively; P < .05). Accuracy in generating an appropriate differential diagnosis was 61% for ChatGPT vs 57% for Bard (P = .45). ChatGPT asked an average of 9.2 questions on history vs Bard's 6.8 questions (P < .001), with accuracies of 91% vs 68% reporting the most-likely diagnosis, respectively (P < .01). Appropriate medical dispositions were suggested with accuracies of 50% by ChatGPT vs 41% by Bard (P = .40); appropriate home interventions/treatments with accuracies of 59% vs 55% (P = .94), and red flag signs/symptoms with accuracies of 79% vs 54% (P < .01), respectively. Detailed and comparative performance breakdowns according to complication latency and urgency are presented. CONCLUSIONS: ChatGPT represents the superior LLM for the potential application of AI technology in postoperative medical support chatbots. Imperfect performance and limitations discussed may guide the necessary refinement to facilitate adoption.
Subject(s)
Artificial Intelligence , Postoperative Complications , Humans , Female , Postoperative Complications/etiology , Postoperative Complications/diagnosis , Postoperative Complications/therapy , Mammaplasty/methods , Mammaplasty/adverse effects , Adult , Diagnosis, DifferentialABSTRACT
Introduction: Aesthetic liposuction represents one of the most commonly performed cosmetic procedures worldwide. The purpose of this article is to examine and synthesize reported complication rates and explore the analytical prospect of possible patient or procedure-related predictive factors associated with specific complications. Methods: A systematic review was performed using the Pubmed, Cochrane, and Embase databases in line with specific criteria set to ensure an accurate assessment of complication rates; extracted data was synthesized through a random-effects model and meta-analysis of proportions. Results: A total of 60 studies were included in the meta-analysis, representing 21,776 patients undergoing aesthetic liposuction. Most studies followed an observational design. The overall complication rate was 12% (95% confidence interval [CI] 8%, 16%). When stratifying according to specific complications, the incidence of contour irregularities was determined to be 2% (95% CI 1%, 2%), seroma 2% (95% CI 1%; 2%), hematoma 1% (95% CI 0%, 1%), surgical site infection 1% (95% CI 1%, 2%), fibrosis or induration 1% (95% CI 1%, 2%), and pigmentary changes 1% (95% CI 1%, 1%), among others. A meta-regression to identify patient- or procedure-related factors associated with greater complication rates proved infeasible given the nature of the available data. Conclusion: Overall, liposuction demonstrated a relatively low complication rate profile, however, a considerable degree of heterogeneity exists within the examined literature preventing the recognition of predictive risk factors. While this calls for efforts to establish consensus on unified methods of outcomes reporting, the present meta-analysis can serve to provide practitioners with an evidence-based reference to improve informed consent and inform clinical guidelines, specifically pertaining to the incidence of commonly encountered complications in aesthetic liposuction, of which presently available survey studies and database queries remain devoid.
Introduction : La liposuccion esthétique est l'une des procédures esthétiques le plus souvent réalisées dans le monde. L'objectif de cet article est d'étudier et synthétiser les taux de complications rapportés et d'explorer la possibilité d'analyse de possibles facteurs prédictifs liés aux patients ou à la procédure en association avec des complications spécifiques. Méthodes : Une revue systématique a été exécutée à partir des bases de données Pubmed, Cochrane et Embase selon un ensemble de critères spécifiques pour assurer une évaluation précise des taux de complications; les données extraites ont été synthétisées par un modèle d'effets aléatoires et une méta-analyse des pourcentages. Résultats : Un total de 60 études a été inclus dans la méta-analyse, représentant 21 776 patients subissant une liposuccion esthétique. La plupart des études étaient observationnelles. Le taux global de complications était de 12% (IC à 95% : 8% à 16%). Après stratification selon des complications spécifiques, les incidences suivantes parmi d'autres ont été établies : irrégularités de contour a été établi à 2% (IC à 95% : 1% à 2%), sérome 2% (IC à 95% : 1% à 2%), hématome 1% (IC à 95% : 0% à 1%), infection du site opératoire 1% (IC à 95% : 1% à 2%), fibrose ou induration 1% (IC à 95% : 1% à 2%) et modification de la pigmentation 1% (IC à 95% : 1% à 1%). Une méta-régression visant à identifier des facteurs liés aux patients ou à la procédure pour les taux de complications les plus élevés s'est avérée infaisable, compte tenu de la nature des données disponibles. Conclusion : Globalement, la liposuccion a montré un relativement bas profil en termes de taux de complications. Il existe cependant une hétérogénéité considérable dans les publications étudiées, empêchant d'identifier des facteurs de risque prédictifs. Cela appelle à des efforts en vue de l'établissement d'un consensus sur des méthodes uniformisées de déclaration des résultats, mais la présente méta-analyse peut permettre aux praticiens de disposer d'une référence basée sur des constatations probantes pour améliorer le consentement éclairé et enrichir les lignes directrices cliniques, en particulier pour ce qui concerne l'incidence des complications fréquemment vues dans la liposuccion esthétique. En effet, les études, enquêtes et bases de données actuellement disponibles en sont dépourvues.
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Introduction: The COVID-19 pandemic imparted an important shift in strategies postgraduate surgical programs use to recruit, interact with, and select medical students applying through the Canadian Resident Matching Service (CaRMS). With this unprecedented shift toward virtual applicant selection, this study sought to explore and analyze perspectives of the first cohort of program directors (PDs) and applicants who participated in this process. Methods: A cross-sectional survey study was designed using Google Forms for both PDs and applicants participating in the 2021 CaRMS surgical subspecialty selection process. Questions pertained to format and content of virtual engagement methods, the interview itself, as well as advice for future applicants. Results: Thirty-five PDs and 40 successful applicants (n = 75) participated in the study. Cost reduction was the most commonly reported benefit of online interviewing by PDs (85%), followed by efficiency (71%), enhanced resource management (49%), and ability to conduct more interviews (23%). Strong letters of reference (80%) and interview performance (74%) remained the most significant factors in virtual applicant selection. Attendance to virtual recruitment events did not increase the likelihood of offering interviews (n = 24, 69% of PDs), although the ability to perform in-person electives held tremendous value. Most applicants (90%) reported on virtual information sessions as the best method for learning about programs; work culture and environment were topics most valued as discussion points (90%). Successful applicants provided an average confidence of 76% regarding their suitability with their matched programs. Seventy-three percent of applicants (n = 29) had either a preference for virtual interviews or were equivocal, while 51.4% of PDs (n = 18) preferred interviews to be conducted virtually for future cohorts. Conclusion: Trainees are entering residency with confidence following a virtual selection process, and PDs feel confident in their selections. Although no clear consensus exists regarding preference for virtual or in-person interviews, several advantages for virtual resident selection exist. The influence of an in-person elective was found difficult to replace, regardless of interview format. The importance of applicant engagement with programs prior to interviews is highlighted and discussed with recommendations provided for best practices.
Introduction: La pandémie de COVID-19 a induit un important changement de stratégies de l'utilisation des programmes chirurgicaux de 3e cycle pour recruter, interagir avec les étudiants en médecine et sélectionner les étudiants déposant une candidature par le biais du CaRMS, le service d'affectation des résidents canadiens. Avec ce mouvement sans précédent vers une sélection virtuelle des candidats, l'étude a cherché à explorer et analyser les points de vue de la première cohorte de directeurs de programmes (DP) et de candidats ayant participé à ce processus. Méthodes: Une enquête transversale a été conçue à l'aide de Google Forms pour, à la fois, les DP et les candidats participant au processus de sélection de sous-spécialité chirurgicale 2021 du CaRMS. Des questions portaient sur le format et le contenu des méthodes de contact virtuelles, l'entretien proprement dit ainsi que sur des conseils pour les candidats futurs. Résultats: Trente-cinq DP et quarante candidats acceptés (n = 75) ont participé à l'étude. La réduction des coûts a été l'avantage des entretiens en ligne le plus souvent cité par les DP (85 %) suivie de l'efficacité (71 %), d'une meilleure gestion des ressources (49 %) et de la capacité à réaliser plus d'entretiens (23 %). De solides lettres de recommandation (80 %) et la performance au cours de l'entretien (74 %) restaient les facteurs les plus significatifs pour la sélection virtuelle des candidats. La participation aux événements virtuels de recrutement n'augmentait pas la probabilité d'offre d'un entretien (n = 24, 69 % des DP), même si la possibilité de réaliser des entretiens facultatifs en personne avait une valeur considérable. La plupart des candidats (90 %) ont indiqué que les séances d'information virtuelles étaient la meilleure méthode pour en savoir plus sur les programmes; la culture et l'environnement de travail étaient les thèmes ayant le plus de valeur comme sujets de discussion (90 %). Les candidats ayant réussi ont indiqué à 76 % qu'ils s'estimaient confiants sur le fait de bien correspondre aux programmes auxquels ils étaient affectés. Soixante-treize pour cent des candidats (n = 29) avaient une préférence pour les entretiens virtuels ou étaient dans le doute, tandis que 51,4 % des DP (n = 18) préféraient que les entretiens des cohortes futures soient menés virtuellement. Conclusion: Les stagiaires commencent leur résidence avec confiance après un processus de sélection virtuel et les DP se sentent confiants quant à leurs choix. Même s'il n'existe pas un franc consensus concernant une préférence pour les entretiens virtuels ou en face à face, la sélection à distance des résidents présente plusieurs avantages. L'influence d'un entretien optionnel en personne s'est avérée difficile à remplacer, quelle que soit la forme donnée à l'entretien. L'importance de l'engagement du candidat dans des programmes antérieurs aux entretiens est soulignée et discutée avec des recommandations fournies pour de meilleures pratiques.
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Objectives: Metacarpal non-unions are complex hand defects that can lead to severe hand impairment. Treatment may require the use of artificial or autologous bone grafts. This systematic review aims to describe the outcomes of bone grafting following metacarpal non-union in an attempt to establish an optimal therapeutic protocol for this complication. Methods: A systematic review was conducted in adherence with PRISMA guidelines. Data collection and analysis were performed in duplicate and confirmed by a third investigator. Our primary outcomes focused on radiological time to bone fusion and rates of non-union. Additionally, functional outcomes and complications were analyzed as means of central tendency. Results: Eighteen studies were included in the systematic review, accounting for a total of 47 patients. The average follow-up time was 12.4 months. Fourteen studies analyzed radiological outcomes, with atrophic non-union representing the most common type. The time to bone fusion, assessed radiologically, following bone graft was an average of 6.9 months (n = 14), with a 100% rate of union in 42 patients. Regarding patient-reported pain improvement, 76% of patients experienced pain relief. Moreover, all patients reported a complete subjective return to baseline hand function. Adverse events, limited to hematoma and seroma, were seen in three patients, representing a complication rate of 11.8% in the examined population. Conclusions: Metacarpal non-union can be treated successfully via vascularized and non-vascularized bone grafting. Based on the available evidence, bone grafts demonstrate favorable union rates, post-operative pain reduction, hand function recovery, earlier bone fusion times, and minimal complications in the context of metacarpal non-union management.
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Evidence-based medicine stipulates that clinical decision-making should revolve around scientific evidence. The goal of the present study is to evaluate the methodological quality of surgical research recently published in JAMA Surgery, International Journal of Surgery, and British Journal of Surgery, the three surgical journals with the highest impact factor. An electronic search of the PUBMED database was performed to retrieve all articles published in the JAMA Surgery, International Journal of Surgery, and British Journal of Surgery in the year 2022. Three authors independently reviewed all retrieved articles and methodological designs of the publications were analyzed and rated using a modification of the Oxford Centre for Evidence-Based Medicine Levels of Evidence (Oxford Levels of Evidence scale). The initial search identified 1236 articles of which 809 were excluded after title and abstract screening. The remaining 427 underwent full text/methods read, of which 164 did not meet the inclusion/exclusion criteria. A total of 273 studies were included in the analysis. The average level of evidence was 2.5 ± 0.8 across all studies assessed. The majority of study designs were comprised of retrospective cohorts (n = 119), prospective cohorts (n = 47), systematic reviews of non RCTs (n = 39), and RCTs (n = 37). There was no significant difference in the average level of evidence between the top three journals (p = 0.50). Most clinical studies in the highest impact factor surgical journals are of level III evidence, consistent with earlier literature. However, our analysis demonstrates a relatively higher percentage of LOE I and II compared to what was previously published in the literature.