Academic Surgery in the Era of Large Language Models: A Review.

Importance: This review aims to assess the benefits and risks of implementing large language model (LLM) solutions in an academic surgical setting. Observations: The integration of LLMs and artificial intelligence (AI) into surgical practice has generated international attention with the emergence of OpenAI's ChatGPT and Google's Bard. From an administrative standpoint, LLMs have the potential to revolutionize academic practices by reducing administrative burdens and improving efficiency. LLMs have the potential to facilitate surgical research by increasing writing efficiency, building predictive models, and aiding in large dataset analysis. From a clinical standpoint, LLMs can enhance efficiency by triaging patient concerns and generating automated responses. However, challenges exist, such as the need for improved LLM generalization performance, validating content, and addressing ethical concerns. In addition, patient privacy, potential bias in training, and legal responsibility are important considerations that require attention. Research and precautionary measures are necessary to ensure safe and unbiased use of LLMs in surgery. Conclusions and Relevance: Although limitations exist, LLMs hold promise for enhancing surgical efficiency while still prioritizing patient care. The authors recommend that the academic surgical community further investigate the potential applications of LLMs while being cautious about potential harms.

Importance of Diversity, Equity, and Inclusion in the Hepatopancreatobiliary Workforce.

Diversity is a catalyst for progress that prevents institutional stagnation and, by extension, averts descent to mediocrity. This review focuses on the available data concerning hepatopancreatobiliary (HPB) surgical workforce demographics and identifies evidence-based strategies that may enhance justice, equity, diversity, and inclusion for HPB surgeons and their patients. We report that the current United States HPB surgical workforce does not reflect the population it serves. We review data describing disparity-perpetuating hurdles confronting physicians from minority groups underrepresented in medicine at each stage of training. We further examine evidence showing widespread racial and socioeconomic disparities in HPB surgical care and review the effects of workforce diversity and physician-patient demographic concordance on healthcare outcomes. Evidence-based mitigators of structural racism and segregation are reviewed, including tailored interventions that can address social determinants of health toward the achievement of true excellence in HPB surgical care. Lastly, select evidence-based data driving surgical workforce solutions are reviewed, including intentional compensation plans, mentorship, and sponsorship.

Supply and demand of hepatopancreatobiliary surgeons in the United States.

BACKGROUND: Hepatopancreatobiliary (HPB) surgery requires specialized training and adequate case volumes to maintain procedural proficiency and optimal outcomes. Studies of individual HPB surgeon supply related to annual HPB case demand are sparse. This study assesses the supply and demand of the HPB surgical workforce in the United States (US). METHODS: The National Inpatient Sample (NIS) was queried from 1998-2019 to estimate the number of HPB procedures performed. To approximate the number of HPB surgeons, models based on previous HPB workforce publications were employed. We then calculated the number of HPB surgeons needed to maintain volume-outcome thresholds at current reported levels of centralization. RESULTS: In 2019, approximately 37,335 patients underwent inpatient HPB procedures in the US, while an estimated 905-1191 HPB surgeons were practicing. Assuming 50% centralization and an optimal volume-outcome threshold of 24 HPB cases-per-year, only 778 HPB surgeons were needed. Without adjustment in centralization, by 2030 there will be a demand of fewer than 12 annual cases per HPB surgeon. CONCLUSION: The current supply of HPB surgeons may exceed demand in the United States. Without alteration in training pathways or improved care centralization, by 2030, there will be insufficient HPB case volume per surgeon to maintain published volume-outcome standards.

Surgery for colorectal liver metastases: Anatomic and non-anatomic approach.

Liver resection is potentially curative for patients with colorectal liver metastasis, but an advanced understanding of tumor biology and improved adjuvant therapies have facilitated an ongoing evolution of metastatic resection, even in the setting of a significant metastatic disease burden. As indications for surgery have expanded, preferred techniques and timing have been debated. This commentary reviews the merits of anatomic versus non-anatomic approaches to colorectal liver metastasis resection, considering oncologic outcomes, overall survival, and conflicting theories in the pathophysiology of the metastatic liver spread.

Effects of High-Intensity Interval Training Protocols on Liver Enzymes and Wellness in Women.

BACKGROUND: Single-modality, high-intensity interval training (HIIT) using traditional cardiorespiratory exercise selection has been found to provide similar and sometimes superior cardiometabolic effects compared with moderate-intensity continuous training. However, little is known regarding the cardiometabolic and psychosocial effects of HIIT using resistance training modalities. Therefore, this study aims to compare the effects of HIIT using rowing (R-HIIT) and multimodal HIIT (MM-HIIT) using resistance training on liver enzymes, cardiometabolic risk factors, and psychosocial outcomes. METHOD: Recreationally active females with a body mass index <30 kg/m2 (N = 16, 23.0 ± 5.9 years) were randomized into a MM-HIIT or R-HIIT group and completed a 12-week HIIT intervention (ClinicalTrials.gov registration number: https://clinicaltrials.gov/ct2/show/NCT03093441) using principles of social cognitive theory (SCT). Participants completed pre- and postintervention measurements on anthropometrics, resting heart rate, blood pressure, blood measures (lipids, liver enzymes, and glucose), exercise self-efficacy, and perceived wellness. Analysis of covariance was used to examine differences in postintervention measures between groups after controlling for baseline values, waist circumference, and waist-to-height ratio. RESULTS: R-HIIT group had significantly decreased alanine aminotransferase (mean difference = 13.16, P=0.013, effect size (ES) = 0.44, confidence interval (CI) = 3.40 to 22.92) and aspartate aminotransferase (mean difference = 10.79, P=0.024, ES = 0.38, CI = 1.67 to 19.90) levels compared with the M-HIIT group, and the whole group had improved wellness scores (14.72 ± 2.6 to 16.89 ± 2.76, P=0.002). CONCLUSION: R-HIIT may be an effective preventative method for improving liver health in females without obesity. When using principles of SCT, HIIT may enhance overall well-being.