Preoperative Consultation Research Articles

Leveraging Large Language Models (LLM) for the Plastic Surgery Resident Training: Do They Have a Role?

Introduction Large language models (LLMs) are designed for recognizing, summarizing, translating, predicting, and generating text-based content from knowledge gained from extensive data sets. ChatGPT4 (Generative Pre-trained Transformer 4) (OpenAI, San Francisco, California, United States) is a transformer-based LLM model pretrained on public data as well as data obtained from third-party sources using deep learning techniques of fine tuning and reinforcement learning from human feedback to predict the next text. We wanted to explore the role of LLM as a teaching assistant (TA) in plastic surgery. Material and Methods TA roles were first identified in available literature, and based on the roles, a list of suitable tasks was created where LLM could be used to perform the task. Prompts designed to be fed in to the LLM (specifically ChatGPT) to generate appropriate output, were then created and fed to the ChatGPT model. The outputs generated were scored by evaluators and compared for interobserver agreement. Results A final set of eight TA roles were identified where a LLM could be utilized to generate content. These contents were scored for usefulness and accuracy. These were scored independently by the eight study authors in a scoring sheet created for the study. Interobserver agreements for content accuracy, usefulness, and clarity were 100% for content generated for the following: interactive case studies (generation), simulation of preoperative consultations, and generation of ethical considerations. Discussion LLMs in general and ChatGPT (on which this study is based) in specific, can generate answers to questions and prompts based on huge amount of text fed into the model for training the underlying language model. The answers generated have been found to be accurate, readable, and even indistinguishable from human-generated text. This capability of automated content synthesis can be exploited to generate summaries to text, answer short and long answers, and generate case scenarios. We could identify a few such scenarios where the LLM could in general be utilized to play the role of a TA and aid plastic surgery residents in particular. In addition, these models could also be used by students to obtain feedback and gain reflection which itself stimulates critical thinking. Conclusion Incorporating LLMs into the educational arsenal of plastic surgery residency programs can provide a dynamic, interactive, and individualized learning experience for residents and prove to be worthy TAs of future.

Preoperative evaluation of the elderly patient.

Nowadays, the pre-operative evaluation of older patients is a critical step in the decision-making process. Clinical assessment and care planning should be considered a whole process rather than separate issues. Clinicians should use validated tools for pre-operative risk assessment of older patients to minimize surgery-related morbidity and mortality and enhance care quality. Traditional pre-operative consultation often fails to capture the pathophysiological and functional profiles of older patients. The elderly's pre-operative evaluation should be focused on determining the patient's functional reserve and reducing any possible peri-operative risk. Therefore, older adults may benefit from the Comprehensive Geriatric Assessment (CGA) that allows clinicians to evaluate several aspects of elderly life, such as depression and cognitive disorders, social status, multi-morbidity, frailty, geriatric syndromes, nutritional status, and polypharmacy. Despite the recognized challenges in applying the CGA, it may provide a realistic risk assessment for post-operative complications and suggest a tailored peri-operative treatment plan for older adults, including pre-operative optimization strategies. The older adults' pre-operative examination should not be considered a mere stand-alone, that is, an independent stage of the surgical pathway, but rather a vital step toward a personalized therapeutic approach that may involve professionals from different clinical fields. The aim of this review is to revise the evidence from the literature and highlight the most important items to be implemented in the pre-operative evaluation process in order to identify better all elderly patients' needs.

Evaluation of Preoperative Cardiology Consultations: Incidence, Characteristics and Implications for Perioperative Management

Background: This retrospective study examines the importance of preoperative cardiology consultations in optimizing patient care and anesthesia surgical perioperative management. Methods: The study includes 7,756 patients from the Department of Anesthesiology at Mohammed V Military Teaching Hospital. Out of these, 122 patients were referred to cardiology consultations. Demographics, surgical specialties, reasons for referral, diagnostic tests, and interventions were analyzed. Results: Referred patients (average age 61.45 years) were mainly over 65 years old, with 59.01% being male. Common surgical specialties seeking consultations were abdominal surgery (30.327%), orthopedic surgery (26.230%), and urological surgery (19.672%). Hypertension, dyslipidemia, and diabetes were prevalent risk factors. Most patients were classified as ASA II (50%) or ASA III (27.04%), with NYHA I (61.5%) or NYHA II (31.2%) classifications. Referrals were due to ECG abnormalities (41.0%), routine evaluation (19.7%), and history of myocardial infarction or previous coronary angiography (39.3%). Discussion: Preoperative cardiology consultations accounted for 1.57% of all pre-anesthesia clinic patients. They were vital in assessing and managing cardiovascular risks, consistent with previous studies. The impact of these consultations was evident in optimizing patient management through treatment plan adjustments and interventions. Conclusion: Preoperative cardiology consultations play a crucial role in identifying and managing cardiovascular risks, contributing significantly to patient care and improving perioperative management. Further research should evaluate long-term outcomes and cost-effectiveness across different patient populations.

Teleconsultation for preoperative evaluation and informed consent-Are we ready for a paradigm shift?

In Germany, approximately 17 million anaesthesiological procedures and, consequently, roughly the same number of preoperative consultations are conducted each year. So far, these have predominantly taken place in person. However, recent developments in technology, medical-legal aspects, and politics, combined with the catalyzing effect of the pandemic situation, have led to a significant boost in telemedicine. In the field of anaesthesia, there are new approaches to implementing telemedicine in the pre- and postoperative setting. This article focuses on the preoperative setting and presents general requirements for a teleconsultation as preoperative evaluation, the current state of technology, and medical-legal aspects.

The effects of a multidisciplinary pathway for perioperative management of patients with hip fracture

ABSTRACT Objectives To determine if a multidisciplinary pathway focused on non-opioid pain management, delirium assessment, and resource utilization improved outcomes in geriatric hip fracture patients. The goal was to reduce opioid usage, consultation not congruent with guidelines, and increase use of regional anesthesia to reduce delirium and improve outcomes. Methods An observational study was performed on hip fracture patients before and after the intervention. Hospitalists were educated on indications for preoperative cardiac consultation and specialized preoperative cardiac testing according to evidence-based guidelines with the inpatient cardiology service. Additional education on multimodal analgesia, limiting opioids, and peripheral nerve blocks was provided by the acute pain service. Pre-intervention outcomes from 1 July 20171 July 2017 to 31 May 201831 May 2018 (N = 92) were compared to post-intervention outcomes from 1 July 20181 July 2018 to 31 May 201931 May 2019 (N = 98) and included delirium, length of stay, 30-day readmission rate, time from arrival to procedure start time, time to first physical therapy session, and completion of cardiology consult time. We examined adherence, use of nerve blocks, and pre- and post-operative pain scores and opioid use. Results Delirium was reduced from 50.0% (N = 46/92) to 28.6% (N = 28/98); p = 0.002. Postoperative opioid use (IV morphine milligram equivalents) decreased from an average of 57.2 mg (±67.7) to 42.6 mg (±58.2),P < .0001. There was a significant decrease in mean pre-operative (5.4 ± 4.14 to 5.05 ± 2.8, P < .0001) and post-operative pain scores (4.3 ± 5.2 to 3.2 ± 2.2, P < .0001). There was a significant reduction in time to cardiology consultation from 18 h] to 12 h ; p < .001). Conclusions A multidisciplinary collaboration between hospitalists, anesthesiologists, and cardiologists for hip fracture patients was associated with a reduction in pain and delirium and time to cardiologist evaluation. Prospective studies focusing on additional patient-centered outcomes are warranted.

Palliative Care Consultation Utilization Among Patient Undergoing Surgery for Metastatic Spinal Tumors

In patients undergoing surgery for spinal metastasis, we sought to: (1) describe patterns of palliative care consultation, (2) evaluate the factors that trigger palliative care consultation, and (3) determine the association of palliative care consultation on longer-term outcomes. A single-center, retrospective, case-control study was conducted for patients undergoing spinal metastasis surgery from February 2010 to January 2021. The primary outcome was receiving a palliative care consultation, and the timing of consultation was divided into same hospital stay consultation, preoperative versus postoperative consultation, and early (<Postoperative day 7) versus late (≥Postoperative day 7) consultation. Of 363 patients undergoing surgery for spinal metastasis, 62 (17.0%) patients received palliative care consultation during the same hospitalization, 11 (17.7%) were preoperative, and 51 (82.2%) were postoperative. Among same-stay consultations, 32 (51.6%) were early and 30 (48.4%) were late. Palliative care consultation recipients had worse preoperative Karnofsky Performance Scale (KPS) score (P < 0.001), were more likely to have other organ metastases (P= 0.005) or cord compression (P= 0.026), had longer hospitalization (P < 0.001), and were less likely to be discharged home (P < 0.001). Patients presenting with mechanical pain were more likely to receive preoperative consults compared with postoperative (P= 0.029), and earlier compared with later consultations (P= 0.046). Regarding long-term outcomes, patients with same-stay palliative care consultation had significantly shorter overall survival (log-rank; P < 0.001), worse KPS postoperatively (P= 0.017), and worse KPS and Modified McCormick Scale at the last follow-up (P < 0.001). Only 1 in 6 patients received palliative care consultation. Patients receiving same-stay palliative care consultation had more advanced local and systemic disease burden. Increased utilization of palliative care consultation in patients with spine metastasis is needed.

Comparison of morbidity-related parameters between autologous and allogeneic bone grafts for alveolar ridge augmentation from patients' perspective-A questionnaire-based cohort study.

Alveolar ridge augmentation is often required before dental implant placement. In this context, autologous bone grafts are considered the biological gold standard. Still, bone block harvesting is accompanied by some serious potential disadvantages and possible complications, such as pain, bleeding, and nerve irritation. Several studies aimed to compare autologous to allogeneic bone grafts concerning bone quality and implant survival rates; this is the first prospective study analyzing and comparing morbidity-related parameters after alveolar ridge augmentation using autogenous and allogeneic bone blocks from patients' perspective. Using a questionnaire, 36 patients were asked to evaluate the surgery as well as the post-operative period concerning pain, stress, sensibility deficits, satisfaction with, and consequences from the surgery as well as the preferred procedure for future alveolar ridge augmentations. No significant differences were shown regarding stress and pain during and after surgery, whereas the rate of nerve irritations was twice as high in the autologous group. The swelling was significantly higher in patients with autologous bone blocks (p = 0.001). Nevertheless, the overall satisfaction of patients of both groups was very high, with over 8/10 points. The swelling was the main reason for patients' discomfort in both groups and was significantly higher after autologous bone augmentation. Since this side effect seems to be a highly relevant factor for patients' comfort and satisfaction, it needs to be discussed during preoperative consultation to allow shared decision-making considering the anticipated morbidity.

Labiaplasty in Asian women: Motivation, technique feasibility, and patient reported outcomes

Labiaplasty is an increasingly popular aesthetic procedure. However, there is a lack of information regarding different surgical procedures and Asian patients' motivations and outcomes. This study aimed to understand patients' motivations for seeking labiaplasty and to examine surgical outcomes of different procedures. This retrospective study enroled patients between August 2016 and May 2021. Patient demographics, surgical procedures, complications, and revision surgeries were reviewed. Responses to questionnaires regarding patient motivations for undergoing labiaplasty, pre- and postoperative discomfort and aesthetics, Rosen's Self-Esteem Scale (RSES) scores, and Female Genital Self-Image Scale (FGSIS) scores were recorded. One hundred thirty-one patients were included, with an average age of 30.3±7.78 years. Eighty-seven (66.4%) patients underwent bilateral labiaplasty, and 44 (33.6%) underwent unilateral labiaplasty. The surgical techniques included 61 (46.6%) direct resections, 50 (38.2%) wedge resections, and 20 (15.3%) "hockey stick" procedures. Wound dehiscence occurred in 37 (28.2%) patients. A significant increase in complications occurred after the hockey stick procedure and wedge resection. Patients' motivation for surgery included aesthetic reasons in 62.0%, symptom relief in 91.5%, and repeated infection in 4.2%. There was a significant difference between pre- and postoperative genital aesthetics (p0.001) and discomfort symptoms (p0.001). The average RSES score was 19.68±4.03, and the average FGSIS score was 20.77±3.20. Pain and discomfort remained the most important motivations for Asian women to seek labiaplasty, followed by aesthetic reasons. With good preoperative consultation and surgical planning, satisfaction can be achieved concerning functional and aesthetic aspects.

Implication of nutritional status for adverse outcomes after surgery for metastatic spine tumors.

Surgery for metastatic spinal tumors can have a substantial impact on patients' quality of life by alleviating pain, improving function, and correcting spinal instability when indicated. The decision to operate is difficult because many patients with cancer are frail. Studies have highlighted the importance of preoperative nutritional status assessments; however, little is known about which aspects of nutrition accurately inform clinical outcomes. This study investigates the interaction and prognostic importance of various nutritional and frailty measures in patients with spinal metastases. A retrospective analysis of consecutive patients who underwent surgery for spinal metastases between 2014 and 2020 at the Massachusetts General Hospital was performed. Patients were stratified according to the New England Spinal Metastasis Score (NESMS). Frailty was assessed using the metastatic spinal tumor frailty index. Nutrition was assessed using the prognostic nutritional index (PNI), preoperative body mass index, albumin, albumin-to-globulin ratio, and platelet-to-lymphocyte ratio. Outcomes included postoperative survival and complication rates, with focus on wound-related complications. This study included 154 individuals (39% female; mean [SD] age 63.23 [13.14] years). NESMS 0 and NESMS 3 demonstrated the highest proportions of severely frail patients (56.2%) and nonfrail patients (16.1%), respectively. Patients with normal nutritional status (albumin-to-globulin ratio and PNI) had a better prognosis than those with poor nutritional status when stratified by NESMS. Multivariable regression adjusted for NESMS and frailty showed that a PNI > 40.4 was significantly associated with decreased odds of 90-day complications (OR 0.93, 95% CI 0.85-0.98). After accounting for age, sex, primary tumor pathology, physical function, nutritional status, and frailty, a preoperative nutrition consultation was associated with a decrease in postoperative wound-related complications (average marginal effect -5.00%; 95% CI -1.50% to -8.9%). The PNI was most predictive of complications and may be a key biomarker for risk stratification in the 90 days following surgery. Nutrition consultation was associated with a reduced risk of wound-related complications, attesting to the importance of this preoperative intervention. These findings suggest that nutrition plays an important role in the postsurgical course and should be considered when developing a treatment plan for spinal metastases.

Quality of Life and Age-Related Macular Degeneration

The aim was to measure the life quality of patients with age-related macular degeneration. The survey included patients with age-related macular degeneration, aged 65 years and older. Recruitment of participants was performed from the preoperative consultation at the adult ophthalmology department. Investigation sheets containing socio-demographic, clinical data and the Moroccan version of the NEI VFQ25 quality of life questionnaire; were handed out to each patient. The association of the scores with the visual acuity was studied using the correlation coefficients. A total of 75 patients were enrolled including 56% women and 44% men and an average time of 3 .6 years since diagnosis of age-related macular degeneration with a mean age of of 76.9 ± 6.2 years. Average visual acuity (VA) in the better eye is 6/10 and 2/10 in the worse eye. The mean global VFQ-25 score was 48.7 ± 24.8. The significant public health burden of AMD includes both its negative effects on quality of life and on the economy. AMD causes a marked decrease in quality of life, underestimated by many, including physicians who regularly treat patients with AMD.

Two surgical pathways for isolated hip fractures: A comparative study.

Hip fractures (HF) are common among the aging population, and surgery within 48 h is recommended. Patients can be hospitalized for surgery through different pathways, either trauma or medicine admitting services. To compare management and outcomes among patients admitted through the trauma pathway (TP) vs medical pathway (MP). This Institutional Review Board-approved retrospective study included 2094 patients with proximal femur fractures (AO/Orthopedic Trauma Association Type 31) who underwent surgery at a level 1 trauma center between 2016-2021. There were 69 patients admitted through the TP and 2025 admitted through the MP. To ensure comparability between groups, 66 of the 2025 MP patients were propensity matched to 66 TP patients by age, sex, HF type, HF surgery, and American Society of Anesthesiology score. The statistical analyses included multivariable analysis, group characteristics, and bivariate correlation comparisons with the χ² test and t-test. After propensity matching, the mean age in both groups was 75-years-old, 62% of both groups were females, the main HF type was intertrochanteric (TP 52% vs MP 62%), open reduction internal fixation was the most common surgery (TP 68% vs MP 71%), and the mean American Society of Anesthesiology score was 2.8 for TP and 2.7 for MP. The majority of patients in TP and MP (71% vs 74%) were geriatric (≥ 65-years-old). Falls were the main mechanism of injury in both groups (77% vs 97%, P = 0.001). There were no significant differences in pre-surgery anticoagulation use (49% vs 41%), admission day of the week, or insurance status. The incidence of comorbidities was equal (94% for both) with cardiac comorbidities being dominant in both groups (71% vs 73%). The number of preoperative consultations was similar for TP and MP, with the most common consultation being cardiology in both (44% and 36%). HF displacement occurred more among TP patients (76% vs 39%, P = 0.000). Time to surgery was not statistically different (23 h in both), but length of surgery was significantly longer for TP (59 min vs 41 min, P = 0.000). Intensive care unit and hospital length of stay were not statistically different (5 d vs 8 d and 6 d for both). There were no statistical differences in discharge disposition and mortality (3% vs 0%). There were no differences in outcomes of surgeries between admission through TP vs MP. The focus should be on the patient's health condition and on prompt surgical intervention.

Nursing Interventions in the Perioperative Pathway of the Patient with Breast Cancer: A Scoping Review.

The decrease in average hospitalisation time and the increase in outpatient surgery in some types of breast cancer represent gains for the reduction of the negative impact of hospitalisation in women with breast cancer but are also a challenge for the organisation of nursing care to prepare women for surgery, reduce anxiety about the interventions, and ensure continuity of care in the postoperative period. The aim of this study is to identify nursing interventions present in the care provided to patients with breast cancer during the perioperative period. A scoping review was the method chosen to answer the research question: What are the specialised nursing interventions in the perioperative pathway of the patient with breast cancer? Inclusion and exclusion criteria were defined for the articles that were identified in the CINAHL and MEDLINE databases; later, additional sources were identified from the list of bibliographic references for each selected study. The final bibliographical sample consisted of seven articles, which allowed the identification of three key moments of nursing interventions in the perioperative period of patients with breast cancer: the preoperative consultation, the reception of the patient in the operating room, and the postoperative consultation. Factors such as psychological, emotional, and spiritual support, communication and patient-centred care, health education and surgical safety, and the definition of a perioperative pathway for these patients contribute significantly to patients' satisfaction and the improvement of their quality of life. The results of this study make it possible to establish recommendations for practise and for research, increasing the range of nurses' actions.

Patient perspectives on the usefulness of the MBSAQIP Bariatric Surgical Risk/Benefit Calculator: a randomized controlled trial.

The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Bariatric Surgical Risk/Benefit Calculator uses procedure-specific prediction models to generate individualized surgical risk/outcome estimates. This tool helps guide informed consent and operative selection. We hypothesized that calculator use would influence patient procedure choice. To assess patient perspectives on the bariatric surgical calculator. A randomized controlled trial at an MBSAQIP-accredited center. During the preoperative bariatric surgical office consultation, patients were randomized into 2 groups: the control group received conventional surgeon-led counseling, whereas surgeons used the risk/benefit calculator to guide decision making for the calculator group. Surveys were completed by patients following consultations to evaluate satisfaction and perceived impact of the risk/benefit calculator on operative selection. Between 2020 and 2022, 61 patients were randomized to the calculator group and 68 patients to the control group. The percentage of patients whose procedure of choice changed following consultation was similar in the calculator versus control group (44.3% versus 41.2%; P = .723). However, calculator group patients were less likely to perceive surgeon counseling as very important for their decision making (43.3% versus 76.5%; P < .001). Eighty-five percent of calculator group patients rated the calculator as useful or very useful, and only 1.7% found it not very important. The reasons patients changed procedure choice were similar between the groups (P = .091); the most common cause was to improve their anticipated outcome (48.7% versus 54.8%). While the risk/benefit calculator was perceived as a helpful tool by most patients, its use did not influence their procedure choice. However, the patient-reported usefulness and importance of the calculator during surgeon counseling suggest that the information provided has weight in patient decision making.

Palliative Care Consults and Frailty Screening in High-Risk Vascular Surgery Patients

Palliative care has increasingly been integrated into the management of high-risk surgery because of the beneficial effect on patient quality of life. However, the utilization of palliative care in vascular surgery remains unclear due to a lack of data. The purpose of this study was to determine the palliative care consult rate in high-risk vascular surgery patients. A retrospective chart review was performed at a single Veteran Affairs Medical Center from 2013 to 2021. High-risk vascular surgery patients were identified by using the Veterans Affairs Surgical Quality Improvement Program (VASQIP) risk score of >4%, which predicted 30-day mortality. Patient demographics, operative procedures, and clinical outcomes were collected. A total of 126 patients underwent a high-risk vascular surgery operation. The surgical procedures consisted of 78 amputations, 19 bypasses, 18 endovascular aneurysm repair/stents, and 11 thrombectomy/arterial repair. Palliative care was consulted in 44 patients (35%) during the hospitalization: 8 patients (18%) had preoperative consults, whereas 36 patients (82%) had postoperative consults. The overall 30-day mortality was 15%, and the 1-year mortality rate was 34%. The 30-day and 1-year mortality rates were higher in those patients who received palliative care consultation (36% and 64%, respectively) compared with those without consult (0% and 21%, respectively). The palliative care consults had a higher referral rate in more frail patients, by Revised Analysis Index (RAI): n = 13 of 57 (23%) nonfrail (RAI <20), n = 14 of 44 (32%) frail (RAI = 21-32), and n = 17 of 25 (68%) very frail (RAI >33). The majority of the palliative care consults were obtained for goals of care discussion (80%) compared with withdrawal of care (20%). Palliative care is generally underused for vascular surgery patients, but our data demonstrated a palliative care consult rate of 35% in high-risk vascular surgery patients. A frailty screening program can further stratify high-risk vascular surgery patients who would benefit from an early palliative care consult.

Is pre-operative audiometry a reliable predictor of ossicular chain condition?

ObjectiveInvestigation of ossicular chain (OC) status before surgery is important for preoperative patient consultation. This research aimed to investigate the relationship between pre-operative audiometric values and intra-operative OC condition in a relatively large population of chronic otitis media (COM) surgeries. MethodsIn this descriptive-analytic cross-sectional study, we evaluated 694 patients who underwent COM surgeries. We analyzed pre-operative audiometric data and intraoperative findings including ossicular anatomy, ossicular mobility, and the condition of middle ear mucosa. ResultsThe optimal cut-off values of pre-operative speech reception threshold (SRT), mean air-conduction (AC), and mean air-bone gap (ABG) for predicting OC discontinuity were 37.5 dB, 37.2 dB, and 28.4 dB, respectively. For the prediction of OC fixation, the optimal cut-off points of SRT, mean AC, and mean ABG were 37.5 dB, 40.3 dB, and 32.8 dB, respectively.The computing of Cohen's d (95 % confidence interval) demonstrated the greater mean ABG in ears with OC discontinuity in comparison with ears with normal ossicles in all types of pathologies. There was a descending trend of Cohen's d from cholesteatoma to tympanosclerosis and then to granulation tissue and hypertrophic mucosa.There was a substantial relation between the type of pathology and OC status (P < 0.001). Ears with tympanosclerosis plaque had the most fixed OC among all types of pathologies (40 ears, 30.8 %), and ears with no pathology had the most normal OC (135 ears, 83.3 %). ConclusionsThe results supported the view that pre-operative hearing is a key determining factor for the prediction of OC status.

A primer for the student joining the adult cardiac surgery service tomorrow: Primer 1 of 7

A primer for the student joining the adult cardiac surgery service tomorrow: Primer 1 of 7

Validation of apredictive model for speech discrimination after cochlear impIant provision.

If sufficient speech discrimination is no longer achieved with conventional hearing systems, an audiological indication for acochlear implant (CI) is given. However, there are no established target criteria for CI aftercare with regard to the level of speech comprehension to be achieved. The aim of this study is to validate an existing predictive model for speech comprehension after CI provision. This is applied to different patient groups. The prospective study included 124postlingually deaf adults. The model is based on preoperative maximum monosyllabic recognition score, aided monosyllabic recognition score at 65 dBSPL, and age the time of implantation. The model was investigated with regard to prediction accuracy for monosyllabic recognition with CI after 6months. Mean speech discrimination improved from 10% with hearing aid to 65% with CI after 6months, with astatistically significant improvement in 93% of cases. Deterioration of aided unilateral speech discrimination was not observed. The mean prediction error was 11.5percentage points in the cases with preoperative scores better than zero and 23.2percentage points in all other cases. Cochlear implantation should also be considered in patients with moderately severe to severe hearing loss and insufficient speech discrimination with hearing aids. The model based on preoperatively measured data for predicting speech discrimination with CI can be used in preoperative consultation and in the context of postoperative quality assurance.

THREE-DIMENSIONAL SCANNING IN RHINOPLASTY AND INDIVIDUAL PATIENT EXPERIENCE

Introduction: Three-dimensional facial scanning has been the object of study for decades and increasingly being used in rhinoplasty, and has recently been applied to surgical simulation. The patient’s perspective in this context should be explored, so that surgeons can individualize their approach. Objectives: Acess the patient’s perspective on three-dimensional scanning in rhinoplasty and their experience during the evaluation and simulation processes in preoperative consultation. Material and methods: Longitudinal, prospective and qualitative study, with the application of a questionnaire to patients who searched for rhinoplasty, during the preoperative consultation after obtaining images through 3D scanning and case simulation. Results: All participants agreed that three-dimensional scanning optimizes patient-surgeon communication; that it should become routine in the preoperative evaluation of cosmetic surgeries; and they felt more confident about the surgery after this process. None of the interviewees mentioned discomfort while obtaining the images. More than 60% were surprised by the images obtained by the three-dimensional facial scanning and by the result of the simulation. Discussion: The use of computerized imaging in the preoperative consultation transforms patients from passive listeners to active participants, who express their intentions and are involved in the discussion of the objectives of the surgery to which they will be submitted. Reservations regarding cost, additional time, and increased patient expectations must be considered. Conclusion: Three-dimensional facial scanning is an additional tool in the rhinoplasty preoperative period, bringing benefits to the communication and relationship between physicians and patients.

What Changes Have Occurred in Opioid Prescriptions and the Prescribers of Opioids Before TKA and THA? A Large National Registry Study.

What Changes Have Occurred in Opioid Prescriptions and the Prescribers of Opioids Before TKA and THA? A Large National Registry Study.

Opportunities for shared decision-making about major surgery with high-risk patients: a multi-method qualitative study

BackgroundLittle is known about the opportunities for shared decision-making when older high-risk patients are offered major surgery. This study examines how, when, and why clinicians and patients can share decision-making about major surgery. MethodsThis was a multi-method qualitative study, combining video recordings of preoperative consultations, interviews, and focus groups (33 patients, 19 relatives, 36 clinicians), with observations and documentary analysis in clinics in five hospitals in the UK undertaking major orthopaedic, colorectal, and/or cardiac surgery. ResultsThree opportunities for shared decision-making about major surgery were identified. Resolution-focused consultations (cardiac/colorectal) resulted in a single agreed preferred option related to a potentially life-threatening problem, with limited opportunities for shared decision-making. Evaluative and deliberative consultations offered more opportunity. The former focused on assessing the likelihood of benefits of surgery for a presenting problem that was not a threat to life for the patient (e.g., orthopaedic consultations) and the latter (largely colorectal) involved discussion of a range of options while also considering significant comorbidities and patient preferences. The extent to which opportunities for shared decision-making were available, and taken up by surgeons, was influenced by the nature of the presenting problem, clinical pathway, and patient trajectory. ConclusionsDecisions about major surgery were not always shared between patients and doctors. The nature of the presenting problem, comorbidities, clinical pathways, and patient trajectories all informed the type of consultation and opportunities for sharing decision-making. Our findings have implications for clinicians, with shared decision-making about major surgery most feasible when the focus is on life-enhancing treatment.