Subspecialty Of Surgery Research Articles

Discussion of The Passion Tax: Valuation Disparities Among Academic and Nonacademic Surgery Subspecialties

Discussion of The Passion Tax: Valuation Disparities Among Academic and Nonacademic Surgery Subspecialties

Comparing Otolaryngology Subspecialties' Changes in Medicare Reimbursement From 2013 to 2024.

Identify differences in Medicare reimbursement changes for general otolaryngology, pediatric otolaryngology, head and neck oncology, laryngology, rhinology, otology, facial plastic and reconstructive surgery, and sleep surgery subspecialties from 2013 to 2024. Subspecialty-based procedures' facility prices and relative value units (RVUs) were sourced from the Centers for Medicare & Medicaid Services' Physician Fee Schedule. Prices were adjusted for inflation, and the average percent change in facility price and RVUs for each subspecialty was calculated. Each subspecialty's average inflation-adjusted, facility price change was compared to general otolaryngology using t-tests, and differences between subspecialties were assessed using Dunn's test. From 2013 to 2024, general otolaryngology's average percent change was -29.9% and significantly differed from facial plastic and reconstructive surgery (-26.4% [-5.5 to -0.7%]; p = 0.011) and sleep surgery (-23.7% [-19.2 to -2.2%]; p = 0.016). Rhinology (-32.5% [-1.3 to 6.1%]), otology (-30.2% [-6.5 to 7.6%]), laryngology (-29.3 [-4.2 to 2.1%]), head and neck (-27.4% [-5.7 to 0.2%]), and pediatric otolaryngology (-25.8% [-14.6 to 3.8%]) also decreased drastically but were not significantly different from general otolaryngology. For the multiple comparisons test, rhinology was statistically different from sleep surgery and facial plastic and reconstructive surgery. General otolaryngology and rhinology were more negatively affected due to changes in work and practice expense RVUs. Universal decreases were due to inflation and legislative reductions to the conversion factor. Medicare's budget constraints, potential effects on access to otolaryngology services, and continuing inflation warrant lobbying efforts to address these changes to maintain financial viability. NA Laryngoscope, 2025.

Practice patterns among ophthalmic surgeons in treating concomitant oculoplastic conditions in preoperative period: A questionnaire-based study

BACKGROUND Addressing oculoplastic conditions in the preoperative period ensures both the safety and functional success of any ophthalmic procedure. Some oculoplastic conditions, like nasolacrimal duct obstruction, have been extensively studied, whereas others, like eyelid malposition and thyroid eye disease, have received minimal or no research. AIM To investigate the current practice patterns among ophthalmologists while treating concomitant oculoplastic conditions before any subspecialty ophthalmic intervention. METHODS A cross-sectional survey was disseminated among ophthalmologists all over India. The survey included questions related to pre-operative evaluation, anaesthetic and surgical techniques preferred, post-operative care, the use of adjunctive therapies, and patient follow-up patterns. RESULTS A total of 180 ophthalmologists responded to the survey. Most practitioners (89%) felt that the ROPLAS test was sufficient during pre-operative evaluation before any subspecialty surgery was advised. The most common surgical techniques employed were lacrimal drainage procedures (Dacryocystorhinostomy) (63.3%), eyelid malposition repair (36.9%), and ptosis repair (58.7%). Post-operatively, 47.7 % of respondents emphasized that at least a 4-week gap should be maintained after lacrimal drainage procedures and eyelid surgeries. Sixty-seven percent of ophthalmologists felt that topical anaesthetic procedures should be preferred while performing ocular surgeries in thyroid eye disease patients. CONCLUSION Approximately 50% of ophthalmologists handle prevalent oculoplastic issues themselves, seeking the expertise of an oculoplastic surgeon under particular conditions. Many ophthalmologists still favor using ROPLAS as a preliminary screening method before proceeding with cataract surgery. Eyelid conditions and thyroid eye disease are not as commonly addressed before subspecialty procedures compared to issues like nasolacrimal duct obstruction and periocular infections.

Knowledge of medical students regarding pediatric surgery subspecialty, Mansoura Manchester medical program fresh graduates

Knowledge of medical students regarding pediatric surgery subspecialty, Mansoura Manchester medical program fresh graduates

Gender and Racial Diversity Assumed by Text-to-Image Generators in Microsurgery and Plastic Surgery-related Subspecialities

Since the release of ChatGPT by OpenAI in November 2022, generative artificial intelligence (AI) models have attracted significant attention in various fields, including surgery. These advancements have been particularly notable for creating highly detailed and contextually accurate images from textual prompts. A notable area of clinical application is the representation of surgeon demographics in various specialties, particularly in the context of microsurgery and plastic surgery-related subspecialties. This cross-sectional study, conducted in June 2024, utilized the latest version of the Copilot Creative Mode powered by DALL-E 3 to generate images of surgeons across various plastic surgery subspecialties. Real-world demographic data from the US, Japan, and Zambia were compared with AI-generated images for an accurate representation analysis. Five hundred images (350 from various subspecialties and 150 from geographical sources) were analyzed. The AI model predominantly generated images of male and female surgeons with a statistical underrepresentation of female and Black microsurgeons. Geographical prompts influenced the representation, with an overrepresentation of female (64.0%; p<0.001) and Black (16.0%; p<0.001) plastic surgeons in the US and exclusively Asian surgeons in Japan. Discrepancies were also observed in the depiction of surgical equipment, with the majority of AI-generated microsurgeons inaccurately portrayed using either surgical loupes (46.0%) or optical microscopes (32.0%), not with surgical microscopes (4.0%). This study revealed significant disparities between AI-generated images and actual demographics in the fields of microsurgery and plastic surgery-related subspecialties, highlighting the need for more diverse and accurate training datasets for AI models.

Scoping review of robotics technology in spinal surgery with highlights of the Annual Seattle Science Foundation Course.

Robotic assistance has become increasingly prevalent in spinal surgery in recent years, emerging as a tool to increase accuracy and precision and lower complication rates and radiation exposure. The 7th and 8th Annual Seattle Science Foundation (SSF) Robotics Courses showcased presentations and demonstrations from some of the field's most experiences leaders on latest topics in robotics and spinal surgery, including cutting-edge preoperative planning technologies, augmented reality (AR) in the operating room, cervical fusion with transpedicular screws, and neuro-oncologic management. We provide a scoping review of the use of robotics technology in spinal surgery featuring highlights from the 7th and 8th Annual SSF Robotics Courses. A scoping review of the literature was conducted (last search conducted in July 2024). Key search terms included "robotic assistance", "spine surgery", and "robotic technology" on the PubMed database. Additionally, highlights are included from the 7th and 8th Annual SSF Robotics Courses. Applications of navigation robotics span subspecialties of spine surgery including deformity correction, minimally invasive approaches, lateral single position operations, spinal oncology, and cervical fusion. Tips on overcoming traditional obstacles of robotics integration such as streamlining staff workflow and adoption while financing robotic-assisted technology are shared. Future directions of robotics enhanced with AR may further guide surgeon decision-making, assist in more practical fashion intraoperatively, and optimize patient outcomes. While improved precision and accuracy, less radiation, and standardization of procedures represent current advantages of robotic-assistance across spine surgery, robotics in spine surgery will usher more transformative changes to patient care and operative skill in coming years.

Differences in Medicare payment and practice characteristics for orthopedic surgery subspecialties

Background Medicare payment, practice, and patient characteristics give perspective on the lifestyle, challenges, and attractiveness unique to each orthopedic surgery subspecialty. Changes to Medicare reimbursement may also affect health care delivery, warranting policy change. We analyzed differences in orthopedic surgery subspecialty characteristics and Medicare payments. Methods The Centers for Medicare and Medicaid Services data set was filtered by Current Procedural Terminology (CPT) codes unique to each orthopedic surgery subspecialty in 2019. After filtering by unique CPT codes, 100 randomized physicians were validated for each subspecialty: adult reconstruction and arthroplasty, trauma, sports medicine, hand surgery, shoulder and elbow surgery, foot and ankle surgery, and spine surgery. Data gathered included unique procedural codes, number of beneficiaries, services provided, and the total Medicare allowed amount. Differences were assessed with post hoc tests. Subspecialty changes in Medicare payment were assessed using the Physician Fee Schedule and compared using a single-factor analysis of variance. Results On average, hand surgery recorded the most unique CPT codes (106) and the highest volume of beneficiaries (571). Adult reconstruction and arthroplasty had the fewest unique codes (60) and the greatest total Medicare payment ($328,000). Spine surgery had the lowest number of beneficiaries (387) and lowest number of services provided (1752). Lastly, sports medicine provided the largest volume of services (4221). Mean total codes, unique codes, and total patients differed between subspecialties. Varying differences in average Medicare payment, total billed codes, total unique codes, total patients, patient race, patient age, patient sex, and patient health were found for all orthopedic surgery subspecialties in 2019. Conclusions These data may illustrate financial incentives for orthopedic surgery residents to pursue certain subspecialties.

Patterns of Specialty Palliative Consultation for Patients Admitted to Surgical Services.

Background: Historically, there have been perceptions that engagement with palliative care (PC) services may preclude potentially curative but high-risk operations. As such, we sought to investigate the relationship between specialty PC consultation and the care trajectory of surgical patients. We hypothesized that PC consultation would be associated with increased frequency of nonoperative treatments being chosen among surgical inpatients. Design: All general surgery and general surgery subspecialty patients receiving PC consultation at a single tertiary academic medical center from 2020 to 2021 were identified. Surgical operations were stratified as "elevated risk" in accordance with 2014 American Heart Association guidelines. Retrospective chart review was performed, and comparisons were made with univariable statistics. Results: We identified a total of 729 patients who received specialty PC consultation, 159 of whom were admitted to a surgical service. PC was actively involved in consultation for surgical decision making in 27% (43/159) of these encounters. PC assistance with surgical decision making was associated with a greater incidence of elevated-risk operative procedures during admission compared with patients without presurgical PC consultation (OR 3.29 [2.51, 7.16]). There was no association between PC involvement with surgical decision making and odds of discharge to hospice (OR 0.42 [0.18, 1.51]) nor death during admission (OR 0.66 [0.21, 2.10]). Conclusions: We found that specialty PC involvement in surgical decision making does not preclude the pursuit of disease-directed surgical treatment. Contrary to our hypothesis, our single institutional data demonstrate that early PC consultation can be synergistic with surgical disease management and does not preclude elevated-risk operative care.

The Impact of Minimally Invasive Gynecologic Surgery Subspecialty Training on Outcomes of Myomectomy: A Retrospective Cohort Study

Study ObjectiveTo compare surgical outcomes among patients undergoing minimally invasive myomectomy (MIM) or abdominal myomectomy (AM) with MIGS subspecialists versus general obstetrician/gynecologists (OB/GYNs), and to characterize the complexity of myomectomies by surgeon type. DesignRetrospective cohort study. SettingQuaternary care institution. ParticipantsPatients who underwent MIM (laparoscopic or robotic) or AM with a fellowship-trained MIGS subspecialist or general OB/GYN from 3/15/2015-3/14/2020. InterventionsMyomectomy. ResultsOf 609 myomectomies, 460 (75.5%) were MIM, 404 (87.8%) of which were performed by MIGS subspecialists. The remaining 149 (24.5%) cases were AM, 36 (24.1%) of which were performed by MIGS subspecialists. Compared to general OB/GYNs, MIGS subspecialists excised a greater number of fibroids for both MIM (median 3.0 [range 1.0-30.0]) vs. 2.0 [1.0-9.0], p<.001) and AM (21.0 [10.0-60.0] vs. 6.0 [1.0-42.0], p<.001), and had a greater proportion of uteri >20 weeks size for AM (22.2% vs. 3.5%, p=.003). Composite perioperative complication rates were significantly higher for general OB/GYNs than for MIGS subspecialists (29.0% vs. 11.8%, adjusted odds ratio [aOR] 2.70, 95% confidence interval [CI] 1.48-4.92). In a subgroup analysis of MIM only, general OB/GYNs had higher rates of composite perioperative complications (28.6% vs. 9.9%, aOR 4.51, 95% CI 2.27-8.97), excessive blood loss and/or transfusion (10.7% vs. 3.0%, unadjusted odds ratio [OR] 3.92, 95% CI 1.41-10.91), surgery time ≥ 90%ile (25.0% vs. 8.9%, aOR 5.05, 95% CI 2.39-10.64), and conversions to laparotomy (10.7% vs. 0.2%, unadjusted OR 48.36, 95% CI 5.71-409.93). For AM only, there were no significant differences in perioperative complication rates between groups. ConclusionFellowship-trained MIGS subspecialists had improved surgical outcomes for MIM compared to general OB/GYNs, with fewer conversions to laparotomy, reduced surgery time, and less blood loss, while outcomes for AM were similar by surgeon type. MIGS subspecialists excised a greater number of fibroids regardless of surgical approach, highlighting a level of comfort in complex benign gynecology beyond endoscopic surgery at our institution.

Classification and Treatment Protocol of Post-bariatric Patients: An Anamnestic and Psychiatric Profiling.

Post-bariatric surgery is one of the fastest-growing subspecialties in plastic surgery. The increase in the number of surgical procedures has not been followed by an equivalent categorization of patients. Surgical innovations and technical refinements are widespread, while clear classification and objectification of surgical indications are lacking. A retrospective monocentric study was carried out. We included 135 patients operated in our department of plastic surgery between January 1, 2015, and December 31, 2019. Patients were adults with a history of bariatric surgery. We analyzed two major and two minor criteria before the reconstructive procedure was performed. We divided patients into three clusters (A, B and C) according to the number and nature of major criteria met. We then compared the incidence of postoperative complications and the percentage of body weight regained at 1 year after surgery between the groups. We also tested the impact of minor criteria in each cluster. Our sample had a mean age of 48.5 years, a mean BMI of 27.68 kg/m2, 19 (14.1%) male patients, 116 (85.9%) female patients. We included 81 (60.0%) patients in cluster A; 44 (32.6%) patients in cluster B; and 10 (7.4%) patients in cluster C. Comparison between these groups shows us a higher incidence of postoperative complications in patients in clusters B and C. In addition, patients with diagnosed psychiatric disorders showed a 70% complication rate (p = 0.038) while we found no significant correlations with the other criteria analyzed. The classification proposed based on our criteria may represent a first step toward classifying post-bariatric patients and reinforcing the surgical indication in these patients. It also enables us to identify the patients who are most at risk of complications. 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 .

Content and development of pharyngology and laryngology

Pharyngology and laryngology is an important subspecialty of Otolaryngology Head and Neck Surgery. It involves congenital diseases, trauma and foreign bodies, inflammatory diseases, obstructive sleep apnea, benign lesions, laryngeal nerve and cricoarytenoid joint diseases, swallowing disorders, laryngopharyngeal reflux diseases, voice medicine, as well as laryngeal microsurgery and endoscopic surgical treatment of benign and malignant tumors of this area. The disease spectrum is wide and involves many surgical techniques and methods.

Perceptions of homelessness: Is there variation across medical careers and specialties?

Medical students, residents and faculty are all capable of holding biases towards stigmatised groups like people experiencing homelessness. This study sought to investigate how the level of training may influence perceptions of homelessness among medical students, residents and faculty. Additionally, we sought to understand how different specialities perceive people experiencing homelessness and whether this changes at various points in a career. The Health Professionals' Attitudes Towards the Homeless Inventory (HPATHI) was administered to medical students, residents and faculty at one institution in the United States. Basic demographics as well as length of time spent in practice were collected in addition to HPATHI responses. A total of 1,141 individuals were invited to complete the survey, including 736 medical students, 214 residents and 191 faculty. Two hundred and ninety individuals participated in the survey and 238 recorded complete responses were analysed for a sample response rate of 238/1141 (20.9%.) Overall perceptions of homelessness across the entire sample were positive and not greatly influenced by the level of training during a medical career. Medical students across classes were largely in agreement and there was a noticeable increase in positive perceptions for students engaged in clinical rotations. However, clinical specialties demonstrated wide variation in perceptions, with the most prominent differences amongst individuals from surgical subspecialties of General Surgery and Obstetrics & Gynaecology. Our study demonstrates the largely favourable attitudes physicians, residents and students have towards people experiencing homelessness with implications for future work to support greater exposure to underserved populations during training. Specialty choice appears to play a larger role in the formation of attitudes towards underserved populations rather than the length of time spent in a particular specialty.

The Impact of Minimally Invasive Gynecologic Surgery Subspecialty Training on Outcomes of Benign Hysterectomy

The Impact of Minimally Invasive Gynecologic Surgery Subspecialty Training on Outcomes of Benign Hysterectomy

Trends in general surgeon operative practice patterns in a modern cohort

IntroductionAnalyzing general surgeons’ operative case mix can provide an update on contemporary practice patterns and inform pragmatic residency training. MethodsWe performed a retrospective cohort study of general surgeons in Florida, Iowa, and Maryland, 2016–2020. Cases were identified using billing codes. The Cochran-Armitage test of trends was used to evaluate the proportion of practice devoted to specific case types and operative setting over time. ResultsGeneral surgeons (n ​= ​1300) performed 1,287,745 cases. The mean (±SD) annual volume per surgeon for all procedures was 356 (±250), with 198 (±152) general surgery operations, 57 (±142) endoscopic procedures, and 101 (±109) other cases. On average, surgeons operated on 7.1 (±2.6) different organ systems. Trends toward a lower proportion of general surgery operations, and a greater proportion of subspecialty procedures and surgery in the outpatient setting over time were demonstrated (p ​< ​0.001). ConclusionThe practice pattern of the general surgeon continues to be heterogeneous, reflecting the persistent need for a broad training paradigm that permits specialization.

Use of ambient AI scribing: Impact on physician administrative burden and patient care.

418 Background: Medical documentation is necessary to describe encounters for clinical and billing purposes. The increasing time required for medical documentation is contributing to provider stress and burnout. Physicians divide their time and attention between patients and the electronic health record (EHR), negatively impacting the patient physician relationship. Methods: 49 physicians from Texas Oncology participated in a pilot from November 2023 to April 2024 using Deep Scribe (DS) ambient artificial intelligence (AI) technology to document patient clinic visits. Subspecialties of medical oncology, radiation oncology, urology, and breast surgery completed opinion surveys pre and post pilot. Provider adoption, weekly usage, satisfaction scores were measured. Evaluation and management (E&amp;M) diagnosis codes for office visits conducted pre-pilot were reviewed for over 27,000 patient encounters and compared to over 4,500 DS patient encounters. Hierarchical condition category (HCC) codes captured via DS AI were compared to manual capture of billing codes in the pre-pilot period. Results: 77% of providers adopted DS AI technology during the pilot. Median turnaround time for notes was less than 3 minutes. Average satisfaction score was 81%. 91% of providers stated DS was easy to use. 60% of providers believed DS improved the quality of documentation. Providers reported on average 1.5 hours per provider time saved per week. The average number of billed diagnosis codes for non- DS patients was 3 per patient. For the DS patients, the average billed diagnosis per patient was 4.1. Diagnosis codes were categorized as cancer, and other non-cancer HCCs using the CMS-HCC model category version 22. Of the top ten HCC categories, cancer diagnosis codes were better captured by manual coding, whereas DS captured more non-cancer HCC codes across multiple systems, most significantly in endocrine and cardiovascular systems. Conclusions: Data from this pilot study shows physicians reported DS AI improved quality of their documentation and saved physicians’ time. Billing data shows increase capture of non-cancer HCC codes. Use of AI in medical documentation can decrease physician burden and improve quality of patient care. E&amp;M Diagnosis Codes Non-Deep Scribe Deep Scribe Patient visit count 27,236 4,584 Diagnosis code count 82,231 18,702 Average 3.0 4.1 Median 2 3 Mode 2.0 1.0

History and formation of “Limb lengthening and reconstruction surgery — LLRS” as a subspecialty of orthopedic surgery

In 1998, the first meeting of members of the Association for the Study and Application of the Methods of Ilizarov (ASAMI) was held in the USA to introduce and popularize the methods developed in Kurgan by Professor G. Ilizarov and his staff. During 2005-2016, other communities worked in parallel with ASAMI, which went beyond the use of only the Ilizarov apparatus. Since 2017, the joint meetings have been called “Combined congress of the ASAMI-BR and ILLRS societies”. This actually became the basis for the definition of “Limb Lengthening and Reconstruction Surgery (LLRS)” as a subspecialty of orthopedic surgery that treats patients with nonunions, congenital and acquired long bone, large joints deformities of the upper and lower extremities. LLRS is based on the Ilizarov method and discovery (“Ilizarov effect”) with the rational use of external and internal fixation, osteotomy and soft tissue procedures. It takes at least three years for an orthopedic surgeon to become a specialist in the field of LLRS, and the education must be staged. A significant role in this is played by the ASAMI-BR ILLRS congresses, ExFix LLRS courses held in many countries, ExFix modules integrated into courses provided as part of the education of AO Trauma, as well as extensive world literature.

Assessment of Education and Management of Endometriosis Among Colorectal Surgeons and Residents

Study ObjectiveTo identify the type of endometriosis education and surgical training colorectal surgery residents are exposed to during training. To determine the current surgical management of endometriosis among recently graduated colorectal surgeons and their level of comfort. DesignA qualitative cross-sectional study was performed. An anonymous questionnaire was emailed to colorectal surgery residents of 2023 and recent graduates for completion. Data was then extracted and analyzed from REDCap. A chi-square test was performed on the primary outcome variables. SettingA REDCap electronic survey was administered through email to each participant. PatientsAll colorectal surgery residents in 2023 and recent graduates from Colon and Rectal Surgery subspecialty from 2012 to 2022. InterventionsA 17-item anonymous questionnaire was sent via email through REDCap. Measurements and Main ResultsThe survey was completed by 70 participants. Most respondents (58.5%) did not receive formal education on bowel endometriosis. Forty percent of participants (28/70) did not feel they received adequate training for surgical management of bowel endometriosis. In terms of surgical exposure, 3.8% (2) responded they had been involved in >15 bowel endometriosis cases and 18 (25.7%) had been exposed to 1–5 cases during colorectal training. Factors that predicted feeling adequately trained in managing endometriosis included formal endometriosis education (OR 4.70, 95% CI 1.37−16.12, p-value .027) and surgical exposure during training (OR 4.38, 95% CI 1.18–16.26, p-value .014). Additionally, the number of cases exposed during training is highly correlated with feeling adequately trained. ConclusionMore than half of colorectal surgeons did not receive formal education on bowel endometriosis and the majority had only been exposed to 1–5 cases during their colorectal training. An overwhelming majority were interested in further education. This study highlights opportunities for improvement in the exposure to education and surgical management of endometriosis among colorectal surgery trainees.

The Impact of Minimally Invasive Gynecologic Surgery Subspecialty Training on Outcomes of Benign Laparoscopic Hysterectomy: A Retrospective Cohort Study

Study ObjectiveTo compare surgical outcomes among patients undergoing minimally invasive hysterectomy (MIH), laparoscopic or robotic, with minimally invasive gynecologic surgery (MIGS) subspecialists, gynecologic oncologists (GO), or general obstetrician/gynecologists (OB/GYN). DesignRetrospective cohort study. SettingQuaternary care academic hospital. Patients or participantsPatients undergoing MIH for benign indications from 3/2015 to 3/2020 were included. InterventionsMIH. Measurements and Main ResultsThe primary outcome was the odds of a composite of any intra- or postoperative complications within 30 days of surgery by surgeons’ group.A total of 728 MIHs were performed during the study period and constituted the cohort, of which 368 (50.5%) were performed by MIGSs, 144 (19.8%) by GOs, and 216 (29.7%) by OB/GYNs.Intra- and postoperative complications occurred in 11.7% of the MIGS group, 22.9% of the GO group (OR 2.25, 95%CI 1.36-3.71) and 25.9% of the OB/GYN group (OR 2.65, 95%CI 1.70-4.12). Major intra- or postoperative complications were associated with surgeons’ groups (OR 7.02 95%CI 2.67-18.47, and 6.84 95%CI 2.73-17.16 for GO and OB/GYN compared with MIGS, respectively). Intraoperative complication rates were significantly lower for MIGS surgeons (1.4%) than for GOs (9.0%, OR 7.21 95%CI 2.52-20.60) and OB/GYNs (9.7%, OR 7.82 95%CI 2.90-21.06). There was a higher odd of postoperative complications for OB/GYNs compared with MIGS (18.5% vs. 10.9%, OR 1.86 95%CI 1.16-3.00). Rates of conversion to laparotomy were lowest among MIGS surgeons (0.3%) compared to GOs (7.6%) and OB/GYNs (7.9%). Estimated blood loss 90th percentile or higher and surgery time 90th percentile or higher were more common for OB/GYNs compared with MIGS surgeons (OR 2.12 95%CI 1.07-4.22; OR 2.48 95%CI 1.49-4.12, respectively). ConclusionFellowship trained MIGS subspecialists had improved surgical outcomes for benign MIH compared with GOs and OB/GYNs, with lower rates of perioperative complications and fewer conversions to laparotomy.

ChatGPT for improving postoperative instructions in multiple fields of plastic surgery

BackgroundClear discharge instructions are vital for patients and caregivers to manage post-op care at home. However, they often exceed the sixth-grade reading level recommended by national associations. We hypothesize that ChatGPT could help rewrite instructions to this level for increased accessibility and comprehension. We aim to assess readability, understandability, actionability, and safety of ChatGPT rewritten post-op instructions in four Plastic Surgery subspecialties: Breast, Craniofacial, Hand, and Aesthetic surgery. MethodsWe obtained post-op instructions from four index procedures in Plastic Surgery. We utilized ChatGPT to rewrite at the sixth- and fourth-grade reading levels. Readability was determined by seven readability indexes, understandability and actionability by the PEMAT-P questionnaire, and safety by the primary surgeons. ResultsOverall, average readability of the original post-op instructions ranged between seventh-eighth grade. Of the sixth-grade ChatGPT instructions, only one was lowered to the sixth-grade level. Of the fourth-grade ChatGPT instructions, all were reduced to sixth-grade or below, but none achieved fourth-grade level. Understandability scores increased as reading level decreased while actionability scores decreased for fourth-grade rewrites. Safety was not compromised in all rewrites. ConclusionsOur findings suggest that ChatGPT can adapt post-op instructions to a more readable sixth-grade level without compromising safety. We suggest prompting ChatGPT to write 1-2 grade levels lower than the desired reading level. While understandability increased for all ChatGPT rewrites, actionability decreased for fourth-grade level instructions. Sixth-grade remains as the optimal reading level for post-op instructions. This study demonstrates that ChatGPT can help improve patient care by improving readability of post-op instructions.

Assessment of LGBTQ+ Diversity, Equity, and Inclusion in Subspecialty Surgery Literature: A Scoping Review

ObjectiveTo identify LGBTQ+ DEI publications and contextualize the current frequency of the literature across subspecialty surgical fields. MethodsA PRISMA systematic review using PubMed, MEDLINE, and Web of Science was conducted in April 2024. Inclusion criteria required intra-field DEI content of defined subspecialties while foreign language literature, poor methodology, and duplicates were excluded. The primary endpoint was the number of publications across subspecialties. Secondary endpoints included publication dates, study design, and sample size. ResultsOf the 702 articles identified, 27 were included. Neurological surgery had 2 studies while plastic surgery, orthopedic surgery, otolaryngology, and thoracic surgery had 11, 7, 5, and 2 respectively. There was a statistically significant different frequency of publications across subspecialties (p = 0.031). Post-hoc residual analysis indicated neurosurgery and thoracic surgery had statistically fewer publications, while plastic surgery had statistically more (p = 0.04, 0.002, 0.21, 0.42, 0.04 for neurological Surgery, plastic surgery, orthopedic surgery, otolaryngology, and thoracic surgery, respectively). Secondary outcomes found a majority of publication dates between 2022 to 2024. Study methodologies involved cross-sectional studies, editorials, and retrospective reviews (14, 11, and 3 respectively) and contained a median sample size of 248.5. ConclusionsThis systematic review provides objective data to contextualize DEI literature across surgical subspecialties. Overall, this review highlights the lack of LGBTQ+ DEI literature within neurosurgery and advocates for correcting this gap for the benefit of both surgeons and patients. Understanding the current numbers and evaluating progress in other surgical fields might provide solutions.