ABSTRACT
Introduction: Achilles tendon rupture is one of the most common musculoskeletal injuries and accounts to 20 % of all large tendon ruptures The surgical choice of a procedure might play a role in the incidence of postoperative complications. This study aimed to estimate and compare the incidence of complications occurring within a 30-day window following primary surgical repair of the Achilles tendon with or without a graft. Methods: A retrospective cohort study was conducted using the ACS NSQIP database from 2005 to 2021. Patients were divided into 2 cohorts (primary surgical repair with and without graft). Results: A total of 7010 patients were included in the analysis. Among the graft group, 10.9 % reported any complication which was double the percentage of complications in the no graft group. Only 3.8 % of the no graft patients had reported systemic complications compared to 8.3 % in the graft group. Chronic steroid use was found to be an effect modifier in the incidence of any complications after primary surgical repair when comparing graft versus no graft (P-value 0.016). Conclusion: Surgical repairwith tendon graft develops more complications than repairing without graft. Therefore, it is imperative for physicians to strive for an early diagnosis, as any delay in treatment significantly raises the likelihood of complications. Levels of evidence: III, Retrospective Cohort Study.
ABSTRACT
PURPOSE: Artificial Intelligence (AI), and specifically ChatGPT, has shown potential in healthcare, yet its performance in specialized medical examinations such as the Orthopaedic Surgery In-Training Examination and European Board Hand Surgery diploma has been inconsistent. This study aims to evaluate the capability of ChatGPT-4 to pass the American Hand Surgery Certifying Examination. METHODS: ChatGPT-4 was tested on the 2019 American Society for Surgery of the Hand (ASSH) Self-Assessment Exam. All 200 questions available online (https://onlinecme.assh.org) were retrieved. All media-containing questions were flagged and carefully reviewed. Eight media-containing questions were excluded as they either relied purely on videos or could not be rationalized from the presented information. Descriptive statistics were used to summarize the performance (% correct) of ChatGPT-4. The ASSH report was used to compare ChatGPT-4's performance to that of the 322 physicians who completed the 2019 ASSH self-assessment. RESULTS: ChatGPT-4 answered 192 questions with an overall score of 61.98%. Performance on media-containing questions was 55.56%, while on non-media questions it was 65.83%, with no statistical difference in performance based on media inclusion. Despite scoring below the average physician's performance, ChatGPT-4 outperformed in the 'vascular' section with 81.82%. Its performance was lower in the 'bone and joint' (48.54%) and 'neuromuscular' (56.25%) sections. CONCLUSIONS: ChatGPT-4 achieved a good overall score of 61.98%. This AI language model demonstrates significant capability in processing and answering specialized medical examination questions, albeit with room for improvement in areas requiring complex clinical judgment and nuanced interpretation. ChatGPT-4's proficiency is influenced by the structure and language of the examination, with no replacement for the depth of trained medical specialists. This study underscores the supportive role of AI in medical education and clinical decision-making while highlighting the current limitations in nuanced fields such as hand surgery.
ABSTRACT
Obesity is a risk factor for severe respiratory diseases, including COVID-19 infection. Meta-analyses on mortality risk were inconsistent. We systematically searched 3 databases (Medline, Embase, CINAHL) and assessed the quality of studies using the Newcastle-Ottawa tool (CRD42020220140). We included 199 studies from US and Europe, with a mean age of participants 41.8-78.2 years, and a variable prevalence of metabolic co-morbidities of 20-80 %. Exceptionally, one third of the studies had a low prevalence of obesity of <20 %. Compared to patients with normal weight, those with obesity had a 34 % relative increase in the odds of mortality (p-value 0.002), with a dose-dependent relationship. Subgroup analyses showed an interaction with the country income. There was a high heterogeneity in the results, explained by clinical and methodologic variability across studies. We identified one trial only comparing mortality rate in vaccinated compared to unvaccinated patients with obesity; there was a trend for a lower mortality in the former group. Mortality risk in COVID-19 infection increases in parallel to an increase in BMI. BMI should be included in the predictive models and stratification scores used when considering mortality as an outcome in patients with COVID-19 infections. Furthermore, patients with obesity might need to be prioritized for COVID-19 vaccination.
