Can AI Answer My Questions? Utilizing Artificial Intelligence in the Perioperative Assessment for Abdominoplasty Patients.

BACKGROUND: Abdominoplasty is a common operation, used for a range of cosmetic and functional issues, often in the context of divarication of recti, significant weight loss, and after pregnancy. Despite this, patient-surgeon communication gaps can hinder informed decision-making. The integration of large language models (LLMs) in healthcare offers potential for enhancing patient information. This study evaluated the feasibility of using LLMs for answering perioperative queries. METHODS: This study assessed the efficacy of four leading LLMs-OpenAI's ChatGPT-3.5, Anthropic's Claude, Google's Gemini, and Bing's CoPilot-using fifteen unique prompts. All outputs were evaluated using the Flesch-Kincaid, Flesch Reading Ease score, and Coleman-Liau index for readability assessment. The DISCERN score and a Likert scale were utilized to evaluate quality. Scores were assigned by two plastic surgical residents and then reviewed and discussed until a consensus was reached by five plastic surgeon specialists. RESULTS: ChatGPT-3.5 required the highest level for comprehension, followed by Gemini, Claude, then CoPilot. Claude provided the most appropriate and actionable advice. In terms of patient-friendliness, CoPilot outperformed the rest, enhancing engagement and information comprehensiveness. ChatGPT-3.5 and Gemini offered adequate, though unremarkable, advice, employing more professional language. CoPilot uniquely included visual aids and was the only model to use hyperlinks, although they were not very helpful and acceptable, and it faced limitations in responding to certain queries. CONCLUSION: ChatGPT-3.5, Gemini, Claude, and Bing's CoPilot showcased differences in readability and reliability. LLMs offer unique advantages for patient care but require careful selection. Future research should integrate LLM strengths and address weaknesses for optimal patient education. LEVEL OF EVIDENCE V: 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 .

Exploring the Unknown: Evaluating ChatGPT's Performance in Uncovering Novel Aspects of Plastic Surgery and Identifying Areas for Future Innovation.

BACKGROUND: Artificial intelligence (AI) has emerged as a powerful tool in various medical fields, including plastic surgery. This study aims to evaluate the performance of ChatGPT, an AI language model, in elucidating historical aspects of plastic surgery and identifying potential avenues for innovation. METHODS: A comprehensive analysis of ChatGPT's responses to a diverse range of plastic surgery-related inquiries was performed. The quality of the AI-generated responses was assessed based on their relevance, accuracy, and novelty. Additionally, the study examined the AI's ability to recognize gaps in existing knowledge and propose innovative solutions. ChatGPT's responses were analysed by specialist plastic surgeons with extensive research experience, and quantitatively analysed with a Likert scale. RESULTS: ChatGPT demonstrated a high degree of proficiency in addressing a wide array of plastic surgery-related topics. The AI-generated responses were found to be relevant and accurate in most cases. However, it demonstrated convergent thinking and failed to generate genuinely novel ideas to revolutionize plastic surgery. Instead, it suggested currently popular trends that demonstrate great potential for further advancements. Some of the references presented were also erroneous as they cannot be validated against the existing literature. CONCLUSION: Although ChatGPT requires major improvements, this study highlights its potential as an effective tool for uncovering novel aspects of plastic surgery and identifying areas for future innovation. By leveraging the capabilities of AI language models, plastic surgeons may drive advancements in the field. Further studies are needed to cautiously explore the integration of AI-driven insights into clinical practice and to evaluate their impact on patient outcomes. LEVEL OF EVIDENCE V: 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.

Impact of nutrition on skin wound healing and aesthetic outcomes: A comprehensive narrative review.

Background: While current wound treatment strategies often focus on antimicrobials and topical agents, the role of nutrition in wound healing and aesthetic outcomes is crucial but frequently overlooked. This review assesses the impact of specific nutrients and preoperative nutritional status on surgical outcomes. Methods: A comprehensive search was conducted in PubMed, Scopus, Web of Science, and the Cochrane Library, from the inception of the study to October 2023. The study focused on the influence of macronutrients and micronutrients on aesthetic outcomes, the optimization of preoperative nutritional status, and the association between nutritional status and postoperative complications. Inclusion criteria were English language peer-reviewed articles, systematic reviews, meta-analyses, and clinical trials related to the impact of nutrition on skin wound healing and aesthetic outcomes. Exclusion criteria included non-English publications, non-peer-reviewed articles, opinion pieces, and animal studies. Results: Omega-3 fatty acids and specific amino acids were linked to enhanced wound-healing and immune function. Vitamins A, B, and C and zinc positively influenced healing stages, while vitamin E showed variable results. Polyphenolic compounds showed anti-inflammatory effects beneficial for recovery. Malnutrition was associated with increased postoperative complications and infections, whereas preoperative nutritional support correlated with reduced hospital stays and complications. Conclusion: Personalized nutritional plans are essential in surgical care, particularly for enhanced recovery after surgery protocols. Despite the demonstrated benefits of certain nutrients, gaps in research, particularly regarding elements such as iron, necessitate further studies. Nutritional assessments and interventions are vital for optimal preoperative care, underscoring the need for more comprehensive guidelines and research in nutritional management for surgical patients.

Improving Visualization of Intramuscular Perforator Course: Augmented Reality Headsets for DIEP Flap Breast Reconstruction.

Background: Augmented reality (AR) technology, exemplified by devices such as the Microsoft HoloLens 2, has gained interest for its potential applications in preoperative guidance. This study explores the use of AR technology for perforator identification during deep inferior epigastric artery perforator (DIEP) flap breast reconstruction. Methods: A case series of five patients where an AR device was used to identify perforators during DIEP flap breast reconstruction is presented. The device was utilized to recognize preoperative perforators and map their extra- and intramuscular routes. Sound and/or color Doppler confirmation was used to verify the findings. Results: In all five cases, the AR device successfully identified preoperative perforators and delineated their extra- and intramuscular routes. AR technology in perioperative visualization of vasculature offers the potential to enhance surgical precision and reduce operative times. By providing an augmented three-dimensional overlay of patients' vascular structures, AR can facilitate a more comprehensive understanding of individual anatomy, ultimately improving surgical outcomes. Conclusions: AR technology shows promise in enhancing perforator identification efficiency and deepening understanding of perforator trajectories during preoperative planning. Nonetheless, additional research is needed to establish whether the advantages of AR technology warrant its widespread adoption for perforator identification.

Artificial or Augmented Authorship? A Conversation with a Chatbot on Base of Thumb Arthritis.

ChatGPT is an open artificial intelligence chat box that could revolutionize academia and augment research writing. This study had an open conversation with ChatGPT and invited the platform to evaluate this article through series of five questions on base of thumb arthritis to test if its contributions and contents merely add artificial unusable input or help us augment the quality of the article. The information ChatGPT-3 provided was accurate, albeit surface-level, and lacks analytical ability to dissect for important limitations about base of thumb arthritis, which would not be conducive to potentiating creative ideas and solutions in plastic surgery. ChatGPT failed to provide relevant references and even "created" references instead of indicating its inability to perform the task. This highlights that as an AI-generator for medical publishing text, ChatGPT-3 should be used cautiously.

Novel Technique with Double Free Flap Design for Advanced Mandibular Osteoradionecrosis: A Case Series.

Advanced mandibular osteoradionecrosis is arguably among the most challenging cases for reconstructive head and neck surgeons. Several reconstructive methods for complex mandibular defects have been reported; however, for advanced mandibular osteoradionecrosis, a safe option that minimizes the risk of renewed fistulation and infections is needed. For this purpose, we present a new technique using a fascia-sparing vertical rectus abdominis musculocutaneous flap as protection for a vascularized free fibula graft (FFG). This technique also optimizes recipient site healing and functionality while minimizing donor site morbidity. Our initial experiences from a 4 patient case series are included. Mean operative time was 551 minutes (SD: 81 minutes). All donor sites were closed primarily. Mean time to discharge was 13 days (SD: 7 days), and mean time to full mobilization was 2 days (SD: 1 days). This double free flap technique completely envelops the FFG and plate with nonirradiated muscle. It allows for the transfer of an FFG without a skin island, thus avoiding the need for split skin graft closure. This results in faster healing and minimizes the risk of fibula donor site morbidity. The skin island of the vertical rectus abdominis musculocutaneous flap has the added benefit of providing intraoral lining, which minimizes contractures and trismus. Although prospective long-term studies comparing this approach to other double flap procedures are needed, we argue that this technique is an optimal approach to safeguard the mandibular FFG reconstruction against the inherent risks of renewed complications in irradiated unhealthy tissue.

Daytime-Dependent Cardioprotection in Cardiac Surgery: A Large Propensity-matched Cohort Study.

BACKGROUND: A recent article provided compelling evidence for a cardioprotective effect of afternoon compared with morning operation in patients undergoing aortic valve replacement. The present study sought to investigate any daytime-dependent effect on perioperative myocardial injury or clinical outcomes in a large cohort of patients undergoing elective cardiac surgery. METHODS: The study identified all patients who underwent nonemergency aortic valve replacement and/or on-pump coronary artery bypass grafting at the Department of Cardiothoracic and Vascular Surgery of Aarhus University Hospital, Aarhus, Denmark between 1999 and 2018. Propensity-score matching was used to create adjusted cohorts for morning and afternoon operation. The primary end point was a composite of 30-day mortality and in-hospital acute myocardial infarction (major adverse cardiac events). Secondary end points were new-onset in-hospital atrial fibrillation, peak creatine kinase-MB levels, and up to 19 years of follow-up for all-cause mortality. RESULTS: The study identified 7148 patients who underwent either aortic valve replacement with or without coronary artery bypass grafting (n = 2806) or isolated coronary artery bypass grafting (n = 4342). Propensity-score matching resulted in comparable cohorts of morning and afternoon operation. The morning and afternoon operation cohorts had no differences in the rates of major adverse cardiac events after both procedures. Similarly, no daytime-dependent variation in the rate of new-onset in-hospital atrial fibrillation, long-term all-cause mortality, or peak creatine kinase-MB levels could be identified. CONCLUSIONS: In this large cohort study of Danish patients, who underwent either aortic valve replacement and/or coronary artery bypass grafting, the study identified no clinically relevant biorhythm for myocardial ischemia-reperfusion tolerance.

Clinical Application of Nasal Filters: An Observational Study on the Usability of Nasal Filters in Managing Seasonal Allergic Rhinitis.

BACKGROUND: A recent park study found a substantial preventive effect of a new nasal filter for seasonal allergic rhinitis. However, the nasal filter still needs to prove that it is sufficiently convenient and comfortable for everyday use during a regular pollen season. OBJECTIVE: The objective of this study was to evaluate the usability of the nasal filter (Rhinix, Rhinix ApS, Aarhus, Denmark) in a large population. METHODS: An observational, open-label study (NCT02108379) conducted during the main grass pollen season in 2014 in Denmark included 1073 participants with seasonal allergic rhinitis, with or without asthma. Participants received the filters for a 2-week use period. Identical online questionnaires were answered after each week of use. End points included ratings on satisfaction, usage, and interest in continued use, stratified by allergy and asthma severity. RESULTS: There were 834 filter users in week 1; 634 of these continued use in week 2. After week 1, 630 (76%) expressed interest in continued use of the filters. Participants who continued use in week 2 had higher screening scores for nasal symptoms (P = .01), had more severe asthma for those with asthma (P = .04), and were more dissatisfied with their usual treatment compared with the participants who discontinued use (P = .03). CONCLUSIONS: Of 834 new users, 630 stated interest in continued use of the filters. On the basis of the findings of this large observational usability study, the nasal filters appear sufficiently convenient and comfortable to use and thus clinically relevant for symptom management for many allergy sufferers.

Preventive effect of nasal filters on allergic rhinitis: A randomized, double-blind, placebo-controlled crossover park study.

BACKGROUND: A recently reported small, out-of-season environmental exposure unit study found nasal filters to be efficacious in preventing seasonal allergic rhinitis (AR). However, nasal filters still need to show efficacy in a natural setting in a regular pollen season. OBJECTIVE: We sought to evaluate the efficacy of nasal filters (Rhinix; Rhinix ApS, Aarhus, Denmark) for the prevention of symptoms related to seasonal AR. METHODS: The trial was a single-center, randomized (1:1), double-blind, placebo-controlled crossover clinical trial (NCT02108574) conducted over 2 days in the main grass pollen season in June 2014 in Aarhus, Denmark, on 65 adults with proven grass allergy. A total nasal symptom score (TNSS) consisting of blocked nose, runny nose, nasal itching, and sneezing was used to evaluate symptoms. The difference in daily∑ TNSS (the sum of 13 ratings) was the primary outcome measure. The difference in maximum TNSS (highest score, 13 ratings) was also evaluated. RESULTS: The nasal filters significantly reduced daily∑ TNSSs (P = .03) and maximum TNSSs (P = .03) compared with placebo. Median relative reductions were 40% for daily∑ TNSSs (P = .02), 43% for maximum TNSSs (P = .004), 83% for daily∑ sneezing (P = .001), 75% for daily∑ watery eyes (P = .02), and 53% for daily∑ runny nose (P = .005) when compared with placebo. The nasal filters were well tolerated, and no serious adverse events were recorded. CONCLUSION: Statistically significant and clinically relevant reductions were achieved for the primary outcome measure of daily∑ TNSS, for maximum TNSS and for a subset of individual symptoms. The results support the preventive role of nasal filters for managing seasonal AR.