Does the Internet Provide Quality Information on Metoidioplasty? Using the Modified Ensuring Quality Information for Patients Tool to Evaluate Artificial Intelligence-Generated and Online Information on Metoidioplasty.

BACKGROUND: Public interest in gender affirmation surgery has surged over the last decade. This spike in interest, combined with extensive free online medical knowledge, has led many to the Internet for more information on this complicated procedure. This study aimed to evaluate the quality of online information on metoidioplasty. METHODS: Google Trends in searches on "metoidioplasty" from 2004 to present were assessed. "metoidioplasty" was searched on three popular search engines (Google, Yahoo, and Bing), and the first 100 websites from each search were extracted for inclusion (Fig. 1). Exclusion criteria included duplicates, websites requiring fees, photo libraries, and irrelevant websites. Websites were assigned a score (out of 36) using the modified Ensuring Quality Information for Patients (EQIP) instrument, which grades patient materials based on content (18), identification (6), and structure (12). ChatGPT was also queried for metoidioplasty-related information and responses were analyzed using EQIP. RESULTS: Google Trends analysis indicated relative search interest in "metoidioplasty" has more than quadrupled since 2013(Fig. 2). Of the 93 websites included, only 2 received an EQIP score greater than 27 (6%). Website scores ranged from 7 to 33, with a mean of 18.6 ± 4.8. Mean scores were highest for websites made by health departments (22.3) and lowest for those made by encyclopedias and academic institutions (16.0). Websites with the highest frequency were research articles, web portals, hospital websites, and private practice sites, which averaged scores of 18.2, 19.7, 19.0, and 17.8, respectively. Health department sites averaged the highest content points (11.25), and academic institutions averaged the lowest (5.5). The average content point across all websites was 7.9 of 18. ChatGPT scored a total score of 29: 17 content, 2 identification, and 10 structures. The artificial intelligence chatbot scored the second highest score among all included online resources. CONCLUSIONS: Despite the continued use of search engines, the quality of online information on metoidioplasty remains exceptionally poor across most website developers. This study demonstrates the need to improve these resources, especially as interest in gender-affirming surgery continues to grow. ChatGPT and other artificial intelligence chatbots may be efficient and reliable alternatives for those seeking to understand complex medical information.

Rise of Acellular Dermal Matrix: Cost Consciousness, Industry Payment, and Publication Productivity.

BACKGROUND: Despite high cost and lack of FDA approval for breast surgery, acellular dermal matrix (ADM) has become commonplace in reconstructive surgery and has been the focus of more than 500 plastic surgery publications since its wide adoption. We hypothesized that ADM-related academic output would correlate with public interest and industry funding. STUDY DESIGN: All PubMed-indexed studies focusing on ADM in 11 plastic surgery journals were included (n = 535). Data on industry funding to the 17 most productive authors were extracted from the Open Payments Database. Google Trends in "breast surgery cost" and related terms were queried. Relationships among publication quantity, author industry funding, and public interest were analyzed by Pearson's correlation and linear regression. RESULTS: The most published authors produced 8 qualifying publications on average (range 5 to 17), with 80% focused on breast surgery. These individuals grossed a total of $19 million industry dollars overall with $17 million (89%) in nonconsulting compensation from ADM-producing companies (NC-ADM). Individual total compensation and NC-ADM compensation, by quartile, were $194,000/$320,000/$1.25 million and $17,000/$210,000/$1.1 million, respectively. These variables showed strong correlation with individual publication rate with a linear regression coefficient of $110K in NC-ADM per publication (p < 0.01). Authors disclosed funding in a mean ± SD of 65 ± 26% of their work with strong correlation between disclosure and NC-ADM (p < 0.01). Google "breast surgery cost" search volume has grown rapidly in significant correlation with ADM publications (p = 0.02). CONCLUSIONS: This study demonstrates significant correlation between ADM-related publication, industry funding, funding disclosure, and public interest. Education in the potential for such relationships and the importance of objectivity in plastic surgery warrants discussion.