Physician vs. AI-generated messages in urology: evaluation of accuracy, completeness, and preference by patients and physicians.

Purpose: To evaluate the accuracy, comprehensiveness, empathetic tone, and patient preference for AI and urologist responses to patient messages concerning common BPH questions across phases of care.

Methods: Cross-sectional study evaluating responses to 20 BPH-related questions generated by 2 AI chatbots and 4 urologists in a simulated clinical messaging environment without direct patient interaction. Accuracy, completeness, and empathetic tone of responses assessed by experts using Likert scales, and preferences and perceptions of authorship (chatbot vs.

Effects of ketorolac on complications and postoperative pancreatic fistula in patients undergoing pancreatectomy.

Background: There are conflicting data on the risk of postoperative pancreatic fistula (POPF) associated with postoperative NSAID use. The primary objective of this multi-center retrospective study was to assess the relationship between ketorolac use and POPF. The secondary objective was to assess for effect of ketorolac use on overall complication rate.

Peritoneal Lavage Cytology Following Neoadjuvant Chemotherapy for Gastric Adenocarcinoma: Low Yield in Detecting Peritoneal Metastases.

Background: Peritoneal lavage cytology (PLC) can detect advanced disease in gastric adenocarcinoma (GC); however, routine practice remains controversial. Furthermore, the effect of neoadjuvant chemotherapy (NAC) on cytological detection of carcinomatosis is unknown.

Methods: Using a 2012-2020 prospective database, we retrospectively reviewed patients with GC who underwent NAC followed by a staging laparoscopic peritoneal lavage with or without biopsy of suspicious peritoneal nodules.

Safety and Efficacy of an Enhanced Recovery Protocol After Hepatic Resection.

Enhanced recovery protocols (ERPs) have shown to improve outcomes in multiple specialties and were recently applied to hepatic resections. The objective of this study was to determine the safety and efficacy of ERP in hepatic resection. Between 2013-2017, 208 patients underwent hepatectomy.

Pancreatectomy in Stage I pancreas cancer: national underutilization of surgery persists.

Background: Pancreatectomy in early pancreas adenocarcinoma has been historically underutilized. This retrospective study examines recent trends in the use of pancreatectomy in clinical Stage I (T1-2N0M0) pancreas cancer.

Methods: Using the 2004-2014 National Cancer Database, patients with clinical Stage I pancreas cancer were identified.

Resectable Distal Pancreas Cancer: Time to Reconsider the Role of Upfront Surgery.

Background: Neoadjuvant chemotherapy (NAC) is increasingly utilized to optimize survival in proximal pancreatic adenocarcinoma. However, few studies have explored the impact of NAC in distal pancreas cancer.

Methods: Patients with resectable pancreatic adenocarcinoma of the body or tail treated with either upfront pancreatectomy or NAC followed by surgery were identified in the 2006-2014 National Cancer Database.

Pasireotide is not effective in reducing the development of postoperative pancreatic fistula.

Background: In a single trial, perioperative pasireotide demonstrated reduction in postoperative pancreatic fistula (POPF) following pancreatectomy, yet recent studies question the efficacy of this drug.

Methods: All patients who underwent pancreatic resection between January 2014 and August 2017 at a single institution were prospectively followed. Starting in February 2016, pasireotide was administered to all pancreatectomies.

Early Contact after Hospital Discharge Does Not Prevent Readmission in Patients Undergoing Pancreaticoduodenectomy.

Studies suggest that early contact (EC) after hospital discharge may help reduce hospital readmissions among medical patients. The objective of this study is to determine if EC after hospital discharge in patients undergoing a pancreaticoduodenectomy (PD) can reduce readmission. We performed a retrospective study of 35 patients who underwent PD over 18 months.

Using Literature Review and Structured Hybrid Electronic/ Manual Mortality Review to Identify System-Level Improvement Opportunities to Reduce Colorectal Cancer Mortality.

Background: Despite colorectal cancer (CRC) screening and survival rates exceeding national averages in the United States, Kaiser Permanente Southern California (KPSC) aimed to identify system-level improvement opportunities to further reduce mortality from CRC.

Methods: To examine modifiable factors contributing to CRC mortality, a structured hybrid electronic/manual mor- tality review was used to examine 50 randomly selected cases among 524 individuals aged 25-75 years diagnosed with stage II, III, or IV CRC after July 2008 who subsequently died. Physicians conducted chart reviews using a standardized data extraction tool based on evidence-based best practices.

Short-term Outcomes of Laparoscopic versus Open Formal Anatomical Hepatectomy: A Case Matched Control Study.

Variability in extent and complexity of hepatic resection complicates prior laparoscopic (LH) and open (OH) hepatectomy comparisons. This study compares the 30-day outcomes of formal anatomical LH and OH by matching patients by location and extent of resection. A retrospective review was conducted for patients undergoing formal anatomical hepatectomies from January 2008 to November 2014.

Comparison of short-term outcomes in laparoscopic vs open hepatectomy.

Importance: Despite the increasing role of laparoscopy in partial hepatic resection, its short-term benefit compared with traditional open surgery remains unclear.

Objective: To compare short-term (30-day) outcomes between laparoscopic (LH) and open (OH) partial hepatectomies.

Design, Setting, And Participants: Retrospective matched case-control study from April 1, 2004, to March 31, 2013, in a tertiary hepatobiliary referral center.

Acute hemodilution is safe in patients with comorbid illness undergoing partial hepatectomy.

Despite increased use of acute hemodilution (AH) to reduce perioperative blood transfusion in patients undergoing partial hepatectomy, there is a lack of data on safety in those with comorbid medical illness. We performed a retrospective review of 96 patients undergoing partial hepatectomy with AH and low central venous pressure (CVP) anesthesia. The cohort was compared with 63 patients undergoing partial hepatectomy using standard anesthetic management (SA) and low CVP anesthesia.

Predictors of early postoperative outcomes in 375 consecutive hepatectomies: a single-institution experience.

Although the safety of hepatic resection has improved, it is still a highly morbid procedure. A retrospective cohort of 375 patients undergoing hepatectomy (2004 to 2012) was done. All procedures were performed by a single surgeon at a tertiary center.

D2 lymph node dissection improves staging in patients with gastric adenocarcinoma.

Debate continues over the recommended extent of routine lymphadenectomy for gastric cancer. Although evidence of improved locoregional control with extended dissection accumulates, understaging and stage migration continue to confound the issue. Our objective was to determine whether D2 lymph node dissection improves staging compared with D1 in patients with gastric adenocarcinoma.

An acute care surgery model improves timeliness of care and reduces hospital stay for patients with acute cholecystitis.

In October 2009, an acute care surgery (ACS) model was implemented to facilitate urgent surgical consults. This study examines the impact of ACS on the timeliness of care and length of hospitalization for patients with acute cholecystitis. A retrospective cohort study was performed of patients presenting to the emergency department (ED) with acute cholecystitis who underwent early cholecystectomy.

Early postoperative outcomes after pancreaticoduodenectomy in the elderly.

Background: Single-institution case series suggest that elderly patients do as well as younger patients after pancreaticoduodenectomy.

Objectives: To compare morbidity and mortality after pancreaticoduodenectomy in patients older than 70 years vs younger patients.

Hypothesis: Elderly patients have worse 30-day outcomes.

Axillary recurrence is low in patients with breast cancer who do not undergo completion axillary lymph node dissection for micrometastases in sentinel lymph nodes.

Completion axillary lymph node dissection (CLND) is presently the standard of care after a positive sentinel lymph node biopsy (SLNB). We hypothesize that the incidence of axillary recurrence in patients who do not undergo CLND for micrometastases is low, and CLND is not necessary for locoregional control. We performed a retrospective chart review of patients with invasive breast carcinoma and micrometastases detected on SLNB.

Completion axillary lymph node dissection not required for regional control in patients with breast cancer who have micrometastases in a sentinel node.

Hypothesis: Completion axillary lymph node dissection (ALND) is not required for regional control in patients with metastases in the sentinel lymph node (SLN).

Design: Prospective cohort study.

Setting: Urban teaching hospital.

The Surgical Care Improvement project (SCIP) initiative to reduce infection in elective colorectal surgery: which performance measures affect outcome?

One component of the Surgical Care Improvement Project (SCIP) is the prevention of surgical site infections (SSIs) by: 1) timing the administration of prophylactic antibiotics (PAs) within 1 hour of incision; 2) using approved PA regimens; and 3) discontinuing PA within 24 hours. We sought to evaluate institutional compliance with SCIP recommendations in patients undergoing elective colorectal surgery and determine whether they affected the incidence of SSI. One hundred four elective colorectal cases were reviewed.

Changing paradigms in breast cancer management: introducing molecular genetics into the treatment algorithm.

Advances in molecular genetics aimed at individualizing breast cancer treatment have been validated. We examined the use of gene assays predictive of distant recurrence in breast cancer and their impact on adjuvant treatment. A retrospective chart review of 58 T1/T2, node-negative, estrogen-receptor positive breast cancer patients that underwent Oncotype DX gene assay testing between January and December 2006 was performed.

Lymphatic mapping in patients with breast cancer and previous augmentation mammoplasty.

Sentinel lymph node biopsy (SLNB) is now an established method of axillary staging in patients with breast cancer. However, the augmented breast poses an interesting challenge to this procedure. We hypothesized that SLNB is feasible in patients with augmented breasts who subsequently develop breast cancer.

Accelerated partial breast irradiation using the MammoSite device: early technical experience and short-term clinical follow-up.

The MammoSite brachytherapy system is a novel form of intracavitary accelerated partial breast irradiation (APBI) that allows treatment over a 5- to 7-day course after breast conserving surgery (BCS). Fifty-one patients with invasive breast carcinoma underwent BCS and APBI using the MammoSite device, with 30 (59%) patients having drain placement in the lumpectomy cavity. Main outcome measures included time to initiating APBI, cosmesis using the Harvard Scale, and local and distant tumor recurrence with short-term follow-up.