Non-elective paraesophageal hernia repair: surgical approaches and short-term outcomes

Sherrill, William; Rossi, Isolina R.; Genz, Michael; Matthews, Brent D.; Reinke, Caroline E.

doi:10.1007/s00464-020-07782-3

Cited by 9 publications

(6 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The mortality rate in these patients is much less than those requiring emergency surgery, but is higher compared with ELHR. In addition, these patients have more major complications and more frequent hernia recurrences 7,15,21 . None of the decompressed patients continued with WW in our model since this is not the standard approach in the United States, and data from Finland showed an in-hospital mortality rate for this approach of 16.4% 20,23 .…”

Section: Resultsmentioning

confidence: 98%

“…A critical variable is the mortality rate for ELHR. This rate has progressively decreased, and in multiple studies is now under 0.5% 6–10 . An important related factor is patient age and mortality with ELHR, but the literature is conflicted on this issue 8,11–15 .…”

Section: Resultsmentioning

confidence: 99%

“…This rate has progressively decreased, and in multiple studies is now under 0.5%. [6][7][8][9][10] An important related factor is patient age and mortality with ELHR, but the literature is conflicted on this issue. 8,[11][12][13][14][15] For our model, we used a tiered mortality rate based on age groups.…”

Section: Mortality Ratementioning

confidence: 99%

“…In addition, these patients have more major complications and more frequent hernia recurrences. 7,15,21 None of the decompressed patients continued with WW in our model since this is not the standard approach in the United States, and data from Finland showed an in-hospital mortality rate for this approach of 16.4%. 20,23 Values used for the variables related to urgent PEH repair are shown in Table 3.…”

Section: Semielective or Emergency Surgery For Acute Peh Complicationsmentioning

confidence: 99%

See 3 more Smart Citations

Elective Laparoscopic Paraesophageal Hernia Repair leads to an Increase in Life-Expectancy over Watchful Waiting in Asymptomatic Patients

DeMeester,

Bernard,

Schoppmann

et al. 2023

Annals of Surgery

View full text Add to dashboard Cite

Objective: The aim of this study was to perform an updated Markov analysis to determine the optimal management strategy for patients with an asymptomatic paraesophageal hernia (PEH): elective laparoscopic hernia repair (ELHR) versus watchful waiting (WW). Summary background data: Currently it is recommended that patients with an asymptomatic PEH not undergo repair based on a 20-year-old Markov analysis. The current recommendation might lead to preventable hospitalizations for acute PEH-related complications and compromised survival. Methods: A Markov model with updated variables was used to compare life-years (LYs) gained with ELHR versus WW in patients with a PEH. One-way sensitivity analyses evaluated the robustness of the analysis to alternative data inputs, while probabilistic sensitivity analysis quantified the level of confidence in the results in relation to the uncertainty across all model inputs. Results: At age 40-90 ELHR led to greater life expectancy than WW, particularly in women. The gain in L-Ys (2.6) was greatest in a 40-year-old woman and diminished with increasing age. Sensitivity analysis showed that alternative values resulted in modest changes in the difference in L-Ys, but ELHR remained the preferred strategy. Probabilistic analysis showed that ELHR was the preferred strategy in 100% of 10,000 simulations for age 65, 98% for age 80, 90% for age 85 and 59% of simulations in 90-year-old women. Conclusions: This updated analysis showed that ELHR leads to an increase in L-Ys over WW in healthy patients aged 40-90 years with an asymptomatic PEH. In this new paradigm all patients with a PEH, regardless of symptoms, should be referred for consideration of elective repair to maximize their life expectancy.

show abstract

Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Section: Mortality Ratementioning

confidence: 99%

Section: Semielective or Emergency Surgery For Acute Peh Complicationsmentioning

confidence: 99%

See 2 more Smart Citations

Elective Laparoscopic Paraesophageal Hernia Repair leads to an Increase in Life-Expectancy over Watchful Waiting in Asymptomatic Patients

DeMeester,

Bernard,

Schoppmann

et al. 2023

Annals of Surgery

View full text Add to dashboard Cite

show abstract

“…Once the chatbots were trained, we asked that it generate a scientific abstract based on the information provided. For each of the 10 abstracts, the chatbots were given the introduction and discussion of 3 relevant publications . Text limitations prevented us from giving the chatbots the entire article.…”

Section: Methodsmentioning

confidence: 99%

Comparison of Medical Research Abstracts Written by Surgical Trainees and Senior Surgeons or Generated by Large Language Models

Holland,

Lorenz,

Cavanagh

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceArtificial intelligence (AI) has permeated academia, especially OpenAI Chat Generative Pretrained Transformer (ChatGPT), a large language model. However, little has been reported on its use in medical research.ObjectiveTo assess a chatbot’s capability to generate and grade medical research abstracts.Design, Setting, and ParticipantsIn this cross-sectional study, ChatGPT versions 3.5 and 4.0 (referred to as chatbot 1 and chatbot 2) were coached to generate 10 abstracts by providing background literature, prompts, analyzed data for each topic, and 10 previously presented, unassociated abstracts to serve as models. The study was conducted between August 2023 and February 2024 (including data analysis).ExposureAbstract versions utilizing the same topic and data were written by a surgical trainee or a senior physician or generated by chatbot 1 and chatbot 2 for comparison. The 10 training abstracts were written by 8 surgical residents or fellows, edited by the same senior surgeon, at a high-volume hospital in the Southeastern US with an emphasis on outcomes-based research. Abstract comparison was then based on 10 abstracts written by 5 surgical trainees within the first 6 months of their research year, edited by the same senior author.Main Outcomes and MeasuresThe primary outcome measurements were the abstract grades using 10- and 20-point scales and ranks (first to fourth). Abstract versions by chatbot 1, chatbot 2, junior residents, and the senior author were compared and judged by blinded surgeon-reviewers as well as both chatbot models. Five academic attending surgeons from Denmark, the UK, and the US, with extensive experience in surgical organizations, research, and abstract evaluation served as reviewers.ResultsSurgeon-reviewers were unable to differentiate between abstract versions. Each reviewer ranked an AI-generated version first at least once. Abstracts demonstrated no difference in their median (IQR) 10-point scores (resident, 7.0 [6.0-8.0]; senior author, 7.0 [6.0-8.0]; chatbot 1, 7.0 [6.0-8.0]; chatbot 2, 7.0 [6.0-8.0]; P = .61), 20-point scores (resident, 14.0 [12.0-7.0]; senior author, 15.0 [13.0-17.0]; chatbot 1, 14.0 [12.0-16.0]; chatbot 2, 14.0 [13.0-16.0]; P = .50), or rank (resident, 3.0 [1.0-4.0]; senior author, 2.0 [1.0-4.0]; chatbot 1, 3.0 [2.0-4.0]; chatbot 2, 2.0 [1.0-3.0]; P = .14). The abstract grades given by chatbot 1 were comparable to the surgeon-reviewers’ grades. However, chatbot 2 graded more favorably than the surgeon-reviewers and chatbot 1. Median (IQR) chatbot 2-reviewer grades were higher than surgeon-reviewer grades of all 4 abstract versions (resident, 14.0 [12.0-17.0] vs 16.9 [16.0-17.5]; P = .02; senior author, 15.0 [13.0-17.0] vs 17.0 [16.5-18.0]; P = .03; chatbot 1, 14.0 [12.0-16.0] vs 17.8 [17.5-18.5]; P = .002; chatbot 2, 14.0 [13.0-16.0] vs 16.8 [14.5-18.0]; P = .04). When comparing the grades of the 2 chatbots, chatbot 2 gave higher median (IQR) grades for abstracts than chatbot 1 (resident, 14.0 [13.0-15.0] vs 16.9 [16.0-17.5]; P = .003; senior author, 13.5 [13.0-15.5] vs 17.0 [16.5-18.0]; P = .004; chatbot 1, 14.5 [13.0-15.0] vs 17.8 [17.5-18.5]; P = .003; chatbot 2, 14.0 [13.0-15.0] vs 16.8 [14.5-18.0]; P = .01).Conclusions and RelevanceIn this cross-sectional study, trained chatbots generated convincing medical abstracts, undifferentiable from resident or senior author drafts. Chatbot 1 graded abstracts similarly to surgeon-reviewers, while chatbot 2 was less stringent. These findings may assist surgeon-scientists in successfully implementing AI in medical research.

show abstract

Assessing the effects of smoking status on outcomes of elective minimally invasive paraesophageal hernia repair

Wang

et al. 2023

Surg Endosc

View full text Add to dashboard Cite

Non-elective paraesophageal hernia repair: surgical approaches and short-term outcomes

Cited by 9 publications

References 18 publications

Elective Laparoscopic Paraesophageal Hernia Repair leads to an Increase in Life-Expectancy over Watchful Waiting in Asymptomatic Patients

Elective Laparoscopic Paraesophageal Hernia Repair leads to an Increase in Life-Expectancy over Watchful Waiting in Asymptomatic Patients

Comparison of Medical Research Abstracts Written by Surgical Trainees and Senior Surgeons or Generated by Large Language Models

Assessing the effects of smoking status on outcomes of elective minimally invasive paraesophageal hernia repair

Contact Info

Product

Resources

About