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  1. Artikel ; Online: Hepatic Artery Infusion Pump Chemotherapy for Colorectal Liver Metastases: What Does the Colorectal Surgeon Need to Know?

    Zhang, Chi / Thiels, Cornelius A

    Diseases of the colon and rectum

    2023  Band 67, Heft 2, Seite(n) 200–204

    Mesh-Begriff(e) Humans ; Hepatic Artery ; Infusion Pumps, Implantable ; Colorectal Neoplasms/drug therapy ; Liver Neoplasms/drug therapy ; Liver Neoplasms/surgery ; Surgeons ; Antineoplastic Combined Chemotherapy Protocols ; Fluorouracil/therapeutic use ; Infusions, Intra-Arterial
    Chemische Substanzen Fluorouracil (U3P01618RT)
    Sprache Englisch
    Erscheinungsdatum 2023-11-16
    Erscheinungsland United States
    Dokumenttyp Journal Article
    ZDB-ID 212581-x
    ISSN 1530-0358 ; 0012-3706
    ISSN (online) 1530-0358
    ISSN 0012-3706
    DOI 10.1097/DCR.0000000000003160
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  2. Artikel ; Online: Academic Surgery in the Era of Large Language Models: A Review.

    Rengers, Timothy A / Thiels, Cornelius A / Salehinejad, Hojjat

    JAMA surgery

    2024  Band 159, Heft 4, Seite(n) 445–450

    Abstract: Importance: This review aims to assess the benefits and risks of implementing large language model (LLM) solutions in an academic surgical setting.: Observations: The integration of LLMs and artificial intelligence (AI) into surgical practice has ... ...

    Abstract Importance: This review aims to assess the benefits and risks of implementing large language model (LLM) solutions in an academic surgical setting.
    Observations: The integration of LLMs and artificial intelligence (AI) into surgical practice has generated international attention with the emergence of OpenAI's ChatGPT and Google's Bard. From an administrative standpoint, LLMs have the potential to revolutionize academic practices by reducing administrative burdens and improving efficiency. LLMs have the potential to facilitate surgical research by increasing writing efficiency, building predictive models, and aiding in large dataset analysis. From a clinical standpoint, LLMs can enhance efficiency by triaging patient concerns and generating automated responses. However, challenges exist, such as the need for improved LLM generalization performance, validating content, and addressing ethical concerns. In addition, patient privacy, potential bias in training, and legal responsibility are important considerations that require attention. Research and precautionary measures are necessary to ensure safe and unbiased use of LLMs in surgery.
    Conclusions and relevance: Although limitations exist, LLMs hold promise for enhancing surgical efficiency while still prioritizing patient care. The authors recommend that the academic surgical community further investigate the potential applications of LLMs while being cautious about potential harms.
    Mesh-Begriff(e) Humans ; Artificial Intelligence ; Language ; Organizations ; Triage
    Sprache Englisch
    Erscheinungsdatum 2024-02-14
    Erscheinungsland United States
    Dokumenttyp Review ; Journal Article
    ZDB-ID 2701841-6
    ISSN 2168-6262 ; 2168-6254
    ISSN (online) 2168-6262
    ISSN 2168-6254
    DOI 10.1001/jamasurg.2023.6496
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  3. Artikel ; Online: Persistent challenges in pancreatic surgery: Postoperative pancreatic fistula prediction in the machine learning era-Response to: Machine learning versus logistic regression for the prediction of complications after pancreaticoduodenectomy.

    Muaddi, Hala / Salehinejad, Hojjat / Thiels, Cornelius A

    Surgery

    2023  Band 175, Heft 5, Seite(n) 1466–1467

    Mesh-Begriff(e) Humans ; Pancreaticoduodenectomy/adverse effects ; Pancreatic Fistula/diagnosis ; Pancreatic Fistula/etiology ; Logistic Models ; Pancreas/surgery ; Machine Learning ; Postoperative Complications/diagnosis ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Risk Factors ; Retrospective Studies
    Sprache Englisch
    Erscheinungsdatum 2023-11-30
    Erscheinungsland United States
    Dokumenttyp Letter
    ZDB-ID 202467-6
    ISSN 1532-7361 ; 0039-6060
    ISSN (online) 1532-7361
    ISSN 0039-6060
    DOI 10.1016/j.surg.2023.10.036
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  4. Artikel ; Online: Deep learning predicts postoperative opioids refills in a multi-institutional cohort of surgical patients.

    Salehinejad, Hojjat / Muaddi, Hala / Ubl, Dan S / Sharma, Vidit / Thiels, Cornelius A

    Surgery

    2024  

    Abstract: Background: To combat the opioid epidemic, several strategies were implemented to limit the unnecessary prescription of opioids in the postoperative period. However, this leaves a subset of patients who genuinely require additional opioids with ... ...

    Abstract Background: To combat the opioid epidemic, several strategies were implemented to limit the unnecessary prescription of opioids in the postoperative period. However, this leaves a subset of patients who genuinely require additional opioids with inadequate pain control. Deep learning models are powerful tools with great potential of optimizing health care delivery through a patient-centered focus. We sought to investigate whether deep learning models can be used to predict patients who would require additional opioid prescription refills in the postoperative period after elective surgery.
    Methods: This is a retrospective study of patients who received elective surgical intervention at the Mayo Clinic. Adult English-speaking patients ≥18 years old, who underwent an elective surgical procedure between 2013 and 2019, were eligible for inclusion. Machine learning models, including deep learning, random forest, and eXtreme Gradient Boosting, were designed to predict patients who require opioid refills after discharge from hospital.
    Results: A total of 9,731 patients with mean age of 62.1 years (51.4% female) were included in the study. Deep learning and random forest models predicted patients who required opioid refills with high accuracy, 0.79 ± 0.07 and 0.78 ± 0.08, respectively. Procedure performed, highest pain score recorded during hospitalization, and total oral morphine milligram equivalents prescribed at discharge were the top 3 predictors for requiring opioid refills after discharge.
    Conclusion: Deep learning models can be used to predict patients who require postoperative opioid prescription refills with high accuracy. Other machine learning models, such as random forest, can perform equal to deep learning, increasing the applicability of machine learning for combating the opioid epidemic.
    Sprache Englisch
    Erscheinungsdatum 2024-05-24
    Erscheinungsland United States
    Dokumenttyp Journal Article
    ZDB-ID 202467-6
    ISSN 1532-7361 ; 0039-6060
    ISSN (online) 1532-7361
    ISSN 0039-6060
    DOI 10.1016/j.surg.2024.03.054
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  5. Artikel ; Online: Cytoreduction and Hyperthermic Intraperitoneal Paclitaxel and Cisplatin for Gastric Cancer with Peritoneal Metastasis.

    Buckarma, EeeLN / Thiels, Cornelius A / Jin, Zhaohui / Grotz, Travis E

    Annals of surgical oncology

    2023  Band 31, Heft 1, Seite(n) 622–629

    Abstract: Background: Peritoneal metastasis (PM) is the most common site of dissemination of gastric cancer (GC) and is associated with a poor prognosis. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for GC with PM remains ... ...

    Abstract Background: Peritoneal metastasis (PM) is the most common site of dissemination of gastric cancer (GC) and is associated with a poor prognosis. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for GC with PM remains controversial due to modest survival and significant morbidity.
    Methods: We conducted a retrospective analysis of patients with GC and PM treated with CRS and HIPEC with cisplatin and paclitaxel for 90 min from June 2019 to December 2022.
    Results: Twenty-two patients were included and received a median of 7 (interquartile range [IQR] 4-8) cycles of neoadjuvant systemic therapy. Seventeen patients (77%) underwent a single neoadjuvant laparoscopic HIPEC, and six (27%) patients received chemoradiation. The median Peritoneal Carcinomatosis Index at the time of CRS was 1 (IQR 0-4), and 21 patients (95%) underwent complete cytoreduction (CC-0). An R0 resection was achieved in 20 (91%) patients, and the median length of stay was 5.5 (IQR 4-7.5) days. There were six (27%) 90-day major complications (Clavien-Dindo grade ≥ 3), one (4%) Common Terminology Classification for Adverse Events (CTCAE) grade 4 cytopenia, and one (4%) acute kidney injury. The rate of anastomotic leak (all grades) was 14%, the 30-day readmission rate was 18%, and the 90-day mortality rate was 0%. At a median follow-up of 24 months, the median progression-free survival (PFS) and overall survival (OS) were not reached. The 1-, 2-, and 3-year PFS rates were 65%, 56%, and 40%, respectively, and the 1-, 2-, and 3-year OS rates were 96%, 78%, and 55%, respectively.
    Conclusions: CRS and HIPEC with paclitaxel and cisplatin is well tolerated and is associated with favorable oncologic and perioperative outcomes.
    Mesh-Begriff(e) Humans ; Cisplatin ; Stomach Neoplasms/pathology ; Combined Modality Therapy ; Cytoreduction Surgical Procedures ; Peritoneal Neoplasms/secondary ; Paclitaxel ; Retrospective Studies ; Hyperthermia, Induced ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Survival Rate
    Chemische Substanzen Cisplatin (Q20Q21Q62J) ; Paclitaxel (P88XT4IS4D)
    Sprache Englisch
    Erscheinungsdatum 2023-10-26
    Erscheinungsland United States
    Dokumenttyp Journal Article
    ZDB-ID 1200469-8
    ISSN 1534-4681 ; 1068-9265
    ISSN (online) 1534-4681
    ISSN 1068-9265
    DOI 10.1245/s10434-023-14379-2
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  6. Artikel ; Online: Gastrointestinal Glomus Tumors: A Single Institution, 20-Year Retrospective Study.

    Zironda, Andrea / Grotz, Travis E / Folpe, Andrew L / Thiels, Cornelius A

    The Journal of surgical research

    2022  Band 283, Seite(n) 982–991

    Abstract: Introduction: Glomus tumors are rare mesenchymal neoplasms composed of cells resembling those of the thermoregulatory glomus body, typically occurring in the skin and superficial soft tissues. Rarely do they occur in the gastrointestinal tract, in ... ...

    Abstract Introduction: Glomus tumors are rare mesenchymal neoplasms composed of cells resembling those of the thermoregulatory glomus body, typically occurring in the skin and superficial soft tissues. Rarely do they occur in the gastrointestinal tract, in particular the stomach, where they have been the subject of case reports and small series. We present our institutional experience with gastrointestinal glomus tumors.
    Methods: A retrospective review of all gastrointestinal glomus tumors was conducted across all three Mayo Clinic sites in Minnesota, Arizona, and Florida from 2001 to 2021. Patient characteristics, pathologic findings, imaging features, operative reports, and clinical outcomes were abstracted. Descriptive statistics were utilized to report outcomes.
    Results: Nine patients with glomus tumors were identified (five men and four women). The median age was 53 [interquartile range (IQR), 44-69] y. Four patients presented with abdominal discomfort, three had anemia or bleeding, and two tumors were incidentally diagnosed. Computed tomography scans identified masses thought to represent gastrointestinal stromal tumors or neuroendocrine tumors in all patients. The tumors were localized to the stomach in all cases, specifically in the gastric antrum. Seven patients underwent preoperative endoscopy, including five with endoscopic ultrasonography. Endoscopic biopsies were interpreted as glomus tumors (n = 3), neuroendocrine tumors (n = 2), and nondiagnostic (n = 2). All patients underwent open (n = 3) or minimally invasive (n = 6) margin-negative resection by wedge resection (n = 5) or distal gastrectomy (n = 4). No nodal metastases were identified radiographically or on pathologic examination. The median tumor size was 2.5 [IQR 1.3-3.4] cm. All tumors showed at least in part typical glomus tumor morphology and smooth muscle actin expression. Aberrant synaptophysin expression was present in the two tumors initially classified as NET. Using the current WHO criteria, tumors were classified as histologically malignant (n = 1) and of "uncertain malignant potential" (n = 8). At a median follow-up of 15 [IQR 1-56] mo, all patients were asymptomatic and without recurrence. Two patients died of unrelated causes. No patients received adjuvant therapies.
    Conclusions: Our 20-year, single institution, 3-site experience with resected gastrointestinal glomus tumors suggests the rarity, predisposition to involve the gastric antrum, and potentially an indolent clinical behavior of many of these tumors. Long-term follow-up is warranted as some previously reported gastric glomus tumors have metastasized, including cases lacking morphologic evidence of malignancy. Surgical resection, with minimally invasive wedge resection alone, is likely sufficient for the management of most gastric glomus tumors.
    Mesh-Begriff(e) Female ; Humans ; Male ; Middle Aged ; Gastrointestinal Neoplasms/diagnosis ; Gastrointestinal Neoplasms/surgery ; Gastrointestinal Stromal Tumors/diagnosis ; Gastrointestinal Stromal Tumors/surgery ; Glomus Tumor/diagnosis ; Glomus Tumor/surgery ; Glomus Tumor/pathology ; Neuroendocrine Tumors ; Retrospective Studies ; Stomach Neoplasms/diagnosis ; Stomach Neoplasms/surgery ; Adult ; Aged
    Sprache Englisch
    Erscheinungsdatum 2022-12-10
    Erscheinungsland United States
    Dokumenttyp Journal Article
    ZDB-ID 80170-7
    ISSN 1095-8673 ; 0022-4804
    ISSN (online) 1095-8673
    ISSN 0022-4804
    DOI 10.1016/j.jss.2022.10.070
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  7. Artikel ; Online: Supply and demand of hepatopancreatobiliary surgeons in the United States.

    Rengers, Timothy / Ubl, Daniel / Habermann, Elizabeth / Cleary, Sean P / Thiels, Cornelius A / Warner, Susanne G

    HPB : the official journal of the International Hepato Pancreato Biliary Association

    2023  Band 26, Heft 2, Seite(n) 299–309

    Abstract: Background: Hepatopancreatobiliary (HPB) surgery requires specialized training and adequate case volumes to maintain procedural proficiency and optimal outcomes. Studies of individual HPB surgeon supply related to annual HPB case demand are sparse. This ...

    Abstract Background: Hepatopancreatobiliary (HPB) surgery requires specialized training and adequate case volumes to maintain procedural proficiency and optimal outcomes. Studies of individual HPB surgeon supply related to annual HPB case demand are sparse. This study assesses the supply and demand of the HPB surgical workforce in the United States (US).
    Methods: The National Inpatient Sample (NIS) was queried from 1998-2019 to estimate the number of HPB procedures performed. To approximate the number of HPB surgeons, models based on previous HPB workforce publications were employed. We then calculated the number of HPB surgeons needed to maintain volume-outcome thresholds at current reported levels of centralization.
    Results: In 2019, approximately 37,335 patients underwent inpatient HPB procedures in the US, while an estimated 905-1191 HPB surgeons were practicing. Assuming 50% centralization and an optimal volume-outcome threshold of 24 HPB cases-per-year, only 778 HPB surgeons were needed. Without adjustment in centralization, by 2030 there will be a demand of fewer than 12 annual cases per HPB surgeon.
    Conclusion: The current supply of HPB surgeons may exceed demand in the United States. Without alteration in training pathways or improved care centralization, by 2030, there will be insufficient HPB case volume per surgeon to maintain published volume-outcome standards.
    Mesh-Begriff(e) Humans ; United States ; Digestive System Surgical Procedures/education ; Surgeons/education
    Sprache Englisch
    Erscheinungsdatum 2023-11-08
    Erscheinungsland England
    Dokumenttyp Journal Article
    ZDB-ID 2131251-5
    ISSN 1477-2574 ; 1365-182X
    ISSN (online) 1477-2574
    ISSN 1365-182X
    DOI 10.1016/j.hpb.2023.11.003
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  8. Artikel ; Online: The Acute Abdomen: A Case-based Survival Guide to What the Surgeon Wants to Know.

    Kirby, John W / Horst, Kelly K / Boyum, James H / Thiels, Cornelius A / Froemming, Adam T / Khandelwal, Ashish

    Radiographics : a review publication of the Radiological Society of North America, Inc

    2024  Band 44, Heft 5, Seite(n) e230161

    Mesh-Begriff(e) Female ; Humans ; Male ; Abdomen, Acute/diagnostic imaging ; Abdomen, Acute/surgery ; Abdomen, Acute/etiology ; Diagnosis, Differential
    Sprache Englisch
    Erscheinungsdatum 2024-04-25
    Erscheinungsland United States
    Dokumenttyp Journal Article
    ZDB-ID 603172-9
    ISSN 1527-1323 ; 0271-5333
    ISSN (online) 1527-1323
    ISSN 0271-5333
    DOI 10.1148/rg.230161
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  9. Artikel: Revolutionizing Postoperative Ileus Monitoring: Exploring GRU-D's Real-Time Capabilities and Cross-Hospital Transferability.

    Ruan, Xiaoyang / Fu, Sunyang / Jia, Heling / Mathis, Kellie L / Thiels, Cornelius A / Wilson, Patrick M / Storlie, Curtis B / Liu, Hongfang

    medRxiv : the preprint server for health sciences

    2024  

    Abstract: Background: Postoperative ileus (POI) after colorectal surgery leads to increased morbidity, costs, and hospital stays. Identifying POI risk for early intervention is important for improving surgical outcomes especially given the increasing trend ... ...

    Abstract Background: Postoperative ileus (POI) after colorectal surgery leads to increased morbidity, costs, and hospital stays. Identifying POI risk for early intervention is important for improving surgical outcomes especially given the increasing trend towards early discharge after surgery. While existing studies have assessed POI risk with regression models, the role of deep learning's remains unexplored.
    Methods: We assessed the performance and transferability (brutal force/instance/parameter transfer) of Gated Recurrent Unit with Decay (GRU-D), a longitudinal deep learning architecture, for real-time risk assessment of POI among 7,349 colorectal surgeries performed across three hospital sites operated by Mayo Clinic with two electronic health records (EHR) systems. The results were compared with atemporal models on a panel of benchmark metrics.
    Results: GRU-D exhibits robust transferability across different EHR systems and hospital sites, showing enhanced performance by integrating new measurements, even amid the extreme sparsity of real-world longitudinal data. On average, for labs, vitals, and assisted living status, 72.2%, 26.9%, and 49.3% respectively lack measurements within 24 hours after surgery. Over the follow-up period with 4-hour intervals, 98.7%, 84%, and 95.8% of data points are missing, respectively. A maximum of 5% decrease in AUROC was observed in brutal-force transfer between different EHR systems with non-overlapping surgery date frames. Multi-source instance transfer witnessed the best performance, with a maximum of 2.6% improvement in AUROC over local learning. The significant benefit, however, lies in the reduction of variance (a maximum of 86% decrease). The GRU-D model's performance mainly depends on the prediction task's difficulty, especially the case prevalence rate. Whereas the impact of training data and transfer strategy is less crucial, underscoring the challenge of effectively leveraging transfer learning for rare outcomes. While atemporal Logit models show notably superior performance at certain pre-surgical points, their performance fluctuate significantly and generally underperform GRU-D in post-surgical hours.
    Conclusion: GRU-D demonstrated robust transferability across EHR systems and hospital sites with highly sparse real-world EHR data. Further research on built-in explainability for meaningful intervention would be highly valuable for its integration into clinical practice.
    Sprache Englisch
    Erscheinungsdatum 2024-04-25
    Erscheinungsland United States
    Dokumenttyp Preprint
    DOI 10.1101/2024.04.24.24306295
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  10. Artikel ; Online: Response: "Comment on 'Wide Variation and Overprescription of Opioids After Elective Surgery' '.

    Habermann, Elizabeth B / Thiels, Cornelius A

    Annals of surgery

    2018  Band 268, Heft 6, Seite(n) e65–e66

    Mesh-Begriff(e) Analgesics, Opioid ; Elective Surgical Procedures
    Chemische Substanzen Analgesics, Opioid
    Sprache Englisch
    Erscheinungsdatum 2018-04-13
    Erscheinungsland United States
    Dokumenttyp Letter ; Comment
    ZDB-ID 340-2
    ISSN 1528-1140 ; 0003-4932
    ISSN (online) 1528-1140
    ISSN 0003-4932
    DOI 10.1097/SLA.0000000000002759
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