Ho, Olivia A.

Surgeons are at high risk of developing long-term Work-Related Musculoskeletal Disorders (WMSDs) due to awkward sustained postures. Passive spine-supporting exoskeletons are a potential intervention to improve posture and reduce fatigue. The NekSpine ® was evaluated by 21 surgeons (15 male) across two hospital sites within a quaternary academic hospital system. Each surgeon performed at least two comparable procedures, one with the exoskeleton and one without. Surgeons completed pre- and postoperative surveys assessing NASA-TLX workload, usability, body-part discomfort, overall fatigue, and workflow disruptions. Eighty-two cases were evaluated (43 exoskeleton cases). Compared with baseline cases, surgeons reported reduced neck and upper back discomfort and lower overall fatigue when using the exoskeleton. The NekSpine ® exoskeleton may reduce spinal discomfort and fatigue during surgery, supporting its potential as an ergonomic intervention for surgeons.

Introduction The Care Hotel is a virtual medicine hybrid model of care implemented at the Mayo Clinic to increase use of enhanced recovery protocols, address hospital capacity and reduce medical costs. This voluntary accommodation offers patients a comfortable environment to receive nursing care postoperatively with in-person daytime monitoring and 24-hour virtual telemonitoring in a hotel setting. This study aims to evaluate postoperative outcomes in patients admitted to the Care Hotel after mastectomy with immediate tissue expander reconstruction compared to standard overnight admission. Methods A retrospective review of the electronic medical record was conducted for patients who underwent mastectomy with immediate tissue expander reconstruction prior to (1/2019–1/2020) and after (7/2021–7/2023) the implementation of the Care Hotel. Postoperative outcomes, including 48-hour ED visit, 48-hour readmission, and 30-day infection, hematoma, seroma, admission, and return to operating room were collected. Results There were 61 patients with 108 tissue expander reconstructions in the hospital admission group and 122 patients with 212 tissue expander reconstructions in the Care Hotel group. The average length of hospital stay was 1.2 days while the average Care Hotel stay was 1.4 days. There were four 48-hour ED visits with 1 admission for 12 hours of observation in the Care Hotel group. There was no statistically significant difference in 30-day infection, seroma, hematoma, readmission, need for IR drain procedure or return to operating room between the groups. Conclusions This investigation demonstrates the safety of postoperative virtual telemonitoring and should encourage providers to utilize virtual visit technology in the immediate postoperative time-period.

Abstract Goals/Purpose To address the complex problems arising from contemporary aesthetic procedures, specifically focusing on the occurrence of antibiotic-resistant non-tuberculosis mycobacterium (NTM) infections following autologous fat grafting and the development of full-thickness burns due to the use of Renuvion for skin tightening. The study underscores the critical need for stringent aseptic techniques, updated sterilization practices, and thorough understanding of new cosmetic technologies to prevent severe complications. Methods/Technique A 45-year-old otherwise healthy female underwent autologous fat grafting to the face and neck tightening with Renuvion in 2023 at an outside aesthetic clinic to address premature facial and cervical ageing. Post-operatively, her course was complicated by multiple midface abscesses from fat grafting and third-degree burns to the neck from Renuvion. She initially sought treatment at a local community hospital, where aspiration was performed which revealed a Mycobacterium fortuitum infection. Despite debridement and antibiotics for the abscesses and xenograft application for her cervical burns, her symptoms persisted, prompting presentation to our tertiary care center. On arrival to our facility, the patient exhibited multiple dermal and subcutaneous abscesses in the premaxillary soft tissues. Broad-spectrum antibiotics were initiated, and she underwent surgical incision and drainage. Cultures identified a multiple resistant Mycobacterium fortuitum complex. Following infectious disease consultation, she commenced a 10-month course of IV antibiotic therapy involving three drugs. Despite this, in 2024, she experienced on-going facial drainage, necessitating further debridement and antibiotic therapy. Results/Complications The patient’s condition was complicated by the discovery of a multiply resistant Mycobacterium fortuitum complex. The infection's resistance to standard antibiotics required an extended and rigorous 10-month treatment regimen involving a combination of macrolide, aminoglycoside, and other antibiotics as well as surgical debridement. Despite aggressive treatment, persistent facial drainage necessitated further surgical intervention. The chronic and recurring nature of the infection significantly increased morbidity and highlighted the need for a multidisciplinary approach to optimize patient outcomes. Additionally, the use of Renuvion led to full-thickness burns, a complication not previously reported in the literature per extensive review. Conclusion This case report and literature review highlights the increasing complexities and potential complications associated with modern aesthetic procedures, specifically antibiotic resistant NTM infections following autologous fat grafting and full thickness burns in the setting of liposuction and Renuvion skin tightening. It underscores the necessity for meticulous aseptic technique, thorough knowledge of equipment, and adherence to modern sterilization protocols to mitigate the risk of infection. Additionally, the development of thermal injuries with Renuvion emphasizes the need for increased reporting to enable proper training and caution with its application. This case report is limited by the inability to definitively identify the source or etiology of the mycobacterium infection and the specific method that led to the full thickness burn, which highlights the need for further investigation and reporting in these areas. This case report is intended to stimulate discussion, investing, and reporting to ultimately improve safety standards in cosmetic surgery and stresses the importance for patients to seek out board-certified and qualified plastic surgeons, as their expertise and adherence to the highest safety standards can significantly reduce the risk of complications such as these.

Accurate identification of surgical instruments is crucial for efficient workflows and patient safety within the operating room, particularly in preventing complications such as retained surgical instruments. Artificial Intelligence (AI) models have shown the potential to automate this process. This study evaluates the accuracy of publicly available Large Language Models (LLMs)—ChatGPT-4, ChatGPT-4o, and Gemini—and a specialized commercial mobile application, Surgical-Instrument Directory (SID 2.0), in identifying surgical instruments from images. The study utilized a dataset of 92 high-resolution images of 25 surgical instruments (retractors, forceps, scissors, and trocars) photographed from multiple angles. Model performance was evaluated using accuracy, weighted precision, recall, and F1 score. ChatGPT-4o exhibited the highest accuracy (89.1%) in categorizing instruments (e.g., scissors, forceps). SID 2.0 (77.2%) and ChatGPT-4 (76.1%) achieved comparable accuracy, while Gemini (44.6%) demonstrated lower accuracy in this task. For precise subtype identification of instrument names (like “Mayo scissors” or “Kelly forceps”), all models had low accuracy, with SID 2.0 having an accuracy of 39.1%, followed by ChatGPT-4o (33.69%). Subgroup analysis revealed ChatGPT-4 and 4o recognized trocars in all instances. Similarly, Gemini identified surgical scissors in all instances. In conclusion, publicly available LLMs can reliably identify surgical instruments at the category level, with ChatGPT-4o demonstrating an overall edge. However, precise subtype identification remains a challenge for all models. These findings highlight the potential of AI-driven solutions to enhance surgical-instrument management and underscore the need for further refinements to improve accuracy and support patient safety.

Background: Effective pain management is crucial for both comfort and outcomes, yet predicting and managing this pain is difficult. This study aimed to analyze postoperative pain in patients undergoing hand surgery at the Mayo Clinic Florida, examining how patient characteristics and anxiety affect pain outcomes. Methods: We conducted a single-arm clinical trial at Mayo Clinic Florida, recruiting patients undergoing hand surgery. Preoperative pain and anxiety were assessed using the Pain Catastrophizing Scale (PCS) and State-Trait Anxiety Inventory (STAI). Postoperatively, patients used an iPhone app to record pain levels and medication use every four hours. Devices were collected three days after surgery. We analyzed the relationship between demographics, PCS, STAI scores, and pain levels using linear and logistic regression models. All statistical tests were two-sided with significance set at p < 0.05, analyzed with R4.2.2. Results: Data were collected from 62 patients (62.9% women, 37.1% men) undergoing hand surgery. Participants were mainly White (90.3%), with 50% being in the middle-aged adult group. Most had low anxiety levels (80.6% STAI-S, 82.3% STAI-T) and low catastrophizing (61.3% PCS). Postoperative pain was low, with median scores between 1.0 and 2.0 over three days. Demographics, anxiety, and catastrophizing were not significant predictors of pain levels. Logistic regression showed time as a significant factor, with pain levels peaking on Day 3. Conclusions: Postoperative pain after hand surgery was generally low, with time being a significant predictor of increased pain. Demographic factors, anxiety, and catastrophizing did not significantly affect pain levels. Pain management should emphasize time-sensitive interventions and ongoing monitoring.

Abstract Objective Peri-implant enhancement can be seen on contrast-enhanced breast MRI, but its association with malignancy has not been described, leading to considerable variability in assessment and recommendations by radiologists. This study evaluated imaging features, management, and outcomes of implant-related enhancement. Methods This multisite IRB-approved retrospective review queried all breast MRI reports for keywords describing peri-implant enhancement, fluid, and/or masses (plus synonymous descriptions) and implant-associated malignancies, with subsequent imaging and chart review. Peri-implant enhancement and implant features were characterized. Assessments and outcomes were evaluated via clinical and imaging follow-up, aspiration/biopsy, and/or capsulectomy to evaluate for association of peri-implant enhancement with implant-related malignancy. Results A total of 100 patients had peri-implant enhancement. Uniform thin peripheral enhancement was most common (79/100, 79%). Capsulectomy was performed in 31/100 (31%), with benign capsular fibrosis/inflammation discovered in 26/31 (83.9%). Breast implant–associated anaplastic large cell lymphoma was present in 2/100 (2%), both with textured implants, while 98/100 (98%) had no implant-related malignancy. MRI recommendations varied: resume routine imaging (26/100, 26%), clinical management (18/100, 18%), follow-up MRI (17/100, 17%), MRI-directed US (17/100, 17%), aspiration/biopsy (11/100, 11%), and surgical consultation (10/100, 10%). Conclusion Peri-implant enhancement is a nonspecific imaging finding with a low malignant association, especially when seen in isolation (no associated effusion, mass, or adenopathy). Implant surface texture should be considered in management recommendations; diagnostic capsulectomy is not recommended in patients with smooth implants. Additional studies are encouraged to validate nonoperative management recommendations.

Introduction: Melanoma is a deadly type of skin cancer that develops from melanocytes and can manifest on the skin or other regions of the body. Its incidence is increasing rapidly, with approximately 100,000 diagnoses and 7000 deaths per year in the US alone. We conducted a cross-sectional study with the aim of determining an association between the cost of care for invasive melanoma and the specialty involved in the treatment to adequately guide future treatment. Methods: We analyzed data from 3817 patients (2013–2018) using the Florida inpatient/outpatient dataset, CMS cost reports, and the National Plan and Provider Enumeration System. Covariates included age, sex, race/ethnicity, insurance type, region, county rurality, the number of procedures, the comorbidity index, obesity, metastatic cancer presence, hospital size, and physician volume. Multivariable mixed linear regression was used to analyze the data, and the cost was adjusted to the 2019 USD. Results: Dermatology had the largest decrease in the overall and outpatient costs compared to general surgery, followed by plastic surgery. The inpatient costs for dermatology and plastic surgery were lower than those for general surgery, but not significantly so. Conclusions: The costs associated with surgical procedures may vary depending on the specialty of the physician treating the patient. Dermatology was associated with lower treatment costs for invasive melanoma compared to other specialties, indicating that physician specialty influences the cost of care.