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Feasibility Evaluation of Large Language Models in Anesthesia-specific Post-operative Care Instructions for Total Knee Arthroplasty
No full textObjective
Large language models (LLMs) are increasingly applied in medicine, but their role in peri-operative education is underexplored. This pilot feasibility study compared four LLMs in producing post-operative care instructions for total knee arthroplasty (TKA).
Methods
OpenAI GPT-4o, Claude 3.7 Sonnet, DeepSeek R1, and Gemini 2.0 Flash generated instructions from a standardized prompt. Outputs were scored (0 = does not meet, 1 = partially meets, 2 = fully meets) for accuracy, clarity, relevance, consistency, and readability. Accuracy was benchmarked against ERAS, ASA guidelines, and UpToDate. Readability was assessed using Flesch-Kincaid indices.
Results
Within this limited sample, Claude, GPT-4o, and DeepSeek R1 demonstrated higher observed accuracy than Gemini, with Claude and GPT-4o showing full alignment with reference standards. Clarity scores were comparable across models. All achieved high relevance and internal consistency. Readability varied, with Gemini generating less readable text and GPT-4o and DeepSeek R1 producing more accessible content.
Conclusion
LLMs can generate accurate, relevant, and consistent instructions, supporting their potential use in anesthesia education. Attention to readability and plain-language prompting may further enhance clinical utility.
Innovation
This study provides one of the first anesthesia-specific evaluations of multiple LLMs, showing feasibility and opportunities for AI-driven patient communication
Hyperkalemia and Pneumonia: A Retrospective Study on Mortality Outcomes in Southwest Missouri
Full text linkBackground: Pneumonia stands as a widely known contributor to hospitalization and mortality among adults in the United States. Meanwhile, disruptions in potassium homeostasis such as hyperkalemia may have an impact on in-patient mortality. This study seeks to examine the presence of hyperkalemia and its association with in-patient mortality among pneumonia patients.
Methods: Electronic medical records were used to perform a retrospective observational cohort study in Southwest Missouri patients admitted to the hospital with pneumonia and/or hyperkalemia. Patients were divided into three samples: patients with pneumonia and hyperkalemia (P1), pneumonia without hyperkalemia (P2), and hyperkalemia without pneumonia (P3). The goal was to determine and compare the in-patient mortality rates of these samples.
Results: Patients with both pneumonia and hyperkalemia (P1) demonstrated the highest mortality rate, ranging from 34.25% to 42.31%, significantly surpassing rates observed in patients with pneumonia without hyperkalemia (P2) or hyperkalemia without pneumonia (P3). Notably, patients with pneumonia without hyperkalemia (P2) exhibited a mortality rate comparable to patients with hyperkalemia without pneumonia (P3).
Conclusion: Our study revealed that patients admitted to the hospital with pneumonia and hyperkalemia had a statistically significant increase in mortality in comparison to patients with pneumonia or hyperkalemia independently. Recognizing this association may help identify prognosis and thus guide the management of patients admitted to the hospital with both hyperkalemia and pneumonia
Orthopedic Frailty Risk Stratification (OFRS): A Systematic Review of the Frailty Indices Predicting Adverse Outcomes in Orthopedics
Full text linkBackground: With a growing number of elderly patients requiring elective and non-elective procedures, frailty-based preoperative risk stratification is an emerging tool in orthopedic surgery to minimize adverse postoperative outcomes. This paper sought to understand the current literature regarding preoperative Orthopedic Frailty Risk Stratification (OFRS) and describe the disparate frailty indices and their capabilities for discrimination in predicting adverse postoperative outcomes.
Methods: A literature search was conducted in Pubmed, Cochrane, and Scopus for articles published during or prior to February 2024 assessing frailty following surgery for orthopedic pathologies. Qualitative variables including study characteristics and application of frailty were collected and synthesized. Quantitative meta-analysis was performed for pooled odds ratio (OR) and area under the curve (AUC) of frailty for mortality and complications. All methods were performed in accordance with PRISMA guidelines.
Results: Of the 81 included articles, over half (52%) addressed traumatic orthopedic pathologies with traumatic hip fractures being the most studied in the OFRS (25 studies). Less common categories included oncology, sports, and foot/ankle. Functional status and independence were the most common frailty domain (25, 96.2%) and component across scales (20, 76.9%), respectively. The 5-Item Modified Frailty Index (mFI-5) was the most common frailty index (28 publications). Meta-analysis demonstrated increasing frailty was an independent predictor of mortality (30-day OR: 2.89, 95% CI: 2.00-4.18; 1 year OR: 1.81, 95% CI: 1.48-2.22, p \u3c 0.001), major complications (OR: 1.63, 95% CI: 1.10-2.41, p = 0.02), and Clavien-Dindo IV complications (OR: 3.26, 95% CI: 2.18-4.87, p \u3c 0.001). Frailty had good discriminatory accuracy for predicting mortality at 30-days (AUC: 0.71, 95% CI: 0.68-0.74, p \u3c 0.001), 3-months (OR: 0.75, 95% CI: 0.65-0.83, p \u3c 0.001), and 1-year (OR:0.74, 95% CI: 0.73-0.75, p \u3c 0.001).
Conclusions: The orthopedic surgery frailty literature is extremely heterogeneous, with disparate frailty scales implemented to measure varying outcomes across many orthopedic pathologies. Despite no consensus on exact scales or definitions, various frailty indices have predicted adverse outcomes
Body Mass Index (BMI) and Associations of Periprosthetic Fracture Risk After TKA: A Systematic Review
Full text linkIntroduction
Total knee arthroplasty (TKA) is one of the most common elective orthopaedic surgeries. Periprosthetic fracture is a rare but potentially devastating complication after TKA. Several known risk factors exist, but the association of body mass index (BMI) with periprosthetic fractures remains largely unknown. This study aims to determine if increased BMI correlates with increased rates of periprosthetic fractures around a TKA.
Methods
A systematic review was conducted across MEDLINE/Pubmed, Cochrane, and Embase databases to evaluate for BMI and TKA periprosthetic fracture. The search used a combination of keywords and Medical Subject Heading (MeSH) terms. Titles and abstracts were screened for inclusion criteria. Full texts were screened and incorporated into this review if they met the inclusion criteria. Meta-analysis was not conducted due to different classifications of BMI categories used and wide variations in statistical analysis and reporting methods in the primary studies.
Results
This review found four retrospective cohort studies and one retrospective case-control study, all level 3 evidence. The studies\u27 results were mixed, and there was no clear association between BMI and the risk of periprosthetic fracture following TKA. Articles that met inclusion criteria in this review demonstrated a lack of a clear and standardized categorization for BMI which prevented meta-analysis of the data.
Conclusion
BMI does not currently exhibit any clear association with the risk of periprosthetic fracture in patients who undergo TKA. Additional prospective and retrospective evidence with standardized BMI classes and longer study durations are needed to determine if BMI is truly associated with the risk of periprosthetic fracture
Transient Quadriplegia With Albuminocytologic Dissociation: A Unique Presentation of Suspected Guillain-Barré Syndrome
Full text linkGuillan-Barré syndrome (GBS) is an autoimmune-mediated process that typically causes a progressive ascending paralysis that can lead to persistence of symptoms, permanent paralysis, and even death. While most cases follow a classical course with gradual progression of symptoms until eventual plateau, atypical and rapid onset clinical presentations can complicate differential diagnosis and diagnostic certainty, leading to late diagnosis by clinicians. A 35-year-old male with a history of intravenous (IV) methamphetamine use presented with a sudden onset and complete motor and sensory triplegia of the bilateral legs and left arm upon waking, which resolved shortly after hospital admission. After transfer for neurological referral, his only complaint of distal extremity paresthesia improved daily until hospital day 3, in which he experienced acute quadriplegia with complete sensory and motor loss, prompting stroke protocol activation. Neuroimaging was unremarkable, but cerebrospinal fluid (CSF) analysis revealed elevated protein (87.3 mg/dL) with albuminocytologic dissociation (ACD). The patient was subsequently initiated on intravenous immunoglobulin (IVIg); however, his symptoms had almost completely resolved prior to the initiation of this treatment. He ultimately experienced full recovery without residual deficits. This case highlights a rare and diagnostically challenging presentation of suspected GBS, marked by transient and recurrent neurologic deficits rather than the classic monophasic presentation. Such presentations may be mistaken for functional disorders or overlooked entirely, delaying appropriate neurological evaluation. Despite rapid resolution of symptoms and other possible underlying etiologies in this case, hallmark CSF findings of elevated protein and ACD supported the diagnosis. This underscores the importance of maintaining a high index of suspicion for GBS in patients with unexplained neurological deficits, especially in the context of a recent illness. Early recognition remains critical to guide management and prevent severe complications