Background: Patient-education materials (PEMs) are essential to improve health literacy, engagement, and treatment adherence, yet many exceed the recommended readability levels. Therefore, individuals with limited health literacy are at a disadvantage. This study evaluated the readability of spine-related PEMs from the American Academy of Orthopaedic Surgeons (AAOS), the North American Spine Society (NASS), and the American Association of Neurological Surgeons (AANS), and examined the potential of artificial intelligence (AI) in optimizing PEMs for improved patient comprehension. Methods: A total of 146 spine-related PEMs from the AAOS, NASS, and AANS websites were analyzed. Readability was assessed using the Flesch-Kincaid Grade Level (FKGL) and Simple Measure of Gobbledygook (SMOG) Index scores, as well as other metrics, including language complexity and use of the passive voice. ChatGPT-4o was used to revise the PEMs to a sixth-grade reading level, and post-revision readability was assessed. Test-retest reliability was evaluated, and paired t tests were used to compare the readability scores of the original and AI-modified PEMs. Results: The original PEMs had a mean FKGL of 10.2 ± 2.6, which significantly exceeded both the recommended sixth-grade reading level and the average U.S. eighth-grade reading level (p < 0.05). ChatGPT-4o generated articles with a significantly reduced mean FKGL of 6.6 ± 1.3 (p < 0.05). ChatGPT-4o also improved other readability metrics, including the SMOG Index score, language complexity, and use of the passive voice, while maintaining accuracy and adequate detail. Excellent test-retest reliability was observed across all of the metrics (intraclass correlation coefficient [ICC] range, 0.91 to 0.98). Conclusions: Spine-related PEMs from the AAOS, the NASS, and the AANS remain excessively complex, despite minor improvements to readability over the years. ChatGPT-4o demonstrated the potential to enhance PEM readability while maintaining content quality. Future efforts should integrate AI tools with visual aids and user-friendly platforms to create inclusive and comprehensible PEMs to address diverse patient needs and improve health-care delivery.

Introduction: Postoperative delirium (POD) is a feared complication following major surgery in elderly patients. Further investigation of the risk factors and consequences of POD following total joint arthroplasty is warranted. Methods: Patients who underwent total knee arthroplasty (TKA) or total hip arthroplasty (THA) were identified using PearlDiver. Patients were filtered into 2 cohorts based on the presence or absence of POD within 7 days of surgery. Epidemiological analyses were performed to examine trends in POD following TKA and THA by age group and year. Comparative analyses were performed on patient demographics and baseline cognitive status. After matching by age, sex, and comorbidities, electrolyte disturbances and 90-day postoperative complications were analysed. Results: Among 2,518,918 (99.7%) no POD and 7240 (0.3%) POD patients who underwent total knee or hip arthroplasty, mean age was 65.58 years, 60.2% were female, and mean CCI was 1.50 for the whole cohort. POD patients frequently had baseline cognitive impairment ( P < 0.001). Incidence of POD decreased from 0.54% in 2010 to 0.10% in 2022 ( P < 0.001) and increased with age ( P < 0.001). POD patients had higher 90-day costs (TKA = $19,572 vs. $10,397, P < 0.001; THA = $18,496 vs. $9,877 P < 0.001). After matching, POD TKA patients had higher rates of hypernatraemia (6.1% vs 4.5%, P = 0.001) and POD THA patients had higher rates of hyponatraemia (26.5% vs 23.1%, P = 0.008). POD patients had higher rates of 90-day postoperative medical and surgical complications ( P < 0.05) than no POD patients. Conclusions: Nearly 0.3% of patients who underwent either TKA or THA between 2010 and 2022 developed transient delirium. POD was most common in elderly patients with baseline cognitive impairment undergoing revision surgery. POD patients had higher rates of 90-day postoperative surgical and joint-related complications. While POD rates have decreased, continued initiative to prevent POD in total joint arthroplasty patients is imperative.

SignificancePhotoacoustic imaging has the potential to improve non-invasive breast cancer diagnosis. However, illumination through the skin introduces a skin tone bias, as greater melanin content increases optical absorption and can create acoustic clutter, reducing the visibility of various target sizes.AimWe investigate the impact of skin tone bias as a function of target sizes in three photoacoustic image reconstruction methods: fast Fourier transform (FFT)-based reconstruction, delay-and-sum (DAS) beamforming, and short-lag spatial coherence (SLSC) beamforming.MethodsThe three imaging methods were applied to channel data from multidomain simulations with 757, 800, and 1064 nm wavelengths, 11 target sizes (ranging 0.5 to 3 mm), 18 skin tones [ranging individual typology angles (ITAs), of –54 deg to 60 deg], and a previously validated realistic 3D breast model. The signal-to-noise ratio (SNR) and generalized contrast-to-noise ratio (gCNR) were measured to assess visibility.ResultsWith 757 and 800 nm wavelengths, targets underlying dark skin tones (ITA range: −54 deg to −33 deg) with sizes ≤3 mm were poorly visible with ≤2.38 to 4.21 mean SNR and ≤0.46 to 0.74 mean gCNR, with smaller targets generally being more visible with lighter skin tones. A 1064-nm transmit wavelength improved visualization with DAS and SLSC beamforming, relative to both FFT reconstruction with a 1064 nm wavelength and DAS or SLSC beamforming with 757 and 800 nm wavelengths. When combined with SLSC beamforming, the 1064-nm wavelength offered the greatest improvements, enabling visualization of simulated target sizes ranging from 0.5 to 3 mm underlying very light (ITA = 60 deg) to dark (ITA=−54 deg) skin tones, with mean SNR ≤10.01 and mean gCNR ≤1. Visualization of simulated vessel structures derived from in vivo photoacoustic images was consistent with simulation-based target size expectations.ConclusionsResults are promising for advancing next-generation photoacoustic imaging systems for breast cancer diagnosis across the range of skin tones represented in healthcare systems throughout the world.

Background: Anterior Lumbar Interbody and Fusion (ALIF) is particularly effective for improving radiographic alignment and functional outcomes. However, it also introduces distinct technical challenges, even for surgeons who are highly experienced with other lumbar fusion approaches. This study analyzes the effect of surgeon experience on clinical outcomes, radiographic parameters, and operative metrics in patients with degenerative lumbar disc disease undergoing single-level L5-S1 anterior lumbar interbody fusion. Methods: Adult patients who underwent L5-S1 ALIF with or without posterior fixation for degenerative disc disease between June 2017 and December 2024 were included. Patients were stratified into Early (from 2017 to December 2020), Middle (January 2021 to December 2022), and Recent (January 2023 to December 2024) groups. Demographics, radiographic alignment, in-hospital outcomes, and 2-year complication and reoperation rates were compared based on time of surgery. Multivariate logistic and linear regression adjusted for age, sex, BMI, comorbidities, prior fusion, and posterior instrumentation was conducted to assess the effect of accumulation of surgeon experience. Results: A total of 203 ALIFs were performed (mean age: 57.6 years; 50.7% female; mean Charlson Comorbidity Index: 2.1). Recent cases showed greater PT reduction (Early = 0.9°, Middle = −1.5°, Recent = −2.2°, p = 0.039), improved PI-LL mismatch correction (−0.4°, −4.8°, −5.4°, p = 0.007), higher L5-S1 lordotic correction (6.7°, 8.4°, 11.4°, p = 0.003), lower estimated blood loss (21.9 mL, 13.8 mL, 10.0 mL, p = 0.006), shorter OR time (107.4 min, 86.6 min, 75.2 min, p < 0.001), and fewer mechanical complications (39.3% vs. 13.7%, p < 0.001) and reoperations (10.7% vs. 2.1%, p = 0.023). Regression showed that each additional year of experience predicted improved alignment, lower blood loss and OR time, and reduced odds of complications (OR = 0.54, p < 0.001) and reoperations (OR = 0.49, p = 0.015). Conclusions: In this single-surgeon, single-center cohort, increasing ALIF-specific experience over time was associated with improvements in sagittal alignment, operative efficiency, and lower complication and reoperation rates. These findings describe the longitudinal learning curve of one surgeon and should be interpreted within this context.