Haig Pakhchanian

BACKGROUND: Bibliometric analysis is a scientific method that can derive insights into major publications' trends within a field. Currently, no bibliometric study has been conducted for Mohs micrographic surgery (MMS). OBJECTIVE: To characterize the most frequently cited articles in MMS. METHODS: Web of Science was used to identify the 100 most cited publications on MMS between 1970 and 2022. Articles were analyzed by title, authorship, institution, journal, year, citation frequency, originating country, funding, citation index, Altmetric score, impact factor, Eigenfactor score, and article influence score. RESULTS: Since January 2023, the top 100 articles had 9,096 total citations, ranging from 47 to 304. The top cited publication was “Mohs surgery is the treatment of choice for recurrent (previously treated) basal-cell carcinoma” in 1989. The top contributing organization was Harvard University (17%) and top contributing authors were Brodland, DJ (12%) and Zitelli, JA (11%). The year 2005 accounted for most of the articles (12%). Most articles were from the Journal of the American Academy of Dermatology (32%) and Dermatologic Surgery (27%). The United States contributed to 76% of the top articles. CONCLUSION: This bibliometric analysis offers researchers a detailed overview of important MMS publications and provides useful data into current findings steering MMS research and practice.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic strained the United States healthcare system, and associated policies resulted in the postponement or cancellation of many elective surgeries. While most orthopaedic surgeons are aware of how the pandemic affected their patients’ care, broader national trends in the operative treatment of orthopaedic knee pathology are poorly characterized. Therefore, the purpose of this study was to identify trends in orthopaedic knee procedures during the COVID-19 pandemic. Methods: The TriNetX database was queried for orthopaedic knee procedures performed from March 2018 to May 2021. Procedures were classified as arthroplasty (total knee arthroplasty (TKA), revision total knee arthroplasty) or non-arthroplasty (tendon or ligament repair, fracture fixation). Procedural volume per healthcare organization was determined over five seasons from March 2020 to May 2021 and compared to overlapping pre-pandemic periods from March 2018 to May 2019. Descriptive analysis was performed, and comparisons were made using a Student’s T-test. Results: Compared to the pre-pandemic period, there were significant decreases in primary TKA (p=0.016), femoral or entire tibial component revision TKA (p=0.005), and open treatment of femoral shaft fractures (p=0.007) in spring 2020. Procedural volume returned to baseline in summer 2020 through winter 2021. In spring 2021, primary TKA (p=0.017) and one component revision TKA (p=0.003) increased compared to the pre-pandemic period. Conclusion: The greatest decrease in knee procedures occurred early in the pandemic. Rates of these procedures have since rebounded, with some exceeding pre-pandemic levels. Hospitals are now better able to accommodate orthopaedic surgical volume while continuing to care for patients with COVID-19.

The aim of this study was to compare state-by-state concentrations of oculoplastic surgeons against patient demand using Google Search Trends data, in order to identify potential areas of unmet need. Google Trends data from 2004 to 2019 was collected to determine relative search volumes for the keyword “blepharoplasty” in each US state and the District of Columbia. Oculoplastic surgeon density was calculated by dividing the number of active American Society of Plastic and Reconstructive Surgeons members in 2019 by the State Census Bureau population estimates. Relative search volume values were divided by the local concentration of surgeons, and results were normalized between 0 and 100 to obtain a relative demand index for each state. Oculoplastic surgeon density varied widely across the country. The greatest concentrations of surgeons per 100,000 people were in D.C. (0.708) and Rhode Island (0.378), while the lowest were in Montana, New Mexico, North Dakota, South Dakota, and Wyoming (all 0). Relative search volumes were tightly distributed, ranging between 100 (Hawaii) and 45 (Vermont). The highest relative demand was found in low surgeon density states, such as Hawaii, Montana, New Mexico, North Dakota, South Dakota, and Wyoming. The lowest relative demand was found in DC (5), Rhode Island (12), and Utah (12). Our results revealed vast disparities in surgical concentrations across the US and highlighted a number of areas with a relative undersupply of oculoplastic surgeons. Further investigation is necessary to examine the underlying factors impacting the supply and distribution of oculoplastic surgeons.

There has been a disparity in familiarity regarding the public interest in gastroenterology terminologies during the COVID-19 pandemic. This study aimed to understand the outcomes of the public’s view on gastrointestinal topics and their potential social effects. This study is a comparative analysis of American Google Trends gastrointestinal terminology during the COVID-19 pandemic compared to a similar time frame (March 2018-February 2020) to determine how trends in the patient-seeking behavior of gastrointestinal terminology changed throughout the pandemic. The analysis discovered a substantial decrease in search volumes of gastrointestinal topics, more significantly in the first pandemic months. Later in the pandemic, search volumes trended toward pre-pandemic years in terms of public interest. In the case of gastrointestinal procedures, endoscopy and colonoscopies, they surpassed pre-pandemic interest levels statistically (p-values of 0.01 and 0.002). The public’s decreased interest in gastrointestinal topics at the beginning of the COVID-19 pandemic may have adverse effects on the healthcare maintenance of patients who could have had a positive outcome in their gastrointestinal health with proper monitoring. Although gastrointestinal internet searches increased toward pre-pandemic levels as the seasons progressed, further research is needed to determine the social impact of decreased public interest.

E18535 Background: Cancer accounts for a massive burden of global disease, healthcare expenditure, and is one of the leading causes of death worldwide, accounting for approximately 1 in 6 deaths. As both the incidence and prevalence of cancer continue to increase, along with the percentage of the population over the age of 65, it is important to understand patient demand for oncologists. Previous studies have predicted a shortage of over two thousand oncologists by 2025. The inconsistencies between supply and demand for oncologists require analysis and supervision to identify potential gaps in oncological care and fulfill patient demand for quality care. Methods: The average relative search volume (RSV) for the term “oncologist” was determined by analyzing Google Trends from 2004-2019 for each state. The oncologist per capita values were computed by taking the number of oncologists per state and then dividing by the corresponding 2019 Census estimates. The RSV values were then divided by per capita values to quantify demand index and standardized to generate a relative demand index (RDI). A spearman’s rho correlation test was also conducted to assess the relationship between RDI and overall 2019 state health rankings as conducted by the America’s Health Rankings group. Results: The states with highest RSV was New Jersey (100), Florida/Tennessee (98), and Connecticut (97), while the lowest RSV were Oregon (53), Alaska (44), and Vermont (41). The RDI for oncologists was greatest in Idaho (100), Mississippi (86), and Arkansas (77) while the lowest were for Vermont (15), Massachusetts (14), and District of Columbia (8). Spearman’s rho test revealed a strong negative relationship between RDI and overall state health ranking that was statistically significant (r_s= -0.6363, p < 0.001). Conclusions: These trends may give us a preliminary idea of states that have unmet healthcare needs in oncology. Further studies are warranted.