It is well known that China has a large population, although the country is still facing considerable medical pressure due to a lack of anesthesiologists. At present, the number of day surgery procedures is increasing and therefore preoperative evaluation is a very important part of anesthesia(Ojo et al.2010). At present, ChatGPT's exploration in the medical field is still focused mainly on medical education and scientific writing, and there is relatively little use of it in clinical and research scenarios(Shay et al.2023; Kung et al.2023). One of the key benefits of ChatGPT is its ability to provide instant, accurate, and personalized responses to a wide range of questions related to health care(Liu et al.2023; Cascella et al.2023; Odom-Forren et al.2023). A study by Gupta(Gupta et al.2024) searched the database to determine how it could be helpful to anesthesia providers, including pre-operative management, ICU management, pain management, and palliative care, and also to provide additional assistance to anesthesiologists (e.g., education, quality assurance, and research).
ASA is an important index for preoperative evaluation of both anesthesia and surgical risk, and has been used widely and recognized in the world(Riley et al.2014; Mayhew et al.2019). Lim(Lim et al.2023) suggested that GPT is able to classify ASA-PS consistently and correctly in multiple simulated patient scripts with appropriate justification, and has similar performance to that of human anesthesiologists in the majority of cases. In our study, ChatGPT has a certain reference value in the ASA classification of patients' physical condition, with its ASA classifications being basically similar to those of the expert group.
This study used ChatGPT extracts to learn information on the patient's medical history, examination results, type of surgery, and method of anesthesia. Using this information, appropriate risk assessment indicators can be obtained, thereby saving a certain amount of energy and time for surgeons and anesthesiologists, making it a very efficient preoperative evaluation method. As far as we are aware, this is the first study to assess the ability of ChatGPT to make ASA grading and preoperative evaluation of patients that would have some clinical value.
ChatGPT and the experts had different opinions on whether patients could enter the day surgery procedure. ChatGPT mostly recommended patients for day surgery after assessing their physical condition, surgical method, and anesthesia risk. For patients with an ASA ≥ 2, the panel preferred to recommend further examination and treatment before considering the suitability for day surgery. Even for more seriously ill patients, the panel recommended canceling day surgery at a higher rate.
Do these results mean that ChatGPT is more aggressive in considering the risks of anesthesia surgery, while the panel is more conservative? The reasons for this difference analyzed by our team may be as follows: 1. Possibly related to the working habits of each expert group, with some groups having a stricter level for indication of day surgery; 2. ChatGPT analyzes the patients’ objective indicators and the conclusion is made after synthesizing all these indicators, thereby defining the reference value; 3. The medical staff cannot consider which side is right or wrong, with the actual decision based on either the surgeon or anesthesiologist's understanding of the guidelines or the patient's condition.
Although our study showed the benefits of ChatGPT as a tool, there remain problems and limitations that need to be considered. Firstly, the correctness and validity of the content must be considered, as incorrect content may mislead the patient. While ChatGPT can provide a lot of information and assistance, at the moment it cannot completely replace human healthcare workers in all situations. Compared to search engines, it is not possible to find the source of ChatGPT's information. Taken together, these findings indicate that ChatGPT sometimes answers questions incorrectly, with the information it uses currently not updated since 2021. In addition, ChatGPT cannot access the Internet in real time. To overcome these limitations, manual auditing can be used to screen the content generated, and allow its accuracy to be judged (Lee and Choi et al.2023).
Secondly, attention should be paid to ethical and privacy issues. During the process of communicating with ChatGPT, patients provide their personal basic information and medical conditions, sometimes including pictures of their private parts. Although ChatGPT claims that it does not save conversations with users, it needs to be understood that sensitive health information may be damaged or abused during transmission and browsing. It is therefore necessary to implement sound data protection measures, including encryption of sensitive information and secure data transmission. In addition, because ChatGPT provides extremely rich emotional value, it is necessary to be careful that anxious patients do not become psychologically dependent on this "friend". Strict ethical and privacy regulations therefore need to be established to limit the scale of information input and emotional output of ChatGPT.
Above all, ChatGPT has the potential to revolutionize the way programs are evaluated for patients by providing accurate and effective clinical help. With any new technology, there are shortcomings that need to be addressed, although the potential benefits of ChatGPT in the field of ambulatory surgical evaluation are enormous. Development is the name of the day, and healthcare workers need to keep up with this trend and explore this promising area of technology. In this regard, it has been proposed that LLM represented by ChatGPT has the potential to add a new dimension to solving clinical problems.
It is also important to realize that ChatGPT is just a machine and cannot replace the humanity and compassion that are so essential to our profession(Odom-Forren et al.2023). As we continue to explore the possibilities of AI in healthcare, it is important to embrace these new technologies and use them to augment, rather than replace, important clinical work(Odom-Forren et al.2023).