Assessing AI in Various Elements of Enhanced Recovery After Surgery (ERAS)-Guided Ankle Fracture Treatment: A Comparative Analysis with Expert Agreement

Rui Wang,1 Xuanming Situ,1 Xu Sun,2 Jinchang Zhan,1 Xi Liu3 1Department of Orthopaedic, Zhongshan City Orthopaedic Hospital, Zhongshan, Guangdong Province, People’s Republic of China; 2Department of Orthopaedic Trauma, Beijing Jishuitan Hospital, Beijing, People’s Republic of China; 3Department of Sports, Sun Yat-sen Memorial Primary School, Zhongshan, Guangdong Province, People’s Republic of ChinaCorrespondence: Rui Wang, Department of Orthopaedic, Zhongshan City Orthopaedic Hospital, Zhongshan, Guangdong Province, People’s Republic of China, Tel +86 18699690080, Fax +86 760 89907577, Email [email protected]: This study aimed to assess and compare the performance of ChatGPT and iFlytek Spark, two AI-powered large language models (LLMs), in generating clinical recommendations aligned with expert consensus on Enhanced Recovery After Surgery (ERAS)-guided ankle fracture treatment. This study aims to determine the applicability and reliability of AI in supporting ERAS protocols for optimized patient outcomes.Methods: A qualitative comparative analysis was conducted using 35 structured clinical questions derived from the Expert Consensus on Optimizing Ankle Fracture Treatment Protocols under ERAS Principles. Questions covered preoperative preparation, intraoperative management, postoperative pain control and rehabilitation, and complication management. Responses from ChatGPT and iFlytek Spark were independently evaluated by two experienced trauma orthopedic specialists based on clinical relevance, consistency with expert consensus, and depth of reasoning.Results: ChatGPT demonstrated higher alignment with expert consensus (29/35 questions, 82.9%), particularly in comprehensive perioperative recommendations, detailed medical rationales, and structured treatment plans. However, discrepancies were noted in intraoperative blood pressure management and preoperative antiemetic selection. iFlytek Spark aligned with expert consensus in 22/35 questions (62.9%), but responses were often more generalized, less clinically detailed, and occasionally inconsistent with best practices. Agreement between ChatGPT and iFlytek Spark was observed in 23/35 questions (65.7%), with ChatGPT generally exhibiting greater specificity, timeliness, and precision in its recommendations.Conclusion: AI-powered LLMs, particularly ChatGPT, show promise in supporting clinical decision-making for ERAS-guided ankle fracture management. While ChatGPT provided more accurate and contextually relevant responses, inconsistencies with expert consensus highlight the need for further refinement, validation, and clinical integration. iFlytek Spark’s lower conformity suggests potential differences in training data and underlying algorithms, underscoring the variability in AI-generated medical advice. To optimize AI’s role in orthopedic care, future research should focus on enhancing AI alignment with medical guidelines, improving model transparency, and integrating physician oversight to ensure safe and effective clinical applications.Keywords: artificial intelligence, AI, enhanced recovery after surgery, ERAS, ankle fracture, comparative analysis, medical decision-making, interdisciplinary collaboration, ChatGPT