{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T12:56:01Z","timestamp":1790772961047,"version":"4.1.0"},"reference-count":28,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To review the landscape of cloud\u2010native analytics platforms and large language models (LLMs) applied to surgical outcomes research; to present the development of an automated head and neck free flap outcomes database as a reference implementation for using lakehouse architectures in the development of clinical databases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources<\/jats:title>\n                    <jats:p>PubMed and Embase from January 2018 through June 2026.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A scoping review of PubMed and Embase was conducted using five searches combining data architecture (e.g., \u201cdata lakehouse,\u201d \u201ccloud\u2010native\u201d), clinical text extraction (\u201cnatural language processing,\u201d \u201cLLM\u201d) surgical outcomes (\u201cpostoperative,\u201d \u201csurgical outcome\u201d), and domain\u2010specific databases (\u201cfree flap,\u201d \u201cmicrovascular reconstruction,\u201d \u201cautomated\u201d). Studies were reviewed if they described database development incorporating automated outcomes classification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 311 studies identified, five studies included elements of incremental processing, pattern\u2010matching\u2010gated LLM classification, or fault\u2010tolerant parallel processing for prospective database maintenance. No implementation examples combined all architectural characteristics. We present the development of a production database for microvascular surgery that automatically identifies free flap cases, collects and analyzes operative notes, validates cohort membership through LLM reasoning, and classifies outcomes across multiple dimensions (flap type, indication, flap failure, hardware complications, bony complications, etc.), all operating incrementally as new cases enter the electronic health record and existing cases are updated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We describe what appears to be the first data lakehouse\u2010based automated surgical database applied to otolaryngology, detail architectural decisions required for production, and identify critical unresolved challenges including LLM validation standards, data access barriers, and the translation of clinical domain expertise into computational logic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>N\/A.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.70956","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T11:56:48Z","timestamp":1790769408000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Lakehouse\u2010Driven Surgical Databases: Scoping Review and Implementation of a Free Flap Database"],"prefix":"10.1002","author":[{"given":"Louis\u2010Xavier","family":"Barrette","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjana M.","family":"Velu","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Troftgruben","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan","family":"Dooley","sequence":"additional","affiliation":[{"name":"Thomas Jefferson University, Sidney Kimmel Medical College  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. Gregory","family":"Farwell","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6639-8830","authenticated-orcid":false,"given":"Robert M.","family":"Brody","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2008.07.018"},{"key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/j.bpa.2011.08.008","article-title":"Perioperative Effectiveness Research Using Large Databases","volume":"25","author":"Freundlich R. E.","year":"2011","journal-title":"Best Practice & Research. 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