Combining principal component analysis and logistic regression for multifactorial fall risk prediction among community-dwelling older adults.

Falls require comprehensive assessment in older adults due to their diverse risk factors. This study aimed to develop an effective fall risk prediction model for community-dwelling older adults by integrating principal component analysis (PCA) with machine learning. Data were collected for 45 fall-related variables from 1630 older adults in Taiwan, and models were developed using PCA and logistic regression. The optimal model, PCA with stepwise logistic regression, had an area under the receiver operating characteristic curve of 0.78, sensitivity of 74 %, specificity of 70 %, and accuracy of 71 %. While dimensionality reduction via PCA is not essential, it aids practicality. Our framework combines PCA and logistic regression, providing a reliable method for fall risk prediction to support consistent screening and targeted health promotion. The key innovation is using PCA prior to logistic regression, overcoming conventional limitations. This offers an effective community-based fall screening tool for older adults.

Myxofibrosarcoma of the Chest Wall Detected on 99mTc-MDP Whole-Body Bone Scan.

Myxofibrosarcoma is a type of soft tissue sarcoma, predominantly characterized by a high propensity for local recurrence, albeit demonstrating a relatively diminished risk for distant metastasis. Its prevalence is notably higher in elderly patients. Here, we present a case of a 73-year-old woman diagnosed with Myxofibrosarcoma. She was subjected to a whole-body bone scan using 99mTc-methylene diphosphonate (MDP) to survey potential bony metastasis. It revealed marked MDP accumulation with peripheral soft tissue uptake in the right lateral chest region of this patient. This imaging phenotype could potentially be attributed to the augmented vascularity within the tumor, a finding that was prominently displayed in this particular case.

Comparing solution-gate and bottom-gate nanowire field-effect transistors on pH sensing with different salt concentrations and surface modifications.

Field-effect transistors (FETs) have been developed as pH sensors by using various device structures, fabrication technologies, and sensing film materials. Different transistor structures, like extended-gate (EG) FETs, floating-gate FET sensors, and dual-gate (DG) FETs, can enhance the sensor performance. In this article, we report the effects of using solution-gate and bottom-gate FET configurations on pH sensing and investigate the influence of different ionic concentrations of buffers in the measured signals. The surface charge of hafnium dioxide (HfO2) affected by the buffer pH, with/without the modification of polyethylene glycol (PEG) terminated with hydroxyl groups, and the location of applied gate voltage are vital factors to the sensor performance in pH sensing. Based on the results, the solution-gate FET exhibits good pH sensitivity even in the high ionic strength solutions of bis-tris propane (BTP), and these values of pH sensitivity are close to the Nernst limit (59.2 mV/pH). In general, silane-PEG-OH modification can reduce the deviations of measured signals in pH sensing. The performance of bottom-gate FET is inferior in the BTP buffers with high ionic solutions but suitable to be operated in low ionic concentrations, such as 0.1, 1, and 10 mM BTP buffers. The size of the ions was also studied and discussed. The solution-gate FET demonstrates excellent performance under high ionic strengths, meaning a more significant potential for detecting biological molecules under physiological conditions.

Comparative Analysis of Fall Risk Assessment Features in Community-Elderly and Stroke Survivors: Insights from Sensor-Based Data.

Fall-risk assessment studies generally focus on identifying characteristics that affect postural balance in a specific group of subjects. However, falls affect a multitude of individuals. Among the groups with the most recurrent fallers are the community-dwelling elderly and stroke survivors. Thus, this study focuses on identifying a set of features that can explain fall risk for these two groups of subjects. Sixty-five community dwelling elderly (forty-nine female, sixteen male) and thirty-five stroke-survivors (twenty-two male, thirteen male) participated in our study. With the use of an inertial sensor, some features are extracted from the acceleration data of a Timed Up and Go (TUG) test performed by both groups of individuals. A short-form berg balance scale (SFBBS) score and the TUG test score were used for labeling the data. With the use of a 100-fold cross-validation approach, Relief-F and Extra Trees Classifier algorithms were used to extract sets of the top 5, 10, 15, 20, 25, and 30 features. Random Forest classifiers were trained for each set of features. The best models were selected, and the repeated features for each group of subjects were analyzed and discussed. The results show that only the stand duration was an important feature for the prediction of fall risk across all clinical tests and both groups of individuals.

Revision of endoscopic sinus surgery in adults: A population-based study in Taiwan.

OBJECTIVE: This study aimed to elucidate the revision rate, time to revision, and factors associated with revision of endoscopic sinus surgery (ESS) in Taiwan. DESIGN: Retrospective study. SETTING: Population-based analysis. PARTICIPANT: We identified all in-hospital patients, aged >20 years, who underwent ESS between 2000 and 2008 from the Taiwan National Health Insurance Research Database, and followed up with them until 2018. MAIN OUTCOME MEASURES: Factors associated with revision surgery were analyzed using multivariable Cox proportional hazard model. RESULTS: Overall, 66 592 patients were identified (mean age, 46.3 years; 62% males). The revision rate was 14.5% (9644/66 592) and time to revision surgery was 5.9 years. Multivariable Cox proportional hazard model showed that young age, male gender (hazard ratio [HR] = 1.18; 95% confidence interval [CI], 1.13-1.23), having nasal polyposis (HR = 1.17; 95% CI, 1.12-1.22), having allergic rhinitis (HR = 1.08; 95% CI, 1.04-1.13), having asthma (HR = 1.26; 95% CI, 1.14-1.39), and surgical time of >4 h (HR = 1.11; 95% CI, 1.06-1.16) were associated with increased risk of revision surgery. Concurrent septal surgery (HR = 0.81; 95% CI, 0.76-0.87), turbinate surgery (HR = 0.91; 95% CI, 0.85-0.97), or septal and turbinate surgery (HR = 0.68; 95% CI, 0.64-0.73) were associated with decreased risks of revision surgery. CONCLUSION: In Taiwan, risk factors for revision ESS are young age, male gender, having nasal polyposis, having allergic rhinitis, having asthma, and long surgical times. Concurrent septal or turbinate surgery decreases the risk of revision.

Effect of Sleep Surgery on Inflammatory Cytokines in Adult Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis.

OBJECTIVE: To evaluate whether sleep surgery is associated with inflammatory cytokine changes. This study hypothesizes cytokines may change after surgery in adult obstructive sleep apnea (OSA). STUDY DESIGN: Systematic review and meta-analysis. METHODS: The study protocol was registered on PROSPERO (CRD42020154425). Two authors independently searched PubMed, Embase, and Cochrane review databases from their inception to June 2021. The keywords used were sleep apnea, inflammatory markers, cytokines, and surgery. The effects of sleep surgery on the apnea-hypopnea index (AHI) and inflammatory cytokines were evaluated using a random-effects model. Both mean difference (MD) and standardized mean difference (SMD) of the changes in cytokines were calculated. RESULTS: Nine studies with 235 adults were included (mean age: 43 years; 82% were men). After sleep surgery, AHI significantly reduced by -11.3 events/h (95% confidence interval [CI], -15.8 to -6.9). In total, 8 and 6 studies were pooled for examining tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) levels, respectively. Sleep surgery significantly reduced TNF-α levels, with an MD of -2.8 pg/ml (95% CI, -5.1 to -0.6) and an SMD of -0.56 (95% CI, -0.85 to -0.27). Furthermore, sleep surgery reduced IL-6 levels, with an MD of -0.6 pg/ml (95% CI, -1.0 to -0.2) and an SMD of -0.66 (95% CI, -0.89 to -0.43). No covariates were identified to be correlated with cytokine changes in subgroup and meta-regression analyses. Funnel plots showed possible publication bias in current data. CONCLUSIONS: In adults, OSA treatment with sleep surgery improves inflammatory cytokines. Laryngoscope, 132:2275-2284, 2022.

Effect of sleep surgery on lipid profiles in adults with obstructive sleep apnea: a meta-analysis.

PURPOSE: The effects of sleep surgery on the lipid profile of adults diagnosed as having obstructive sleep apnea (OSA) remain unclear. This meta-analysis aimed to clarify whether sleep surgeries improve patients' lipid profile. METHODS: The study protocol was registered on PROSPERO (CRD42020154425). Two authors independently searched the PubMed, MEDLINE, EMBASE, and Cochrane review databases up to September 2020 using keywords such as sleep apnea, OSA, sleep apnea syndromes, lipids, and surgery. The effects of sleep surgery on the apnea-hypopnea index (AHI) and lipid profile parameters were evaluated using a random-effects model. RESULTS: Thirteen studies were included, with a total of 710 patients (mean age: 42.0 years; 85% men; mean sample size: 54.6 patients). The summary estimate of AHI change was - 20.6 events/h (95% CI - 25.9 to - 15.3) and the Epworth Sleepiness Scale score was - 4.2 (95% CI - 5.9 to - 2.5). Sleep surgery lowered total cholesterol (mean - 7.7 mg/dL; 95% CI - 12.2 to - 3.2), low-density lipoprotein (mean - 7.2 mg/dL; 95% CI - 11.0 to - 3.3), and triglyceride (mean - 14.0 mg/dL; 95% CI - 22.2 to - 5.8) levels but did not affect high-density lipoprotein (mean 1.5 mg/dL; 95% CI - 0.6 to 3.7) levels. Subgroup analysis revealed that the lipid profile changes were not associated with the surgical procedure but with the degree of OSA improvement. Meta-regression analyses demonstrated that the improvement in the lipid profile was positively correlated with AHI reduction. CONCLUSION: Surgeries for OSA may improve the lipid profile, which is positively correlated with the degree of OSA improvement.

Prevalence of sleep disorders in children with chronic kidney disease: a meta-analysis.

BACKGROUND: The reported prevalence of sleep disorders in children with chronic kidney disease (CKD) varies greatly. A quantitative meta-analysis to estimate the prevalence of sleep disorders among pediatric CKD patients may provide further information. OBJECTIVES: The objective of this study is to estimate the prevalence of sleep disorders in children with CKD. The study protocol was registered on PROSPERO (registration number CRD42021268378). DATA SOURCES: Two authors independently searched the PubMed, MEDLINE, EMBASE, and Cochrane review databases up to June 2021. STUDY ELIGIBILITY CRITERIA: Eligible studies include data of prevalence of sleep disorders in children with CKD. STUDY APPRAISAL AND SYNTHESIS METHODS: The prevalence of restless legs syndrome, sleep-disordered breathing, pediatric obstructive sleep apnea (i.e., apnea-hypopnea index > 1 event/h in polysomnography), excessive daytime sleepiness, and insomnia/insufficient sleep was estimated using a random-effects model. Subgroup analyses were conducted to compare the prevalence of sleep disorders between children on dialysis and not on dialysis. This meta-analysis included 12 studies with 595 children (mean age: 12.9 years; gender ratio: 55.6% boys; mean sample size: 49.6 patients). RESULTS: The prevalence of restless legs syndrome in children with CKD was 21% (95% confidence interval [CI], 14-30%). The prevalence of sleep-disordered breathing, pediatric obstructive sleep apnea, excessive daytime sleepiness, and insomnia/insufficient sleep was 22% (95% CI, 12-36%), 34% (95% CI, 19-53%), 27% (95% CI, 17-41%), and 14% (95% CI, 7-27%), respectively. Subgroup analysis revealed the pooled prevalence of excessive daytime sleepiness was significantly higher in children on dialysis than in children not on dialysis (43.3% vs. 11.2%; P = 0.018). Children on dialysis also had a high prevalence of other sleeping disorders, although the differences did not reach statistical significance. Children with CKD exhibited a 3.9-fold (95% CI, 1.37 to 10.93) increased risk of restless legs syndrome and a 9.6-fold (95% CI, 3.57 to 25.76) increased risk of excessive daytime sleepiness compared with controls. LIMITATIONS: The selected papers are of small sample size, lack of a control group, and exhibit substantial heterogeneity. CONCLUSIONS: Sleep disorders are common in children with CKD. Our results indicate that while the prevalence rates of various sleep disorders were higher in children on dialysis than in children not on dialysis, the prevalence of excessive daytime sleepiness was statistically significant in children on dialysis. A higher resolution version of the Graphical abstract is available as Supplementary information.

Effect of sleep surgery on blood pressure in adults with obstructive sleep apnea: A Systematic Review and meta-analysis.

This meta-analysis evaluates the effect of sleep surgery on blood pressure (BP) in adults with OSA. The study protocol was registered on PROSPERO (CRD42020154425). The PubMed, MEDLINE, EMBASE, and Cochrane databases were independently searched by 2 authors up to March 2020. The keywords used were sleep apnea, OSA, sleep apnea syndromes, surgery, and BP. In 26 studies with 1218 patients (mean age: 46.2 years; 82% men), the mean AHI significantly decreased by 26.2 (95% confidence interval [CI], 21.2 to 31.1) events/hour after sleep surgery. Overall, sleep surgery resulted in a significant reduction in office systolic and diastolic BP by 5.6 mmHg (95% CI, 2.9 to 8.3) and 3.9 mmHg (95% CI, 1.8 to 6.0), respectively, in adults with OSA. According to subgroup analyses, differences in the office BP after sleep surgery were nonsignificant between regions (ie, western vs eastern countries), sample sizes, surgical procedures (ie, pharyngeal surgery vs other surgical procedures), and follow-up periods. Meta-regression analyses revealed that reductions in systolic and diastolic BP were positively correlated with the AHI reduction. In conclusion, sleep surgery significantly reduces BP and AHI in adults with OSA. The BP reduction degree after sleep surgery is positively correlated with the OSA improvement degree.

Epidemiology of pediatric tracheotomy: A population-based study using National Health Insurance Research Database in Taiwan.

OBJECTIVE: Tracheostomy in children is a surgical procedure with considerable morbidity and mortality. However, there is still a lack of population-based survey in pediatric tracheostomy. This study analyses population-based data in pediatric tracheostomy among different ages in Taiwan. METHODS: This study used National Health Insurance Research Database in Taiwan. All children (aged <18 years) who underwent tracheostomy during 1997-2016 were identified. We retrieved data regarding baseline characteristics, perioperative care, and mortality associated with pediatric tracheostomy, and compared differences in variables between different age groups. RESULTS: We observed that 2300 children received tracheostomy (mean age, 8.7 years; 64% boys). Regarding the age group distribution of the patients, 585 (25.4%) were infants (<1 year), 227 (9.9%) were toddlers (1-3 years), 175 (7.6%) were preschool-aged children (3-6 years), 317 (13.8%) were school-aged children (6-12 years), and 996 (43.3%) were adolescents (12-18 years). Surgical indications included pulmonary disorders (64.9%), neurological disorders (38.4%), trauma (32.3%), head injury (25.2%), and congenital anomalies (21.5%). Of these patients, 94.9% required intensive care unit (ICU) care, with the mean length of ICU stay being 63.8 days. The mean length of hospital stay was 74.5 days. The overall mortality at the last follow-up was 43.96% (1011/2300), and the tracheostomy related mortality at the last follow-up was 1.43% (33/2300). Compared with adolescents, infants more commonly underwent tracheostomy in the northern area (66.7% vs 37.2%, P < .001), more commonly received tracheostomy indicated by congenital anomalies (53.7 vs 4.6%, P < .001), had longer ICU stays, had longer hospital stays (100.7 vs 57.5 days, P < .001), and had a higher 5-year mortality rate (42.4 vs 29.6%, P < .001). Multivariable logistic and Cox regression models revealed that young age was associated with an increased risk of prolonged hospital stay and long-term mortality, respectively. CONCLUSIONS: This study elaborates the epidemiology of pediatric tracheostomy in different age groups.

Comparative Analysis of Stress and Deformation between One-Fenced and Three-Fenced Dental Implants Using Finite Element Analysis.

Finite element analysis (FEA) has always been an important tool in studying the influences of stress and deformation due to various loads on implants to the surrounding jaws. This study assessed the influence of two different types of dental implant model on stress dissipation in adjoining jaws and on the implant itself by utilizing FEA. This analysis aimed to examine the effects of increasing the number of fences along the implant and to compare the resulting stress distribution and deformation with surrounding bones. When a vertical force of 100 N was applied, the largest displacements found in the three-fenced and single-fenced models were 1.7469 and 2.5267, respectively, showing a drop of 30.8623%. The maximum stress found in the three-fenced and one-fenced models was 13.518 and 22.365 MPa, respectively, showing a drop of 39.557%. Moreover, when an oblique force at 35° was applied, a significant increase in deformation and stress was observed. However, the three-fenced model still had less stress and deformation compared with the single-fenced model. The FEA results suggested that as the number of fences increases, the stress dissipation increases, whereas deformation decreases considerably.

Random Forest for Automatic Feature Importance Estimation and Selection for Explainable Postural Stability of a Multi-Factor Clinical Test.

Falling is a common incident that affects the health of elder adults worldwide. Postural instability is one of the major contributors to this problem. In this study, we propose a supplementary method for measuring postural stability that reduces doctor intervention. We used simple clinical tests, including the timed-up and go test (TUG), short form berg balance scale (SFBBS), and short portable mental status questionnaire (SPMSQ) to measure different factors related to postural stability that have been found to increase the risk of falling. We attached an inertial sensor to the lower back of a group of elderly subjects while they performed the TUG test, providing us with a tri-axial acceleration signal, which we used to extract a set of features, including multi-scale entropy (MSE), permutation entropy (PE), and statistical features. Using the score for each clinical test, we classified our participants into fallers or non-fallers in order to (1) compare the features calculated from the inertial sensor data, and (2) compare the screening capabilities of the multifactor clinical test against each individual test. We use random forest to select features and classify subjects across all scenarios. The results show that the combination of MSE and statistic features overall provide the best classification results. Meanwhile, PE is not an important feature in any scenario in our study. In addition, a t-test shows that the multifactor test of TUG and BBS is a better classifier of subjects in this study.

Effect of adenotonsillectomy on blood pressure in children with obstructive sleep apnea: a meta-analysis.

BACKGROUND: While adenotonsillectomy (T&A) is widely recognized as the first-line therapy for pediatric obstructive sleep apnea (OSA), effects of T&A on blood pressure (BP) remain unclear. This meta-analysis evaluates the associations between T&A and BP in children with OSA. METHODS: The study protocol was registered on PROSPERO (CRD42020154425). Two authors independently searched the PubMed, Medline, EMBASE, and Cochrane databases. The keywords used were "sleep apnea syndromes," "adenotonsillectomy," and "child." A random-effects model was applied to determine office systolic BP (SBP), diastolic BP (DBP), and ambulatory BP changes. RESULT: Twelve studies with 1193 children were analyzed (mean age: 7.6 y; 54% boys). The apnea-hypopnea index significantly reduced of 9.4 events/h (95% CI, -12.0 to -6.8) after T&A. Office SBP (-0.24 mmHg; 95% CI, -1.64 to 1.16) and DBP (-1.65 mmHg; 95% CI, -3.47 to 0.17) did not decrease significantly after surgery. No significant decreases were observed in 24-h ambulatory BP after T&A. Subgroup analysis showed a significant postoperative decrease in office SBP (-6.23 mmHg; 95% CI, -7.78 to -4.67) and DBP (-7.93 mmHg; 95% CI, -10.37 to -5.48) among children with hypertension but a slight increase in office SBP (2.50 mmHg; 95% CI, 1.14 to 3.86) and DBP (1.98 mmHg; 95% CI, -0.02 to 3.98) in those without (P for heterogeneity < 0.001). CONCLUSION: This meta-analysis suggests the office and ambulatory BP changes after T&A in children with OSA are trivial. Moreover, children with hypertension experience a significantly greater decrease in office BP than children without hypertension.

Using a Stacked Autoencoder for Mobility and Fall Risk Assessment via Time-Frequency Representations of the Timed Up and Go Test.

Fall risk assessment is very important for the graying societies of developed countries. A major contributor to the fall risk of the elderly is mobility impairment. Timely detection of the fall risk can facilitate early intervention to avoid preventable falls. However, continuous fall risk monitoring requires extensive healthcare and clinical resources. Our objective is to develop a method suitable for remote and long-term health monitoring of the elderly for mobility impairment and fall risk without the need for an expert. We employed time-frequency analysis (TFA) and a stacked autoencoder (SAE), which is a deep neural network (DNN)-based learning algorithm, to assess the mobility and fall risk of the elderly according to the criteria of the timed up and go test (TUG). The time series signal of the triaxial accelerometer can be transformed by TFA to obtain richer image information. On the basis of the TUG criteria, the semi-supervised SAE model was able to achieve high predictive accuracies of 89.1, 93.4, and 94.1% for the vertical, mediolateral and anteroposterior axes, respectively. We believe that deep learning can be used to analyze triaxial acceleration data, and our work demonstrates its applicability to assessing the mobility and fall risk of the elderly.

Effect of Sleep Surgery on C-Reactive Protein Levels in Adults With Obstructive Sleep Apnea: A Meta-Analysis.

OBJECTIVES/HYPOTHESIS: To evaluate associations between sleep surgery and CRP (C-reactive protein) levels in adults with obstructive sleep apnea (OSA). STUDY DESIGN: Meta-analysis. METHODS: Two authors independently searched PubMed, Medline, EMBASE, and Cochrane review databases until July 2019. The keywords used were sleep apnea, OSA, sleep apnea syndromes, surgery, C-reactive protein (CRP), and inflammatory markers. The effects of sleep surgery on CRP levels were examined using a random-effects model. RESULTS: Nine studies with 277 patients were analyzed (mean age: 46.5 years; 92% men; mean sample size: 30.8 patients). The mean change in the apnea-hypopnea index (AHI) after surgery was significantly reduced by -21.1 (95% confidence interval [CI], -28.4 to -13.7) events/hr. Overall, sleep surgery resulted in a significant reduction of CRP levels in patients with OSA (standardized mean difference [SMD] = -0.39, 95% CI, -0.67 to -0.11). Patients with postoperative AHI reduction >20 events/hr achieved a greater reduction in CRP than those with AHI reduction <20 events/hr (SMD: -0.72 vs. -0.14, P for heterogeneity = .007). According to subgroup analysis, differences in the CRP levels after surgery were nonsignificant in the different countries (i.e., United States vs. other countries), CRP types (i.e., CRP vs. high-sensitivity CRP), surgical procedures (i.e., pharyngeal surgery vs. other surgical procedures), and follow-up period (i.e., <6 vs. >6 months). CONCLUSIONS: Sleep surgery for OSA resulted in a significant reduction of CRP levels in adults. The beneficial effect of surgery on CRP levels is greater in patients with large improvement in OSA (i.e., AHI reduction >20 events/hr) after sleep surgery. Laryngoscope, 131:1180-1187, 2021.

Estimating Postural Stability Using Improved Permutation Entropy via TUG Accelerometer Data for Community-Dwelling Elderly People.

To develop an effective fall prevention program, clinicians must first identify the elderly people at risk of falling and then take the most appropriate interventions to reduce or eliminate preventable falls. Employing feature selection to establish effective decision making can thus assist in the identification of a patient's fall risk from limited data. This work therefore aims to supplement professional timed up and go assessment methods using sensor technology, entropy analysis, and statistical analysis. The results showed the different approach of applying logistic regression analysis to the inertial data on a fall-risk scale to allow medical practitioners to predict for high-risk patients. Logistic regression was also used to automatically select feature values and clinical judgment methods to explore the differences in decision making. We also calculate the area under the receiver-operating characteristic curve (AUC). Results indicated that permutation entropy and statistical features provided the best AUC values (all above 0.9), and false positives were avoided. Additionally, the weighted-permutation entropy/statistical features test has a relatively good agreement rate with the short-form Berg balance scale when classifying patients as being at risk. Therefore, the proposed methodology can provide decision-makers with a more accurate way to classify fall risk in elderly people.

Association of cumulative surgeon volume and risk of complications in adult uvulopalatopharyngoplasty: a population-based study in Taiwan.

STUDY OBJECTIVES: Patients with obstructive sleep apnea undergoing upper airway surgery are known to have an increased perioperative risk, however, the effect of surgeon volume on this risk is largely unknown. We compared the 30-day readmission, bleeding, and mortality rates in adult patients with obstructive sleep apnea undergoing uvulopalatopharyngoplasty by cumulative surgeon volume. The objective of this study is to compare the risks of complications among different cumulative surgeon volume groups in adult patients undergoing uvulopalatopharyngoplasty and multilevel surgery. METHODS: In this retrospective study, data of all adult inpatients (aged older than 18 years) who underwent uvulopalatopharyngoplasty in Taiwan between 2000 and 2012 were identified from the National Health Insurance Research Database and then analyzed. Using mixed-effect logistic regression, we compared the risks of major complications in patients undergoing uvulopalatopharyngoplasty alone, uvulopalatopharyngoplasty with nasal surgery, and uvulopalatopharyngoplasty with tongue or hypopharyngeal surgery according to groups of cumulative surgeon volume (divided into four quartiles). RESULTS: A total of 36,483 adults were identified (mean age, 38.6 years; 73.7% men). When quartile 4 was used as reference, very low surgeon volume (quartile 1) was associated with higher risks of readmission within 30 days (adjusted odds ratio [aOR] 1.35, 95% confidence interval [CI] 1.17-1.57, P < .001), in-hospital death (aOR, 6.14, 95% CI 1.33-28.27, P = .020), and 30-day mortality (aOR, 4.90, 95% CI 1.83-13.09, P = .002). CONCLUSIONS: Higher complication rates in uvulopalatopharyngoplasty appear to be associated with very low cumulative surgeon volume.

Adenotonsillectomy for the Treatment of Obstructive Sleep Apnea in Children with Prader-Willi Syndrome: A Meta-analysis.

OBJECTIVE: Adenotonsillectomy outcomes in obstructive sleep apnea (OSA) treatment among children with Prader-Willi syndrome (PWS) remain unclear. This study aimed to elucidate the effectiveness of adenotonsillectomy in OSA treatment among children with PWS. DATA SOURCE: PubMed, MEDLINE, Embase, and Cochrane Review up to February 2019. REVIEW METHODS: The registry number of the protocol published on PROSPERO was CRD42015027053. Two authors independently searched the relevant database. Polysomnography outcomes in these children were examined, including net postoperative changes in the apnea-hypopnea index (AHI), net postoperative changes in the minimum and mean oxygen saturation, the overall success rate for a postoperative AHI <1, and the overall success rate for a postoperative AHI <5. RESULTS: Six studies with 41 patients were analyzed (mean age, 5.0 years; 55% boys; mean sample size, 6.8 patients). All children had PWS and received adenotonsillectomy for the treatment of OSA. The AHI was 13.1 events per hour (95% CI, 11.0-15.1) before surgery and 4.6 events per hour (95% CI, 4.1-5.1) after surgery. The mean change in the AHI was a significant reduction of 8.0 events per hour (95% CI, -10.8 to -5.1). The overall success rate was 21% (95% CI, 11%-38%) for a postoperative AHI <1 and 71% (95% CI, 54%-83%) for a postoperative AHI <5. Some patients developed velopharyngeal insufficiency postoperatively. CONCLUSION: Adenotonsillectomy was associated with OSA improvement among children with PWS. However, residual OSA was frequently observed postoperatively in these patients.

Incidence of Multilevel Surgical Procedures and Readmissions in Uvulopalatopharyngoplasty in Taiwan.

IMPORTANCE: Multilevel surgical procedures with uvulopalatopharyngoplasty (UPPP) appear to be associated with more complications than UPPP alone, but general and bleeding-related hospital readmissions have not been specifically investigated to date. OBJECTIVE: To compare the risk of 30-day general and bleeding-related readmissions in adult patients who underwent UPPP alone and those who received a multilevel surgical procedure. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study retrospectively analyzed all cases of UPPP among adults (aged >20 years) in Taiwan from January 1, 2000, to December 31, 2012. Claims data in the Taiwan National Health Insurance Research Database were used. Participants were patients who underwent inpatient UPPP (n = 35 029), and their basic information was acquired from the database. Data analyses were conducted from June 22, 2018, to August 22, 2018. MAIN OUTCOMES AND MEASURES: The risks of major complications in patients who underwent UPPP alone, UPPP with nasal operation, and UPPP with tongue or hypopharyngeal operation were compared using a generalized linear mixed model. RESULTS: In total, 35 029 adults were identified (mean [SD] age of 39.2 [12.2] years, and 25 923 men [74.0%]). The proportion of UPPP concurrent with nasal operation increased from 2000 to 2012 (19.9% to 42.9%), as did that of UPPP with concurrent tongue or hypopharyngeal operation (2.7% to 5.2%). The rate of readmission for any reason after UPPP with nasal operation was higher than that for UPPP alone (4.7% vs 3.7%; adjusted odds ratio [aOR], 1.22; 95% CI, 1.09-1.37). The rate of readmission for any reason and readmission for bleeding for UPPP with tongue or hypopharyngeal operation (aOR, 1.68; 95% CI, 1.34-2.11) was also higher than that for UPPP alone (aOR, 2.34; 95% CI, 1.72-3.17). However, a multilevel surgical procedure was not associated with an increased risk of bleeding-related reoperation, regardless of the concurrent procedure. CONCLUSIONS AND RELEVANCE: The incidence of multilevel UPPP in Taiwan increased from 2000 to 2012, and these surgeries appeared to be associated with a higher risk of complications; results of this study suggest that these findings should be considered during surgical decision-making.

Trends in the management of peritonsillar abscess in children: A nationwide population-based study in Taiwan.

OBJECTIVE: Population-based studies analyzing peritonsillar abscess in children are lacking. In this study, a population-based survey of the epidemiology of pediatric peritonsillar abscess in Taiwan was conducted. METHODS: This cross-sectional study was conducted using the Taiwan National Health Insurance Research Database. All cases of inpatient pediatric peritonsillar abscess (age < 18 years) in Taiwan between 2000 and 2012 were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification. Incidence rates of inpatient peritonsillar abscess in children were calculated. Characteristics such as age, gender, hospital level, treatment modalities, imaging studies, drug administration, and length of hospital stays during the study period were analyzed. RESULTS: A total of 12,965 children with peritonsillar abscess were included (mean age, 6.6 years [standard deviation, 4.8 years]; 56.5% boys). The overall incidence was 18 per 100,000 children. Incidence rates decreased from 2000 to 2012 (19.1/100,000 to 8.3/100,000 children) (ptrend < 0.001). During the study period, the proportion of peritonsillar abscess treatments at medical centers increased from 4.6% to 15.0%. The proportion of treatments involving incision and drainage or needle aspiration increased significantly (1.3%-4.1% and 49.4%-65.6%, respectively), whereas treatments with antibiotics only decreased significantly (48.9%-29.0%). The use of computed tomography (CT) increased (1.4%-12%, ptrend < 0.001). The use of nonsteroidal anti-inflammatory drugs, steroids, and penicillin increased during the study period. The mean length of hospital stays increased from 3.78 to 4.67 days. CONCLUSIONS: The incidence of peritonsillar abscess in children decreased between 2000 and 2012 in Taiwan. Moreover, increasing trends were observed in the use of CT, the rates of incision and drainage and needle aspiration procedures, and the length of hospital stay in this study cohort.