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Introduction: In pediatric tonsillectomy management, the consistent tracking of surgical outcomes and adherence to guidelines are vital. This study explores how a surgical dashboard can serve as a tool in research analysis, translating AAO‐HNSF guidelines into measurable performance improvements. Methods: Using a prospective registry from three pediatric hospitals, a Tableau dashboard was constructed to graphically visualize key demographic and postoperative outcomes (including intensive care unit [ICU] utilization, 30‐day emergency department (ED) visits, and postoperative bleed rates) in children undergoing tonsillectomy from 2020 to 2024. From the dashboard data, a retrospective cohort study analyzing 6767 tonsillectomies was conducted from January 2, 2020, to June 20, 2023. Patients were categorized into low‐risk, OSA‐only (by ICD‐10 codes), and high‐risk groups based on comorbidities. Logistic regression identified factors influencing ED revisits and unplanned nursing calls. Three quality initiatives were assessed: preoperative school absence notes, perioperative dexamethasone recording, and post‐tonsillectomy parental education. Results: A total of 2122 (31%) were low‐risk, 2648 (39%) were OSA‐only, and 1997 (30%) high risk. Risk factors that increased the likelihood of ED visits were high‐risk comorbidities (OR = 1.46; 95% CI = 1.24–1.74; p < 0.001) and older age (OR = 1.05; 95% CI = 1.03–1.08; p < 0.001). Risk factors that increased the likelihood of an unplanned nursing communication were high‐risk comorbidities (OR = 1.53; 95% CI = 1.34–1.75; p < 0.001), older age (OR = 1.03, 95% CI = 1.01–1.04; p = 0.001), and Medicaid insurance (OR = 1.25; 95% CI = 1.09–1.43; p = 0.002). Postoperative bleed control was generally comparable between the groups, at 2.8% (low risk), 2.7% (OSA), 3.2 (high risk) (p = 0.651). Conclusion: The dashboard aided in data collection, data visualization, and data analysis of quality improvement initiatives, effectively translating guidelines into tangible measures to enhance care. Level of evidence: NA. [ABSTRACT FROM AUTHOR]

Objective(s): The first‐line treatment for pediatric obstructive sleep apnea (OSA) is adenotonsillectomy. Post‐operative weight gain is a well‐documented phenomenon. We hypothesized that higher peri‐adenotonsillectomy delta weight correlates with lower rates of OSA resolution in pediatric patients. Methods: This was a retrospective cohort study consisting of 250 patients from 2 to 17 years of age at a tertiary academic medical center between January 2021 and December 2022. Polysomnography results and body mass index (BMI) changes were collected through the electronic health record. Univariate and multivariate logistical regression analyses were performed, adjusting for confounding factors. Results: Perioperative delta weight and pre‐operative baseline AHI values were significant predictors of residual OSA. For every 1‐kilogram gain in weight, the odds of residual OSA (AHI >5) increase by 6.0% (OR = 1.06, 95% CI = 1.02–1.10, p < 0.002), and the odds of residual severe OSA (AHI > 10) increase by 8% (OR = 1.08, 95% CI = 1.04–1.12, p < 0.001). Increased AHI, Black/African American race, and male sex were also factors associated with incomplete OSA resolution. Conclusions: Increased peri‐adenotonsillectomy delta weight is associated with higher rates of residual OSA in children. Patients and families should be counseled about appropriate weight loss and control methods before adenotonsillectomy. Level of Evidence: IV Laryngoscope, 134:4141–4147, 2024 [ABSTRACT FROM AUTHOR]

Complex I is the largest member of the electron transport chain in human mitochondria. It comprises 45 subunits and requires at least 15 assembly factors. The subunits can be divided into 14 "core" subunits that carry out oxidation–reduction reactions and proton translocation, as well as 31 additional supernumerary (or accessory) subunits whose functions are less well known. Diminished levels of complex I activity are seen in many mitochondrial disease states. This review seeks to tabulate mutations in the supernumerary subunits of humans that appear to cause disease. Mutations in 20 of the supernumerary subunits have been identified. The mutations were analyzed in light of the tertiary and quaternary structure of human complex I (PDB id = 5xtd). Mutations were found that might disrupt the folding of that subunit or that would weaken binding to another subunit. In some cases, it appeared that no protein was made or, at least, could not be detected. A very common outcome is the lack of assembly of complex I when supernumerary subunits are mutated or missing. We suggest that poor assembly is the result of disrupting the large network of subunit interactions that the supernumerary subunits typically engage in. [ABSTRACT FROM AUTHOR]