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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. [ABSTRACT FROM AUTHOR]

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 [ABSTRACT FROM AUTHOR]

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 [ABSTRACT FROM AUTHOR]

Objective: To investigate readmissions among adult inpatients who underwent uvulopalatopharyngoplasty (UPPP) in Taiwan.Design: Population-based survey.Setting: Retrospective study with the National Health Insurance Database.Methods: All cases of inpatient adult UPPP (age >20 years) from 1997 to 2012 were identified through International Classification of Diseases, Ninth Revision, Clinical Modification. Factors associated with readmission within 30 days after surgery were analyzed.Results: A total of 38,839 adults with UPPP were identified (mean age, 39.3 years; men, 73.7%). The incidence of UPPP was 14.6 per 100 000 adults, which increased from 1997 to 2012 (6.7 to 16.7 per 100,000, Ptrend < .001). The rates of readmission for any reason, readmission for bleeding, reoperation for bleeding, and 30-day mortality were 4.2%, 1.7%, 1.0%, and 0.14%, respectively. Young age increased the risk of reoperation for bleeding, and old age increased the risk of readmission for any reason and mortality. Men had an increased risk of readmission and reoperation. Hypertension was associated with an increased risk of readmission for any reason (odds ratio [OR], 1.29; 95% CI, 1.10-1.51), bleeding-related readmission (OR, 1.89; 95% CI, 1.52-2.36), and reoperation (OR, 2.47; 95% CI, 1.84-3.30). Concurrent hypopharyngeal surgery was associated with an increased risk of readmission for any reason (OR, 1.34; 95% CI, 1.07-1.66) and bleeding-related readmission (OR, 1.69; 95% CI, 1.25-2.27). Finally, the use of steroids was associated with an increased risk of bleeding-related readmission and reoperation.Conclusions: The incidence of adult UPPP increased from 1997 to 2012 in Taiwan. Age, sex, comorbidity, concurrent hypopharyngeal surgery, and drug administration were associated with readmission after inpatient UPPP. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: Because of the lack of population-based analyses, this study elucidated the epidemiology and 30-day postoperative complications of inpatient adult tonsillectomies in Taiwan.Methods: Using the Taiwan National Health Insurance Research Database, we identified all inpatient adult tonsillectomies (age>20years) in Taiwan during 1997-2012 through International Codes of Diseases, 9th Revision. Trend of the inpatient tonsillectomy in adult during the study period was explored. Major complications of readmission, reoperation, and mortality within 30days after tonsillectomies were identified. Factors associated with major complications were analyzed using multivariate logistic model.Results: In total, 27,365 adults received inpatient tonsillectomies (mean age, 38.4±13.0years; 57.2% male). The overall incidence was 10.2 per 100,000 population per year among adults. Incidence rates increased from 1997 (8.2/100,000 adults) to 2012 (11.2/100,000 adults) (P trend<0.001). The rate of readmission for any reason, readmission for bleeding, reoperation for bleeding, and mortality were 4.9%, 2.2%, 1%, and 0.1%, respectively. Young age increased the risk of bleeding-related readmission and reoperation, whereas old age increased the risk of readmission for any reason and mortality. Male gender increased the risk of all major complications. Hypertension was associated with an increased risk of bleeding-related readmission (odds ratio [OR]=2.21; 95% confidence interval [CI] 1.68-2.92) and reoperation (OR=2.17; 95% CI 1.44-3.27). Existing catastrophic illness increased the risk of readmission (OR=4.28; 95% CI 3.60-5.08) for any reason and mortality (OR=3.24; 95% CI 1.37-7.65). Nonsteroidal anti-inflammatory drugs and steroids were associated with an increased risk of readmission or reoperation for bleeding.Conclusion: Incidence rates of inpatient adult tonsillectomy increased during 1997-2012 in Taiwan. Age, gender, comorbidity, and drug administration characteristics were associated with major complications of adult tonsillectomies in this cohort. [ABSTRACT FROM AUTHOR]