Anthony Sheyn

Objectives: To evaluate the association between the Social Vulnerability Index (SVI) and pediatric obstructive sleep apnea (OSA) outcomes, including comorbidities, diagnostic timing, and surgical intervention. Methods: A retrospective review of our institution's TriNetX Research Enterprise Data Warehouse assessed patients aged 0–18 years diagnosed with OSA from 2014 to 2024. Patients were grouped into four SVI quartiles: Low, Low–Medium, Medium–High, and High. Extracted variables included polysomnography (PSG), Continuous Positive Airway Pressure (CPAP), tonsillectomy and adenoidectomy (T&A) surgeries, secondary complications, and the time elapsed between diagnosis and procedures or complications. Results: The study included 5753 patients with an average age of 7.69 years, and 43.9% were in the High SVI quartile. Black or African American patients comprised 75.9% of this highly vulnerable cohort. Overall, 8.7% of the cohort underwent PSG, with no significant differences in testing or time to PSG. There was a significant stepwise increase in comorbid asthma across vulnerability tiers, peaking at 9.4% in the High SVI group ( p = 0.001). High SVI patients underwent T&A at significantly higher rates compared to those in the Low ( p = 0.008) and Low–Medium ( p = 0.002) quartiles. The mean time to surgery was 166.5 days, which did not significantly differ between SVI groups. Conclusion: Children in highly vulnerable neighborhoods experienced a disproportionate burden of comorbid asthma and underwent surgical management for OSA at significantly higher rates. This suggests that socially vulnerable patients may present with more severe disease requiring surgery. Incorporating metrics like SVI into clinical pathways can better guide patient‐centered care and equitable resource allocation. Level of Evidence: 3.

Objective: To characterize the relationship between age and hypocalcemia risk following total thyroidectomy and identify critical age‐related transition points across the lifespan. Methods: The American College of Surgeons National Surgical Quality Improvement Program Thyroidectomy Targeted database was queried for 21,109 adult patients (18+) from 2016 to 2023 who underwent total thyroidectomy. Multivariate regressions utilizing age, sex, race/ethnicity, BMI, surgical specialty, ASA classification, and surgical indication were used to assess odds of hypocalcemia within 30 days of surgery. Additionally, age‐stratified analyses, generalized additive modeling (GAM), and segmented regression were used to assess odds of hypocalcemia. Results: Age was independently associated with 2% decreased odds of hypocalcemia per year older (OR, 0.98; 95% CI, 0.98–0.99; p ‐value < 0.001). GAM and systematic evaluation of 1,683,217 segmented regression models identified six key inflection points at ages 26, 35, 39, 51, 54, and 71, with hypocalcemia risk characterized by sharp changes at these transition points and gradual changes between them. Inflection points in early adulthood were the most consistent across models, while those in older age showed greater variability, suggesting increasing physiological heterogeneity with advancing age. Risk stabilized after age 65 with no significant differences between consecutive age groups. Conclusion: Hypocalcemia risk following total thyroidectomy follows a nonlinear age‐dependent pattern with identifiable transitions, challenging simple continuous or categorical age modeling. Risk stabilizes after the mid‐sixties, though very elderly patients should not be assumed to have lower risk due to advanced age alone. These findings support development of age‐tailored risk stratification tools for more personalized perioperative calcium management. Level of Evidence: 4.

Objective: To identify patterns in prophylactic intravenous antibiotics (PIAB) usage for thyroglossal duct and branchial cleft cyst excisions, and to evaluate whether PIAB improve patient outcomes. Study Design: Retrospective cohort study. Setting: American College of Surgeons National Surgical Quality Improvement Program‐Pediatric (NSQIP‐P) Surgical Antibiotic Prophylaxis Database. Methods: The NSQIP‐P database was queried for pediatric patients (≤18) from 2021 to 2023 who underwent thyroglossal duct or branchial cleft cyst excision. Multivariate regressions assessed associations between PIAB use and outcomes including surgical site infection, unplanned readmission, and reoperation while adjusting for clinicodemographic factors (age, sex, race/ethnicity, admission status, surgical specialty, ASA classification, and wound classification). Results: Of 2106 TGDC and 2837 BCC patients, 83.5% and 68.0% received PIAB, respectively. Hispanic ethnicity, postoperative admission, and clean‐contaminated wound classification were associated with increased PIAB use in both groups. In BCC patients, younger age and treatment by non‐otolaryngologists predicted decreased PIAB use. While univariate analysis in TGDC cases showed lower infection rates with PIAB (OR, 0.52; 95% CI, 0.30‐0.95; P = .025), this was not significant on multivariate analysis (0.59, 0.34‐1.08, P = .074). PIAB did not significantly affect infection, readmission, or reoperation rates in either cohort on multivariate analysis. Conclusion: PIAB use in pediatric TGDC and BCC excisions varies with clinicodemographic factors but did not consistently reduce adverse outcomes. These findings underscore the need to reevaluate the necessity of PIAB and encourage further investigations to develop evidence‐based guidelines for pediatric neck mass surgery.

Objectives: Identifying risk factors for hospital admission, intensive care unit (ICU) admission, and intubation in patients presenting to the emergency department (ED) with renin‐angiotensin‐aldosterone system inhibitor (RAASi) induced angioedema. Methods: This single hospital‐based retrospective cohort study examined ED visits of adult RAASi angioedema patients between January 1, 2006, and August 31, 2016. Clinical events were recorded over the ED visit and the next 2 months. Data extracted included demographics (age, sex, race), symptoms, exam findings, comorbidities, and medication history, intubation details (including difficulty, methods used), and adverse events (hypoxia, cardiac arrest, death). Patient courses, ICU care need, clinical deterioration, therapies, and length of stay were also documented. Results: Of the 755 patients meeting inclusion criteria from our cohort of 1299 patients, 16.2% required intubation during their admission, with 33% admitted to the ICU and 57% to regular hospital floors. Laryngeal swelling was the strongest predictor of adverse outcomes (OR 133.79, p < 0.001), followed by anterior tongue swelling (OR 4.15, p < 0.001), supporting fiberoptic exam as a valuable step in evaluating RAASi angioedema patients. Lip swelling was associated with a decreased likelihood of adverse outcomes such as intubation (OR 0.55, p = 0.049). Shortness of breath did not reliably predict advanced airway outcomes ( p = 0.278). Efficiency models incorporating laryngeal swelling, anterior tongue swelling, and body mass index (BMI) achieved excellent predictive performance (AIC 364.43). Conclusion: In the largest study of single‐site RAASi angioedema patients who underwent fiberoptic laryngoscopy at admission, we identified key clinical factors for more effectively triaging patients at risk for significant angioedema complications. Level of Evidence: 3.

Objectives: Prior studies investigating the impacts of social determinants of health (SDoH) on hypopharyngeal cancer have only assessed the impact of individual factors on patient outcomes. This study uses the CDC's Social Vulnerability Index (SVI) and a national patient cohort to examine how the interrelational influence of SDoH affect hypopharyngeal cancer prognosis, treatment, and follow‐up. Methods: This retrospective cohort study analyzed patients from 1975 to 2017 with a diagnosis of hypopharyngeal carcinoma in the NCI‐SEER database. Net social vulnerability and its contributions from 15 SDoH variables were ranked and scored across all US counties, yielding a SVI. SVI scores were matched to the patient's county of residence, and univariate linear regressions were performed on the length of care and prognosis, while univariate logistic regressions were performed on advanced staging at presentation and treatment modalities across SVI quintiles. Results: Across 16,038 hypopharyngeal cancer patients, there was a significant 22.3% (35.41–27.50 months) decrease in survival time and a 16.6% (40.00–33.36 months) decrease in surveillance time between the lowest and highest overall‐social vulnerability groups. Patients with greater vulnerability were more likely to have advanced staging at presentation and to receive chemotherapy, but less likely to receive surgery or radiation, with each treatment being differentially associated with vulnerability factors. Conclusion: This study on SDoH in adults with hypopharyngeal carcinoma found significant declines in care and prognosis with higher social vulnerability, along with specific associations across SDoH themes, underscoring the need for targeted public health interventions to mitigate these disparities and improve cancer care equity. Level of Evidence: 3.

Supplemental Table 3. Total cohort of 78 Patients with thyroid carcinoma, including those who did and did not undergo genetic testing.

Supplemental Table 4. Patient Cancer and Treatment History.

Supplemental Table 5. Thyroid carcinoma treatment and outcomes for patients with germline CPG PV.

Supplemental Table 2. Genes included on multigene panel tests.

Supplemental Table 1. Germline genetic testing completed.