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Background The study aims to clarify the association of sarcopenia with perioperative and postoperative complications in oral cavity squamous cell carcinoma (OCSCC) patients undergoing curative surgery and to understand the reasons causing the poor oncologic outcomes for OCSCC. Methods We conducted a propensity score matching study to investigate the association of perioperative and postoperative outcomes in OCSCC patients with sarcopenia and without sarcopenia. A retrospective analysis of a large national data set from the Taiwan Cancer Registry Database was conducted. At least two claims for patients with a principal diagnosis of sarcopenia within the 12‐month preoperative period were defined as the criteria for sarcopenia diagnosis (ICD‐10‐CM code M62.84). Sarcopenia was diagnosed through the measurement of low muscle strength and low muscle mass by any one of the patient's attending orthopaedic physician, rehabilitation physician, family medicine specialist or geriatrician. A multivariate logistic regression model was used to calculate the perioperative, and postoperative major complications. Results Our final cohort included 16 293 patients with OCSCC (10 862 and 5 431 in the sarcopenia and nonsarcopenia groups, respectively) who were eligible for further analysis. The sarcopenia group was 10.40% female and 89.60% male, and the nonsarcopenia group was 9.74% female and 90.26% male. The mean age ± standard deviation (SD) were 56.44 ± 11.14 and 56.22 ± 11.29 for sarcopenia and nonsarcopenia groups. OCSCC patients with sarcopenia undergoing curative surgery had a significantly higher blood transfusion rate and volume; longer intensive care unit (ICU) stay, and hospital stay; higher postoperative 30‐day mortality (adjusted odds ratio [aOR]: 1.12, 95% confidence interval [CI] [1.07, 1.56]) and rates of pneumonia (aOR: 1.34, 95% CI [1.20, 1.50]), acute renal failure (aOR: 1.45, 95% CI [1.12, 1.87]) and septicaemia (aOR: 1.29, 95% CI [1.15, 1.45]); higher postoperative first‐year mortality (aOR: 1.18, 95% CI [1.13, 1.51]) and rates of pneumonia (aOR: 1.43, 95% CI [1.30, 1.56]), acute myocardial infarction (aOR: 1.52, 95% CI [1.06, 2.18]) and septicaemia (aOR: 1.29, 95% CI [1.15, 1.45]). Conclusions OCSCC patients with sarcopenia might exhibit more perioperative and surgical complications than those without sarcopenia.

Background and Hypothesis The potential role of anesthesia as an independent risk factor for childhood bipolar disorder (BD) remains unclear. To address this, we conducted a population-based cohort study employing propensity score matching to compare BD incidence between pediatric patients undergoing surgery with and without general anesthesia. Study Design Our study included patients aged 0–3 years who received at least 1 episode of general anesthesia and were hospitalized for over 1 day in Taiwan between January 2004 and December 2014. They were matched 1:1 with a population not receiving general anesthesia to assess pediatric BD incidence. Study Results The study cohort comprised 15 070 patients, equally distributed between the general anesthesia and nongeneral anesthesia groups (7535 each). Multivariate Cox regression analysis revealed adjusted hazard ratios (aHRs; 95% CIs) for pediatric BD in the general anesthesia group as 1.26 (1.04–1.54; P = .021) compared to the nongeneral anesthesia group. Moreover, the incidence rate ratio (95% CI) for the general anesthesia group was 1.26 (1.03–1.53) compared to the nongeneral anesthesia group. Conclusions Early childhood exposure to general anesthesia is significantly associated with an increased risk of pediatric BD. This expands understanding of pediatric BD’s complex development, informing preventive strategies, and enhancing mental health outcomes for vulnerable young patients and global pediatric healthcare.

Purpose No study has compared 30-day and 90-day adverse postoperative outcomes between old-age patients with and those without sarcopenia. Patients and methods We categorize elderly patients receiving major surgery into two groups according to the presence or absence of preoperative sarcopenia that were matched at a 1:4 ratio through propensity score matching (PSM). We analyzed 30-day or 90-day adverse postoperative outcomes and mortality in patients with and without sarcopenia receiving major surgery. Results Multivariate logistic regression analyses revealed that the patients with preoperative sarcopenia were at significantly higher risk of 30-day postoperative mortality (adjusted odds ratio [aOR]. = 1.25; 95% confidence interval [CI]. = 1.03–1.52) and 30-day major complications such as postoperative pneumonia (aOR = 1.15; 95% CI = 1.00-1.40), postoperative bleeding (aOR = 2.18; 95% CI = 1.04–4.57), septicemia (aOR = 1.31; 95% CI = 1.03–1.66), and overall complications (aOR = 1.13; 95% CI = 1.00-1.46). In addition, surgical patients with sarcopenia were at significantly higher risk of 90-day postoperative mortality (aOR = 1.50; 95% CI = 1.29–1.74) and 90-day major complications such as pneumonia (aOR = 1.27; 95% CI = 1.10–1.47), postoperative bleeding (aOR = 1.90; 95% CI = 1.04–3.48), septicemia (aOR = 1.52; 95% CI = 1.28–1.82), and overall complications (aOR = 1.24; 95% CI = 1.08–1.42). Conclusions Sarcopenia is an independent risk factor for 30-day and 90-day adverse postoperative outcomes such as pneumonia, postoperative bleeding, and septicemia and increases 30-day and 90-day postoperative mortality among patients receiving major surgery. Condensed abstract No study has compared 30-day and 90-day adverse postoperative outcomes between patients with and those without sarcopenia. We conducted a propensity score?matched (PSM) population-based cohort study to investigate the adverse postoperative outcomes and mortality in patients undergoing major elective surgery with preoperative sarcopenia versus those without preoperative sarcopenia. We demonstrated that sarcopenia is an independent risk factor for 30-day and 90-day adverse postoperative outcomes, such as postoperative pneumonia, bleeding, septicemia, and mortality after major surgery. Therefore, surgeons and anesthesiologists should attempt to correct preoperative sarcopenia, swallowing function, and respiratory muscle training before elective surgery to reduce postoperative complications that contribute to the decrease in surgical mortality.

PurposeThis retrospective cohort study aimed to investigate the association between chronic postsurgical pain (CPSP) and the risk of postoperative depression in patients undergoing major surgery.MethodsData from Taiwan’s National Health Insurance Research Database were analysed for patients aged over 20 years who underwent major surgery between 2004 and 2018. CPSP was defined as the use of prescribed analgesics for over 3 months postsurgery, with a prescription exceeding 90 cumulative defined daily doses. Propensity score matching (PSM) was employed to match patients with and without CPSP. Cox regression analysis and competing risk analysis were conducted to evaluate the risk of postoperative depression in the CPSP group compared with the no CPSP group.ResultsBefore PSM, 141 466 patients were included, with 37 303 (26.37%) experiencing CPSP. After PSM, 74 606 patients were matched in both groups. The incidence of depression was significantly higher in the CPSP group compared with the no CPSP group (p<0.0001). Cox regression analysis revealed a significantly elevated risk of depression in the CPSP group (adjusted HR: 1.41; 95% CI 1.35 to 1.48; p<0.0001), which persisted across various adjustment models and competing risk analysis. The cumulative depression risk increased over the follow-up period.ConclusionsThis study demonstrates a strong association between CPSP and postoperative depression risk. Addressing CPSP may offer a promising approach to reducing the incidence of postoperative depression and its socioeconomic and familial burdens. Further research is needed to elucidate underlying mechanisms and optimise preventive interventions.

Background Postoperative hyperactive delirium is a common and serious complication in older patients undergoing surgery, but the association between delirium and mortality remains controversial. Compared to other delirium subtypes, hyperactive delirium is characterized by more overt clinical manifestations, facilitating accurate detection and evaluation. This study aimed to clarify this association by comparing long-term mortality between patients with and without postoperative hyperactive delirium, using propensity score matching for robust analysis. Methods We conducted a cohort study to evaluate the association between postoperative hyperactive delirium and long-term mortality in older patients undergoing emergency hip fracture surgery. We used the Taiwan National Health Insurance Service database to identify patients aged 65 years or older who underwent emergency hip fracture surgery between 2008 and 2018. The primary outcome was all-cause mortality. Results A total of 270,437 patients were included in the analysis, with 6,795 patients in the postoperative hyperactive delirium group and 263,642 patients in the no postoperative hyperactive delirium group. After PSM, both groups contained 6,795 patients, ensuring balanced baseline characteristics for comparison. Postoperative hyperactive delirium was an independent risk factor for all-cause death, with an adjusted hazard ratio of 1.62 (95% confidence interval, 1.51–1.74; P  < 0.0001) after PSM. Subgroup analysis revealed that older patients with postoperative hyperactive delirium consistently exhibited significantly higher adjusted hazard ratios of all-cause death compared with those without postoperative hyperactive delirium, regardless of age, sex, income levels, or ASA scores. Although the difference in 5-year overall survival between groups (81.7% vs. 89.8%, P  < 0.0001) was statistically significant, the high survival rates in both groups suggest a modest absolute clinical impact. Conclusion Postoperative hyperactive delirium is an independent risk factor for long-term mortality in older patients undergoing emergency hip fracture surgery. While the statistical association is evident, it is important to carefully consider the modest absolute difference in survival rates and its implications for clinical application. Key points Postoperative hyperactive delirium is independently associated with an increased risk of all-cause death in older patients undergoing hip fracture surgery. Patients with postoperative hyperactive delirium have a significantly higher adjusted hazard ratio for all-cause death compared to those without. Preventing and effectively managing postoperative hyperactive delirium in this population is crucial for improving long-term outcomes and reducing mortality.

PurposeTo elucidate the association of presurgical sarcopenia and long-term non-opioid analgesic and opioid use after elective surgery under general anesthesia.MethodsWe conducted this population-based propensity score matched to investigate the effects of sarcopenia and long-term non-opioid analgesic and opioid use after elective surgery under general anesthesia between 1 October 2016 and 31 December 2019 from Taiwan’s National Health Insurance Research Database. Sarcopenia is a disease and coded as M62.84 in the International Classification of Diseases, 10th Revision, Clinical Modification. The primary outcome was the combined rate of the long-term use of all non-opioid analgesics or opioids over 3 and 6 months after elective surgery. By performing a logistic regression analysis, we calculated the adjusted ORs (aORs) with 95% CIs to identify the independent predictors for long-term non-opioid analgesic and opioid use after surgery.ResultsIn total, 2860 patients underwent elective surgery. The 3-month non-opioid analgesic and opioid use rates were respectively 49.7% and 1.8% in the sarcopenia group and 37.9% and 0.9% in the non-sarcopenia group; by contrast, 6-month non-opioid analgesic and opioid use rates were respectively 31.6% and 1.2% in the sarcopenia group and 17.2% and 0.3% in the non-sarcopenia group. Moreover, presurgical sarcopenia increased the risk of long-term non-opioid analgesic and opioid use after elective surgery under general anesthesia (aORs for non-opioid analgesic use over 3 and 6 months after surgery: 1.17 (95% CI 1.05 to 2.23) and 1.26 (95% CI 1.04 to 1.45), respectively; aORs for opioid use over 3 and 6 months after surgery: 1.17 (95% CI 1.07 to 2.21) and 1.23 (95% CI 1.10 to 3.64), respectively).ConclusionSarcopenia is associated with higher rates of long-term non-opioid analgesic and opioid use after elective surgery under general anesthesia.SummaryThe aim of this study was to compare the long-term use of non-opioid analgesics and opioids after elective surgery under general anesthesia between patients with and without sarcopenia. Results suggest that patients with sarcopenia are more likely to have increased use of non-opioid analgesics and opioids after surgery. Further research is needed to determine if sarcopenia can be modified prior to surgery and if this impacts the need for long-term pain management with these medications.

Background Postoperative sepsis is a severe complication associated with increased mortality and potential long-term cognitive decline, including dementia. However, the relationship between postoperative sepsis and dementia remains poorly understood. Methods This retrospective cohort study used data from the National Database in Taiwan, covering the period from January 1, 2005, to December 31, 2022. The index period for surgeries was set between January 1, 2008, and December 31, 2013, allowing the identification of patients without prior dementia. A landmark period of 12 months following surgery was defined to capture the number of postoperative sepsis events, which were then analyzed for their impact on dementia risk. After 1:4 propensity score matching (PSM), dementia and mortality were evaluated using Cox proportional hazards and Fine-Gray competing risk models. Results Following PSM, 778 patients were in the postoperative sepsis group and 3,112 in the non-postoperative sepsis group. Dementia incidence was higher in the postoperative sepsis group (26%) compared to the non- postoperative sepsis group (13.6%), with a hazard ratio (HR) of 1.25 (95% CI, 1.03–1.52). A dose–response relationship was observed, with dementia rates of 24.5% for one postoperative sepsis event and 34.9% for two or more events, the latter showing an HR of 1.77 (95% CI, 1.17–2.66). Mortality was also elevated in the postoperative sepsis group (40.5% vs. 31.6%; HR 1.45, 95% CI, 1.28–1.65). Conclusions Postoperative sepsis is significantly associated with increased dementia risk in a dose-dependent manner. These findings highlight the importance of enhancing perioperative infection control to reduce both immediate and long-term cognitive complications.

Purpose This study investigates the impact of smoking on major postoperative complications following elective off-pump coronary artery bypass graft (CABG) surgery within an enhanced recovery after surgery (ERAS) program. Methods A total of 3168 patients who underwent elective off-pump and minimally invasive direct CABG under ERAS between January 1, 2017, and December 31, 2020, were enrolled. Propensity score matching was applied to minimize potential confounders when comparing postoperative outcomes between smokers and non-smokers. Results Multivariate logistic regression analyses showed no significant difference in 30-day postoperative mortality between smokers and non-smokers (adjusted odds ratio [aOR]: 1.06, 95% confidence interval [CI]: 0.40–1.56). However, smokers had a higher risk of 30-day major complications, including postoperative acute myocardial infarction (AMI) (aOR: 1.43, 95% CI: 1.02–1.99) and overall postoperative complications (aOR: 1.18, 95% CI: 1.04–1.48). Similarly, for the 31–90-day period, smokers had no significantly higher risk of mortality (aOR: 1.06, 95% CI: 0.49–1.19), but experienced higher rates of major complications, including postoperative AMI (aOR: 1.73, 95% CI: 1.17–2.55) and overall postoperative complications (aOR: 1.48, 95% CI: 1.13–1.92). Conclusions The ERAS program benefits patients undergoing CABG surgery, including smokers, by providing similar major postoperative outcomes to non-smokers, except for increased risks of postoperative AMI and overall complications.

The classical Lotka–Volterra model is mainly a two-dimensional configuration. The two-dimensional form limits the application scenarios of the Lotka–Volterra model. The research objective of this paper is to develop a feasible three population equilibrium model to analyze the industry competition. In order to expand the Lotka–Volterra model to empirical analysis, this paper proposes a symbiosis model of enterprise population based on a three-dimensional Lotka–Volterra model. This paper analyzes the symbiotic system from two aspects: the balanced development of three species and the competitive evolution of the three species, taking the sales volume of three local automobile enterprises in China as the sample for empirical analysis. The symbiotic optimization under the equilibrium state of three populations indicates that there is the possibility of equilibrium and reciprocity in the growth of three automobile product populations. The empirical analysis fully explains the feasibility of this research paradigm. The analysis of competition evolution shows that cooperative action is better than competitive strategy and that comprehensive cooperation is the ideal state of a three-population symbiotic system.

Purpose Postoperative complications and mortality following cholecystectomy persist despite the procedural simplicity. We utilized a nationwide administrative database from Taiwan and conducted propensity score matching (PSM) to investigate the association between sarcopenia and major postoperative complications. Patients and methods This retrospective cohort study analyzed data from the Taiwan National Health Insurance Research Database from 2016 to 2020. Patients who underwent elective cholecystectomy under general anesthesia for gallstone disease were included. They were categorized into two groups: those with sarcopenia and those without. The cohorts were matched at a 1:4 ratio using PSM. Results PSM yielded a final cohort of 13,330 surgical patients (10,664 without sarcopenia and 2666 with sarcopenia). Multivariate logistic regression demonstrated that sarcopenia was significantly associated with higher 30 day mortality (adjusted odds ratio [aOR] = 2.26, 95% confidence interval [CI] 1.61–3.18) and major complications, including acute renal failure (aOR = 1.71, 95% CI 1.02–2.84), pneumonia (aOR = 1.68, 95% CI 1.22–2.31), stroke (aOR = 1.13, 95% CI 1.06–1.57), and overall complications (aOR = 1.23, 95% CI 1.07–1.41). Sarcopenia also increased the risk of 90-day mortality (aOR = 2.09, 95% CI 1.58–2.76) and 90-day major complications, including acute renal failure (aOR = 1.61, 95% CI 1.01–2.56), pneumonia (aOR = 1.70, 95% CI 1.30–2.21), stroke (aOR = 1.28, 95% CI 1.04–1.58), and overall complications (aOR = 1.24, 95% CI 1.09–1.41). Conclusions We found that sarcopenia is an independent risk factor for increased postoperative complications and mortality following cholecystectomy. These findings highlight the importance of preoperative sarcopenia assessment to improve surgical outcomes.