To assess the association between the risk of malnutrition, as estimated by the Patient-Generated Subjective Global Assessment (PG-SGA) numerical scores, and adverse outcomes in oncology patients.

Systematic review and meta-analysis.

A comprehensive search was conducted in PubMed, Web of Science, Embase, CKNI, VIP, Sinomed and Wanfang databases. Studies that examined the association between the risk of malnutrition, as estimated by the PG-SGA numerical scores, and overall survival (OS) or postoperative complications in oncology patients were included. Patients were classified as low risk (PG-SGA ≤ 3), medium risk (PG-SGA 4–8) and high risk of malnutrition (PG-SGA > 8).

Nineteen studies reporting on twenty articles (n 9286 patients).

The prevalence of medium and high risk of malnutrition ranged from 16·0 % to 71·6 %. A meta-analysis showed that cancer patients with medium and high risk of malnutrition had a poorer OS (adjusted hazard ratios (HR) 1·98; 95 % CI 1·77, 2·21) compared with those with a low risk of malnutrition. Stratified analysis revealed that the pooled HR was 1·55 (95 % CI 1·17, 2·06) for medium risk of malnutrition and 2·65 (95 % CI 1·90, 3·70) for high risk of malnutrition. Additionally, the pooled adjusted OR for postoperative complications was 4·65 (95 % CI 1·61, 13·44) for patients at medium and high risk of malnutrition.

The presence of medium and high risk of malnutrition, as estimated by the PG-SGA numerical scores, is significantly linked to poorer OS and an increased risk of postoperative complications in oncology patients.

Coronavirus disease 2019 increased the numbers of patients requiring prolonged mechanical ventilation, with a subsequent increase in tracheostomy procedures. Coronavirus disease 2019 patients are high risk for surgical complications. This review examines open surgical and percutaneous tracheostomy complications in coronavirus disease 2019 patients.

Medline and Embase databases were searched (November 2021), and the abstracts of relevant articles were screened. Data were collected regarding tracheostomy technique and complications. Complication rates were compared between percutaneous and open surgical tracheostomy.

Percutaneous tracheostomy was higher risk for bleeding, pneumothorax and false passage. Surgical tracheostomy was higher risk for peri-operative hypoxia. The most common complication for both techniques was post-operative bleeding.

Coronavirus disease 2019 patients undergoing tracheostomy are at higher risk of bleeding and peri-operative hypoxia than non-coronavirus disease patients. High doses of anti-coagulants may partially explain this. Reasons for higher bleeding risk in percutaneous over open surgical technique remain unclear. Further research is required to determine the causes of differences found and to establish mitigating strategies.

Anecdotally, secondary post-tonsillectomy haemorrhage tends to occur out-of-hours. This study sought to establish whether there is a link between haemorrhage and time of day, and examined correlations with month and with monthly temperature.

Data were obtained for patients in our hospital undergoing surgical arrest of secondary post-tonsillectomy haemorrhage between January 2002 and December 2020. Haemorrhage timing was categorised into daytime (07:00–18:00), evening (18:00–22:00) and overnight (22:00–07:00). The chi-square test was used to assess diurnal and monthly variation in haemorrhage rates (p < 0.05). Pearson's correlation test was used to analyse monthly haemorrhage rates and average monthly temperature.

Fifty per cent of patients suffered post-tonsillectomy haemorrhage overnight and 28.1 per cent haemorrhaged in the evening, representing a significant difference (p = 0.018). The highest rate of haemorrhage was in July (2.96 per cent), which was statistically significant (p = 0.0024). There was a positive correlation between average monthly temperature and haemorrhage rate (Pearson's correlation = 0.478, p = 0.116004), although this was not significant.

Most post-tonsillectomy haemorrhages occur out-of-hours (78.1 per cent), which could be conveyed during the consent process. The haemorrhage rate is lower in winter, which may influence planned operating theatre scheduling.

Numerous factors are considered to impact on the rate of complications during salvage total laryngectomy procedures. Neck dissection could be one of these factors. This study analysed the pattern of lymph node metastasis and rate of occult neck disease during salvage total laryngectomy as well as the impact of neck dissection on survival and complication rates.

This was a retrospective analysis of a prospectively maintained laryngectomy database in two large tertiary teaching hospitals.

The rate of occult neck disease was 11.1 per cent. Most cases with occult neck disease had rT4 disease. Patients with complications, advanced tumour stage and positive margins had a significant decrease in overall survival. Patients receiving elective neck dissection did not have any survival benefit. Positron emission tomography-computed tomography showed a very high specificity and negative predictive value.

According to the low risk of occult neck disease when using contemporary imaging techniques as well as the lack of impact on survival, conservative management of the neck should be considered for crT1-T3 recurrence.

The Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (‘P-POSSUM’) is a two-part scoring system that includes a physiological assessment and a measure of operative severity. This study sought to determine whether risk estimates for this scoring system could be used in major head and neck reconstructive surgery.

A retrospective review was performed of patients undergoing resection for a temporal bone malignancy in a single head and neck centre in Dublin, Ireland, from 2002 to 2021.

The mean ± standard deviation morbidity estimate calculated using the scoring system was 47.6 per cent ± 19.5 per cent. The actual rate of complications was 47 per cent. The optimal cut-off for the scoring system was calculated using the Youden index from the receiver operating characteristic curve, which was 40.5 per cent in this case.

The study indicates that the Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity is a useful tool for predicting morbidity risk in patients undergoing head and neck resection with reconstruction for temporal bone malignancies.

This study aimed to determine the efficacy of probiotic gargles compared with placebo gargles on reducing post-tonsillectomy morbidity in adults.

This was a triple-blind, randomised, controlled trial and feasibility study. Thirty adults underwent elective tonsillectomy and were randomly assigned to receive either probiotic or placebo gargles for 14 days after surgery. Daily pain scores and requirement of analgesia were measured for 14 days post-operatively. Secondary outcomes assessed probiotic safety and tolerability and the feasibility of the trial.

The probiotic group experienced less pain at rest on day 2. However, the amount of oxycodone (5 mg) tablets used was greater in the probiotic group compared with placebo. There were no statistically significant differences in the frequency of adverse effects between both groups. This trial was feasible.

This pilot study suggested that probiotic gargles do not reduce post-tonsillectomy pain or bleeding, highlighting the importance of pilot and feasibility studies in clinical research.

Tonsillectomy is a common surgical procedure in the UK. This study critically examined the current advice provided by UK hospitals to patients about post-operative care.

Post-tonsillectomy patient advice sheets were obtained from 110 UK National Health Service trusts and equivalent organisations. Their contents were analysed and compared with published literature to determine whether the advice being given to patients was evidence-based.

Post-tonsillectomy dietary and fluid intake advice varied between hospitals; although many recommended eating and drinking a normal diet (88 per cent), some recommended eating ‘hard’ (26 per cent) or ‘soft’ (8 per cent) foods. Non-evidence based advice given included avoiding fizzy drinks (21 per cent), fruit juices (9 per cent) and using chewing gum (51 per cent). Reported post-operative risks and safety-netting also varied.

Much of the advice in the available printed information appeared to be anecdotal and not based on, or was contrary to, published evidence. After review of the literature, an evidence-based post-tonsillectomy patient advice sheet was generated for dissemination.

Hypocalcaemia is the most common complication after total or completion thyroidectomy. This study assesses recent evidence on predictive factors for post-thyroidectomy hypocalcaemia in order to identify the patients affected and aid prevention.

Two authors independently assessed articles and extracted data to provide a narrative synthesis. This study was an updated systematic search and narrative review regarding predictors of post-thyroidectomy hypocalcaemia using the Ovid Medline, Embase, Cochrane and Cinahl databases. Results were limited to papers published from January 2012 to August 2019.

Sixty-three observational studies with a total of 210 401 patients met the inclusion criteria. The median incidence was 27.5 per cent for transient biochemical hypocalcaemia, 12.5 per cent for symptomatic hypocalcaemia and 2.2 per cent for permanent hypocalcaemia. The most frequent statistically significant predictor of hypocalcaemia was peri-operative parathyroid hormone level. Symptomatic hypocalcaemia and permanent hypocalcaemia were seen more frequently in patients undergoing concomitant neck dissection.

Many factors have been studied for their link to post-thyroidectomy hypocalcaemia, and this study assesses the recent evidence presented in each case.

This prospective, epidemiological British Ophthalmological Surveillance Unit study into ophthalmic complications of functional endoscopic sinus surgery aimed to determine the minimum incidence, presenting features and management throughout the UK.

Cases of ophthalmic complications of functional endoscopic sinus surgery, between February 2016 and February 2018, were identified through the British Ophthalmological Surveillance Unit reporting card system. Reporting ophthalmic consultants were sent an initial questionnaire, followed by a second questionnaire at six months.

Twenty-six cases of ophthalmic complications of functional endoscopic sinus surgery were reported. The majority (16 cases (62 per cent)) had limitations of ocular motility at presentation. The most common final diagnosis was rectus muscle (33 per cent) and nasolacrimal duct trauma (27 per cent). Using national data, this study reports a minimum incidence of ophthalmic complications of functional endoscopic sinus surgery in the UK of 0.2 per cent over two years.

In terms of ophthalmic complications, functional endoscopic sinus surgery is shown to be safe. Ophthalmic complications are rare, but when they do occur, they commonly result in rectus muscle trauma, often requiring surgical intervention.

The sternocleidomastoid can be used as a pedicled flap in head and neck reconstruction. It has previously been associated with high complication rates, likely due in part to the variable nature of its blood supply.

To provide clinicians with an up-to-date review of clinical outcomes of sternocleidomastoid flap surgery in head and neck reconstruction, integrated with a review of vascular anatomical studies of the sternocleidomastoid.

A literature search of the Medline and Web of Science databases was conducted. Complications were analysed for each study. The trend in success rates was analysed by date of the study.

Reported complication rates have improved over time. The preservation of two vascular pedicles rather than one may have contributed to improved outcomes.

The sternocleidomastoid flap is a versatile option for patients where prolonged free flap surgery is inappropriate. Modern vascular imaging techniques could optimise pre-operative planning.

Autoinflation devices are commonly used for otitis media with effusion and Eustachian tube dysfunction. Generally, these are very safe devices, with few or no complications.

This paper presents a case study of pneumocephalus and orbital emphysema, associated with the use of an autoinflation device, in a 73-year-old woman with Eustachian tube dysfunction and otitis media with effusion, and a history of extensive endoscopic sinus surgery 13 years previously.

A literature review showed autoinflation-related pneumocephalus in patients with skull base defects relating to cranial surgery or tumours; however, this has not been described previously with the Otovent system or its use in relation to functional endoscopic sinus surgery. Given the theoretical risk of undetected bony abnormalities in post-operative functional endoscopic sinus surgery patients, it is suggested that autoinflation devices are used cautiously in patients with a history of sinus surgery.

Parapharyngeal abscess and mediastinitis are rare but very severe post-operative complications following an elective tonsillectomy. Parapharyngeal abscess as a complication to tonsilectomy is very seldom described in the literature and no cases in the paediatric population have been described.

This paper presents, to our knowledge, the first case of life-threatening parapharyngeal abscess and mediastinitis following elective adenotonsillectomy in an otherwise healthy, fully vaccinated 10-year-old girl.

Diagnosing parapharyngeal abscess and mediastinitis can be challenging, but should be suspected and ruled out in cases of post-operative odynophagia, fever, and/or neck swelling and thoracic pain. Diagnosis is made based on magnetic resonance imaging and computed tomography findings. Prompt broad-spectrum intravenous antibiotic treatment and surgical drainage should be initiated. Other severe complications such as meningitis should also be considered.

Submucosal diathermy to the inferior turbinate is a widely practised procedure to improve the nasal airway when nasal obstruction is due to hypertrophy of the inferior turbinate. This paper reports a case of an unusual nasolacrimal complication following submucosal diathermy to the inferior turbinate, and reviews the relevant literature.

A 33-year-old male patient developed a patulous nasolacrimal duct opening following submucosal diathermy of the inferior turbinate. This resulted in spontaneous reflux of air and nasal mucus on to the ocular surface.

This newly recognised complication of submucosal diathermy to the inferior turbinate indicates the need to be aware of the potential risk to the nasolacrimal system with this technique.

Dislocation of the cochlear implant magnet is an uncommon but recognised complication of magnetic resonance imaging in a patient with a cochlear implant.

This paper reports a case of cochlear implant magnet dislocation despite head bandaging. The patient subsequently underwent endoscopic repositioning of the magnet under general anaesthesia. The cochlear implant system was tested intra-operatively and confirmed to be functioning. The patient was well at follow up and the small wound healed well with no complications.

This report presents the endoscopic technique as a viable minimally invasive surgical approach to address cochlear implant magnet dislocation.

Totally endoscopic ear surgery and endoscope-assisted microsurgery are still new concepts, with relatively few centres in the UK performing them. Advantages include better visualisation of difficult to reach areas, such as the sinus tympani, and limited external incisions. This paper reports our short-term outcomes for endoscopic middle-ear surgery.

A prospective review was conducted of the first 103 consecutive patients undergoing totally endoscopic ear surgery or endoscope-assisted microsurgery in 1 centre performed by 1 operator. The outcomes assessed were: tympanic membrane healing, audiological data and complications.

Twenty-five patients underwent endoscope-assisted microsurgery, while 78 had totally endoscopic ear surgery. There were no reported cases of dead ear or permanent facial nerve palsy. The average air–bone gap following stapedectomy was 7.38 dB. The tympanic membrane healing rate was 89 per cent.

Our results confirm that endoscopic middle-ear surgery is safe, and the short-term outcomes are comparable with conventional surgery.

To observe the effects of magnetic resonance imaging scans in Vibrant Soundbridge 503 implantees at 1.5T in vivo.

In a prospective case study of five Vibrant Soundbridge 503 implantees, 1.5T magnetic resonance imaging scans were performed with and without a headband. The degree of pain was evaluated using a visual analogue scale. Scan-related pure tone audiogram and audio processor fitting changes were assessed.

In all patients, magnetic resonance imaging scans were performed without any degree of pain or change in pure tone audiogram or audio processor fitting, even without a headband.

In this series, 1.5T magnetic resonance imaging scans were performed with the Vibrant Soundbridge 503 without complications. Limitations persist in terms of magnetic artefacts.

Re-stenosis and a consequent need for revision surgery are the most common problems in the follow-up period following endoscopic modification of the Lothrop procedure.

This paper reports a new technique for reconstructing and resurfacing of the posterior frontal recess bone for prevention of re-stenosis.

A 46-year-old man presented with a frontal sinus osteoma, and treatment featured an endoscopic modification of the Lothrop procedure. A vascularised, posteriorly based, septal mucosal flap was used in reconstruction. There have been no reported issues over 24 months of follow up.

The use of a nasoseptal flap seems feasible to reduce scarring and recurrence of (common) frontal recess stenosis after a Draf III operation.

The safety of day-case tonsillectomy is widely documented in the literature; however, there are no evidence-based guidelines recommending patient characteristics that are incompatible with day-case tonsillectomy. This study aimed to identify which patients should be considered unsafe for day-case tonsillectomy based on the likelihood of needing critical intervention.

Retrospective review of 2863 tonsillectomy procedures performed at University Hospital Geelong from 1998 to 2014.

Of the patients, 7.81 per cent suffered a post-tonsillectomy complication and 4.15 per cent required intervention. The most serious complications, haemorrhage requiring a return to the operating theatre and airway compromise, occurred in 0.56 per cent and 0.11 per cent of patients respectively. The following patient characteristics were significantly associated with poorer outcomes: age of two years or less (p < 0.01), tonsillectomy indicated for neoplasm (p < 0.01) and quinsy (p < 0.05).

The authors believe that all elective tonsillectomy patients should be considered for day-case surgery, with the following criteria necessitating overnight observation: age of two years or less; an indication for tonsillectomy of neoplasm or quinsy; and an American Society of Anesthesia score of more than 2.