Obese children's extra breathing risk after tonsillectomy shows up in recovery, not on the ward

The edition in brief

A systematic review of 18 studies (60,044 children) found respiratory complications after tonsillectomy in 12.2% of children with obesity and 7.6% of others (OR 1.86), but the excess appeared only in studies that counted events in the post-anaesthesia care unit; in studies limited to the ward, obesity did not raise the odds. The authors suggest obese children who are well through recovery may be safe to discharge. Pooling 26 studies (3,133 patients), lymphoedema affected about half of adults after radiotherapy for mucosal head and neck cancer (49%), with grade 2 or worse in about a third; certainty was very low. In a secondary analysis of a randomised trial of 96 patients having head and neck cancer surgery with free-flap reconstruction, intraoperative dexmedetomidine was associated with less delirium over five days (14.9% vs 34.7%; adjusted OR 0.31). Across 277,187 US ENT operations, 90-day venous thromboembolism occurred in 0.63%, rising to 6.1% after free tissue transfer and 4.4% after lateral skull base surgery; a previous clot was the strongest risk factor. The pearl covers secondary post-tonsillectomy bleeding.