Lymphoedema affects about half of head and neck radiotherapy patients, dexmedetomidine may cut delirium after free-flap surgery, and obesity raises early tonsillectomy complications

The edition in brief

A meta-analysis of 26 mostly retrospective studies (3,133 patients) found pooled lymphoedema prevalence after head and neck radiotherapy of 49% (95% CI 36-62%) with very high heterogeneity (I-squared 94%), 32% for grade 2 or worse, and very low certainty; the authors suggest surveillance within survivorship care. A single-centre randomised trial's delirium analysis (96 patients having free-flap reconstruction) found delirium in 14.9% with intraoperative dexmedetomidine against 34.7% with placebo over 5 days (adjusted OR 0.31, 95% CI 0.10-0.92). A National Cancer Database analysis of 58,184 HPV-negative head and neck cancer patients modelled universal postoperative radiotherapy within 42 days and predicted no change in 5-year overall survival (0.58 observed and predicted), though it is observational and modelled. A meta-analysis of 18 studies (60,044 children) found post-tonsillectomy respiratory complications in 12.2% of children with obesity against 7.6% without (OR 1.86, 95% CI 1.38-2.49), with the excess seen only in studies that counted recovery room events.