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Table 3 Summary of findings for intranasal hot saline irrigation versus room temperature saline irrigation

From: The hemostatic effect of hot saline irrigation in endoscopic sinus surgery: a systematic review and meta-analysis

Hemostatic effect of intranasal hot saline irrigation during endoscopic surgery

Patient or population: Chronic rhinosinusitis

Setting: Endoscopic sinus surgery

Intervention: Hot saline irrigation (48–50 °C)

Comparison: Room temperature saline irrigation (18–20 °C)

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect (95% CI)

№ of participants (studies)

Certainty of the evidence (GRADE)*

Risk with RTSI

Risk with HSI

Intraoperative bleeding score

The mean intraoperative bleeding score was 0

MD 0.51 lower (0.84 lower to 0.18 lower)

212

(3 RCTs)

Very lowa,b

Mean arterial pressure

The mean mean arterial pressure was 0

MD 0.6 lower (2.17 lower to 0.97 higher)

212

(3 RCTs)

Lowa

Surgeon’s satisfaction score

680 per 1000

122 per 1,000 (61 to 224)

RR 0.18 (0.09 to 0.33)

150

(2 RCTs)

Lowa

Duration of surgery (minutes)

The mean duration of surgery (minutes) was 0

MD 9.02 lower (11.76 lower to 6.28 lower)

212

(3 RCTs)

Very lowa,c

Amount of blood loss (ml)

The mean amount of blood loss (ml) was 0

MD 56.4 lower (57.3 lower to 55.51 lower)

212

(3 RCTs)

Lowa

  1. GRADE Working Group grades of evidence
  2. High certainty: we are very confident that the true effect lies close to that of the estimate of the effect.
  3. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
  4. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
  5. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
  6. *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
  7. CI confidence interval; MD mean difference; RR risk ratio; RCT randomized controlled trial; RTSI room temperature saline irrigation; HIS hot saline irrigation
  8. aWe downgraded the quality of evidence by two due to high risk of performance bias where two trials did not report if the participants and the medical personnel were blinded
  9. bWe downgraded the quality of evidence by one due to inconsistency in the methodology among the included studies (heterogeneity of 72%)
  10. cWe downgraded the quality of evidence by one due to imprecision (one study [15], has a small effect and wide CI whereas the other two studies [13, 14] have a very large effect)