{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T15:37:08Z","timestamp":1777563428274,"version":"3.51.4"},"reference-count":37,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:00:00Z","timestamp":1771286400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:00:00Z","timestamp":1771286400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ear Nose Throat J"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Intraoperative bleeding during endoscopic sinus surgery (ESS) impairs visualization and increases operative risks. Hot saline irrigation (HSI) has been proposed as a simple, safe hemostatic adjunct compared with room temperature saline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To evaluate the effects of HSI versus room temperature saline on surgical field visibility, blood loss, operative duration, and hemodynamic stability in ESS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Systematic review and meta-analysis of randomized and nonrandomized controlled trials identified through PubMed, Embase, Cochrane CENTRAL, and ClinicalTrials.gov up to 30 October 2025. Outcomes were pooled using random-effects inverse-variance models in RevMan 5.4.1 by Cochrane.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Seven studies (n\u2009=\u2009453 patients) were included. HSI significantly improved Boezaart bleeding scores (mean difference [MD] \u22120.68, 95% confidence interval [CI] \u22121.01 to \u22120.34;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.0002;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200979.7%), reduced intraoperative blood loss (MD \u221256.33\u2009mL, 95% CI \u221257.22 to \u221255.44;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200937.1%), and shortened operative time (MD \u22129.78\u2009minutes, 95% CI \u221214.62 to \u22124.94;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.0001;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200985.0%). No significant difference was observed in mean arterial pressure (MD \u22120.68\u2009mmHg, 95% CI \u22122.22 to 0.86;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.39).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>HSI significantly enhances surgical field visibility, reduces blood loss, and shortens operative duration during ESS without affecting hemodynamic stability. It represents a safe, low-cost alternative or complement to pharmacological hemostatic agents.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/01455613261423742","type":"journal-article","created":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T04:15:02Z","timestamp":1771388102000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Hot Saline Irrigation for Improving Surgical Field Visibility in Endoscopic Sinus Surgery: A Systematic Review and Meta-Analysis"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6118-717X","authenticated-orcid":false,"given":"Abdur","family":"Rehman","sequence":"first","affiliation":[{"name":"Department of ENT, Head &amp; Neck Surgery, Benazir Bhutto Hospital, Rawalpindi, Punjab, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shahzaib","family":"Maqbool","sequence":"additional","affiliation":[{"name":"Internal Medicine, HCA Healthcare Centerpoint Medical Center, MO, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Rawalpindi Medical University, Rawalpindi, Punjab, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taha","family":"Iftikhar","sequence":"additional","affiliation":[{"name":"Rawalpindi Medical University, Rawalpindi, Punjab, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9830-5649","authenticated-orcid":false,"given":"Rahmat Gul","family":"Omarzai","sequence":"additional","affiliation":[{"name":"Nangarhar University, Daronta, Nangarhar, Afghanistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sadia","family":"Chaudhry","sequence":"additional","affiliation":[{"name":"Department of ENT, Head &amp; Neck Surgery, Benazir Bhutto Hospital, Rawalpindi, Punjab, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,2,17]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1080\/14740338.2021.1926981"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005537-199802000-00001"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-022-02113-0"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-024-09005-0"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.4103\/1012-5574.144965"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/alr.21376"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.12816\/0023354"},{"issue":"1","key":"e_1_3_2_9_2","first-page":"14","article-title":"Histological changes in the nasal mucosa after hot-water irrigation. 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