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Hu Y, Yan A, Jiang F. Effect of Clindamycin compared with Ampicillin-Sulbactam as prophylactic antibiotics for wound infections following major surgery for head and neck cancer: A meta-analysis. Int Wound J 2023; 20:4151-4158. [PMID: 37483017 PMCID: PMC10681415 DOI: 10.1111/iwj.14312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 06/28/2023] [Accepted: 07/01/2023] [Indexed: 07/25/2023] Open
Abstract
A meta-analysis examination was implemented to review the effect of Clindamycin compared with Ampicillin-Sulbactam as prophylactic antibiotics (PAs) management for surgical site wound infections (SSWIs) following major surgery (MS) for head and neck cancer (H&NC). A comprehensive literature examination till May 2023 was done and 1296 interrelated examinations were reviewed. The six elected examinations, enclosed 4293 personals with MS for H&NC were in the utilized examinations' starting point, 1722 of them were utilizing Clindamycin, and 2571 were utilizing Ampicillin-Sulbactam. Odds ratio (OR) and 95% confidence intervals (CIs) were utilized to appraise the consequence of Clindamycin compared with Ampicillin-Sulbactam as PAs management for SSWIs following MS for H&NC by the dichotomous approach and a fixed or random model. Clindamycin had significantly higher SSWI compared with Ampicillin-Sulbactam (OR, 2.65; 95% CI, 1.40-5.02, p = 0.003) in personals with MS for H&NC. Clindamycin had significantly higher SSWI compared with Ampicillin-Sulbactam in personals with MS for H&NC. However, caution needs to be taken when interacting with its values because there was a low sample size of some of the chosen examinations and a low number of examinations found for the comparisons in the meta-analysis.
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Affiliation(s)
- Yue Hu
- Department of OtorhinolaryngologyThe First Hospital of China Medical UniversityShenyangLiaoningChina
| | - Aihui Yan
- Department of OtorhinolaryngologyThe First Hospital of China Medical UniversityShenyangLiaoningChina
| | - Feifei Jiang
- Department of OtorhinolaryngologyThe First Hospital of China Medical UniversityShenyangLiaoningChina
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2
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Tunio S, Dzioba A, Dhami R, Elsayed S, Strychowsky JE. Auto-Substitutions to Optimize Perioperative Antimicrobial Prophylaxis: Pre-Post Intervention Study. Laryngoscope 2023; 133:3403-3408. [PMID: 37159098 DOI: 10.1002/lary.30740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/23/2023] [Accepted: 04/27/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Appropriate administration of perioperative antibiotics can prevent antimicrobial resistance, adverse drug events, surgical site infections, and increased costs to the health care system for many surgeries in Otolaryngology-Head and Neck Surgery (OHNS). OBJECTIVE The objective of the study is to achieve 90% compliance with evidence-based perioperative antibiotic prophylaxis guidelines among elective surgical procedures in OHNS. METHODS The pre-intervention group consisted of patients undergoing elective surgical procedures in the 13 months prior to the interventions (September 2019-2020) whereas the post-intervention group comprised patients undergoing elective procedures during the 8 months following the implementation (October 2020-May 2021). The 4 Es of knowledge translation and the Donabedian framework were used to frame the study. Components of the intervention included educational grand rounds and automatic substitutions in electronic health records. In June 2021, a survey of staff and residents assessed the self-reported perception of following evidence-based guidelines. RESULTS Compliance with antimicrobial prophylaxis guidelines were evaluated based on agent and dose. The overall compliance improved from 38.8% pre-intervention to 59.0% post-intervention (p < 0.001). Agent compliance did not improve from pre- to post-intervention, that is, 60.7% to 62.8%, respectively, (p = 0.68), whereas dose compliance improved from 39.6% to 89.2% (p < 0.001). Approximately 78.5% of survey respondents felt that they strongly agreed or agreed with always following evidence-based antimicrobial prophylaxis guidelines. CONCLUSION Compliance with antimicrobial prophylaxis guidelines improved, primarily due to increased dosing compliance. Future interventions will target agent compliance and selected procedures with lower compliance rates. LEVEL OF EVIDENCE 3 Laryngoscope, 133:3403-3408, 2023.
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Affiliation(s)
- Suhaima Tunio
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Agnieszka Dzioba
- Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada
| | - Rita Dhami
- Department of Pharmacy, London Health Sciences Centre, London, Ontario, Canada
- Department of Health Sciences, Western University, London, Ontario, Canada
| | - Sameer Elsayed
- Department of Medicine, Western University, London, Ontario, Canada
- Department of Pathology & Laboratory Medicine, Western University, London, Ontario, Canada
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Julie E Strychowsky
- Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada
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Locatello LG, Saitta T, Maggiore G, Signorini P, Pinelli F, Adembri C. A 5-year experience with midline catheters in the management of major head and neck surgery patients. J Vasc Access 2023; 24:1412-1420. [PMID: 35441553 DOI: 10.1177/11297298221091141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In the perioperative management of major head and neck surgery (HNS) patients, the performance of midline catheters (MCs) has been never tested. We present here our 5-year experience by reporting MC-related complications and by identifying the preoperative risk factors associated with their development. METHODS Clinical variables were extracted and the dwell time, the number, and the type of postprocedural complications of MCs were retrieved. Complications were classified into major (needing MCs removal and including catheter-related bloodstream infection or deep vein thrombosis or catheter occlusion) and into minor (accidental dislodgement, leaking, etc.). Descriptive statistics and logistic regression models were used in order to identify the predictors of complications. RESULTS A total of 265 patients were included, with a mean age of 67.4 years. Intraprocedural complications occurred in 1.1% of cases, while postprocedural complications occurred in 13.9% of cases (12.05/1000 days), but they were minor in more than 7.0% (5.4/1000 catheter-days). There were 19 minor complications (7.1% or 5.4/1000 catheter-days) while 18 (7%, 5.1/1000 catheter-days) patients experienced at least one major complication. Female sex (OR = 1.963, 95% CI 1.017-3.792), insertion in the right arm (OR = 2.473, 95% CI 1.150-5.318), and an ACE-27 score >1 (OR = 2.573, 95% CI 1.295-5.110) were independent predictors of major complications. CONCLUSIONS MCs appear to represent an effective option in the setting of major HNS. The identification of patients most at risk for MC-related complications should prompt a postoperative watchful evaluation.
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Affiliation(s)
| | - Thomas Saitta
- Section of Anesthesiology and Intensive Care, Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Patrizia Signorini
- Department of Anesthesiology, Careggi University Hospital, Florence, Italy
| | - Fulvio Pinelli
- Department of Anesthesiology, Careggi University Hospital, Florence, Italy
| | - Chiara Adembri
- Section of Anesthesiology and Intensive Care, Department of Health Sciences, University of Florence, Florence, Italy
- Department of Anesthesiology, Careggi University Hospital, Florence, Italy
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4
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Wang Y, Wang M, Hou L, Xiang F, Zhao X, Qian M. Incidence and risk factors of surgical site infection in patients with head and neck cancer: A meta-analysis. Head Neck 2023; 45:2925-2944. [PMID: 37676108 DOI: 10.1002/hed.27504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/08/2023] [Accepted: 08/20/2023] [Indexed: 09/08/2023] Open
Abstract
We systematically review the incidence and risk factors of surgical site infection (SSI) in patients with head and neck cancer. PubMed, Embase, Cochrane Library, and Web of Science databases were searched to obtain studies on the risk factors for SSI in patients with HNC. The retrieval time was from the establishment of the database to February 2023. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias in included studies. Meta-analysis was performed by using Stata 15.1 software. A total of 32 articles including 128 919 patients with head and neck cancer and 2949 cases of SSI were included in this meta-analysis. The incidence rate of SSI in head and neck cancer ranges from 19% to 29%, and the overall infection rate was 24%. Meta-analysis indicated that BMI < 20 kg/m2 (OR, 2.64; 95% CI, 1.74-4.00; I2 , 0%), diabetes (OR, 3.00; 95% CI, 2.12-4.16; I2 , 60.6%), ASA score (OR, 1.51; 95% CI, 1.29-1.77; I2 , 0%), radiotherapy (OR, 2.27; 95% CI, 1.87-2.77; I2 , 44.8%), chemotherapy (OR, 2.36; 95% CI, 1.64-3.40; I2 , 0%), clindamycin antibiotic (OR, 2.99; 95% CI, 1.82-2.93; I2 , 36.5%), deficit repair (OR, 3.76; 95% CI, 1.22-11.59; I2 , 91.4%), neck dissection (OR, 2.13; 95% CI, 1.63-2.79; I2 , 16.4%), blood transfusion (OR, 2.29; 95% CI, 1.52-3.45; I2 , 66.2%), mandibular (OR, 3.17; 95% CI, 1.85-5.42; I2 , 73%), tracheostomy (OR, 2.51; 95% CI, 1.74-3.62; I2 , 86.4%), operation time (OR, 1.42; 95% CI, 1.16-1.74; I2 , 86.4%), ALB (OR, 2.48; 95% CI, 1.95-3.15; I2 , 5.3%) were risk factors of surgical site infection in patients with head and neck cancer (p < 0.05). The results of the sensitivity analysis showed good agreement in all risk factors and the results had stability. The present meta-analysis suggests that BMI < 20 kg/m2 , diabetes, ASA score, radiotherapy, chemotherapy, clindamycin antibiotic, deficit repair, neck dissection, blood transfusion, mandibular, tracheostomy, operation time, and ALB were significant risk factors for SSI.
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Affiliation(s)
- Yu Wang
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Nursing, Affiliated Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingyi Wang
- Department of Oral Maxillofacial & Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lili Hou
- Department of Nursing, Affiliated Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fuping Xiang
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Nursing, Affiliated Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaomei Zhao
- Department of Oral Maxillofacial & Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Meizhen Qian
- Department of Oral Maxillofacial & Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Godse NR, Snyderman CH. Analysis of Otolaryngologic Readmissions at a High-Volume Quaternary Referral Center. Laryngoscope 2023; 133:2546-2552. [PMID: 36633352 DOI: 10.1002/lary.30563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 11/24/2022] [Accepted: 12/28/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To identify common reasons for readmission following otolaryngologic surgery at a high-volume center and identify possible risk factors for readmission. METHODS Retrospective chart review of readmissions identified by hospital-based electronic medical record reporting mechanism. RESULTS From January 2019 to September 2020, there were 87 readmissions following 808 index surgeries. The most common reason for readmission was for planned surgery (23%), followed by post-operative neck infection, bleeding, or pneumonia. Patients with unplanned readmissions had significantly longer index admission duration than patients who were not readmitted (median 7 days vs. median 5 days, resp.; p = 0.0056). Analysis of cases of unplanned readmission for neck infection and bleeding identified the oral cavity/pharynx as the most common site of initial surgery and that a majority of patients had a history of radiation therapy. CONCLUSION Neck infection, bleeding, and pneumonia were the most common reasons for unplanned readmission following otolaryngologic surgery, and a large portion of patients required additional procedures during readmission. Unplanned readmissions for bleeding were significantly more costly than readmissions for neck infections. Long-index hospitalizations, index surgery involving the oral cavity and pharynx, and a history of radiation therapy may be useful clinical features that could stratify the risk of readmission. LEVEL OF EVIDENCE 4, retrospective chart review Laryngoscope, 133:2546-2552, 2023.
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Affiliation(s)
- Neal R Godse
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Carl H Snyderman
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Sugimoto R, Yamanaka H, Tsuge I, Katayama Y, Katsube M, Sakamoto M, Morimoto N. Two-stage skin grafting using a basic fibroblast growth factor-impregnated artificial dermis. Regen Ther 2022; 21:258-262. [PMID: 36092498 PMCID: PMC9420932 DOI: 10.1016/j.reth.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/17/2022] [Indexed: 11/26/2022] Open
Abstract
For traditional artificial dermises, a waiting period of approximately three weeks is required after the first implantation before they are adequately vascularized. The objective of this retrospective case series was to investigate whether full-thickness skin defects, requiring surgical reconstruction, could be successfully treated by implantation of a basic fibroblast growth factor (bFGF)-impregnated artificial dermis and secondary skin grafting with a shorter waiting period. Between January 2019 and January 2021, 19 skin defects in 14 patients (7 male and 7 female) were treated with two-stage skin grafting using bFGF-impregnated collagen-gelatin sponge (CGS). All of them were included in this case series, and the waiting period for skin grafting, success rate of skin grafting, infection during the waiting period, and scar quality 6–12 months postoperatively were retrospectively investigated. As a result, all skin grafting surgeries were successfully performed with a waiting period of 13.3 ± 4.3 days. Infection during the waiting period was observed in three lesions (15.8%); however, all infections were controllable. Postoperative scar quality was acceptable (Vancouver Scar Scale score range, 1–8). In conclusion, compared to traditional artificial dermises, bFGF-impregnated CGSs have the potential to shorten the waiting period without decreasing the success rate of skin grafting. Further studies are required to confirm this finding. We previously developed a novel artificial dermis which is capable of sustained release of bFGF. Skin defects were successfully treated by two-stage skin grafting using bFGF-impregnated CGS. The use of bFGF-impregnated CGS allowed for a short waiting period for secondary skin grafting.
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7
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Practice patterns in transoral robotic surgery: results of an American head and neck society survey. J Robot Surg 2022; 17:549-556. [PMID: 35933632 DOI: 10.1007/s11701-022-01448-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/21/2022] [Indexed: 10/15/2022]
Abstract
To understand perioperative practices for transoral robotic surgery (TORS) among academic medical centers. An electronic cross-sectional survey was distributed to fellows and program directors participating in 49 American Head and Neck Society fellowships. Operative decisions, medical and swallowing management, and disposition planning were assessed. Thirty-eight responses were collected (77.6%). Twenty-three centers (60.5%) performed > 25 cases annually with the remainder performing fewer. The da Vinci Si was the most commonly used platform (n = 28, 73.7%). A majority of institutions advocated tailored resection to adequate margins (n = 27, 71.1%) over fixed subunit-based resection (n = 11, 28.9%). Most surgeons (n = 29, 76.3%) performed neck dissection concurrent with TORS, and 89.5% (n = 34) routinely ligated external carotid artery branches. A minority of institutions (n = 17, 45.9%) endorsed a standardized TORS care pathway. Antibiotic choices and duration varied, the most common choice being ampicillin/sulbactam (n = 21, 55.3%), and the most common duration being 24 h or less (n = 22, 57.9%). Multimodal analgesia was used at 36 centers (94.7%), steroids at 31 centers (81.6%), and pharmacologic venous thromboembolic prophylaxis at 29 centers (76.3%). Nasogastric feeding tubes were placed during surgery at 20 institutions (54.1%). Speech-language pathologists routinely performed postoperative swallow evaluations at 29 (78.4%) sites. Practice patterns are variable among institutions performing TORS. While certain surgical and postoperative practices were quite common, many institutions reported no standard TORS care pathway. Further understanding of the impact of individual practices on outcomes is necessary to develop evidence-based perioperative protocols for TORS.
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8
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Liu MY, Challa M, McCoul ED, Chen PG. Economic Viability of Penicillin Allergy Testing to Avoid Improper Clindamycin Surgical Prophylaxis. Laryngoscope 2022; 133:1086-1091. [PMID: 35904127 DOI: 10.1002/lary.30329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/07/2022] [Accepted: 07/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patients mislabeled with a penicillin allergy are often unnecessarily given prophylactic clindamycin. Thus, otolaryngologists may cause harm due to clindamycin's associated risk of Clostridioides difficile infections (CDI) and surgical site infections (SSI). The objective of this study was to determine the economic feasibility of penicillin allergy testing in preventing unnecessary clindamycin use among patients with an unconfirmed penicillin allergy prior to otolaryngologic surgery. METHODS A break-even analysis was performed using the average cost of penicillin allergy testing and a CDI/SSI to calculate the absolute risk reduction (ARR) in baseline CDI/SSI rate due to clindamycin required for penicillin testing to be economically sustainable. The binomial distribution was used to calculate the probability that current penicillin testing can achieve this study's ARR. RESULTS Preoperative penicillin testing was found to be economically sustainable if it could decrease the baseline CDI rate by an ARR of 1.06% or decrease the baseline SSI rate by an ARR of 1.34%. The probability of penicillin testing achieving these ARRs depended on the baseline CDI and SSI rates. When the CDI rate was at least 5% or the SSI rate was at least 7%, penicillin allergy testing was guaranteed to achieve economic sustainability. CONCLUSION In patients mislabeled with a penicillin allergy, preoperative penicillin allergy testing may be an economically sustainable option to prevent the unnecessary use of prophylactic clindamycin during otolaryngologic surgery. Current practice guidelines should be modified to recommend penicillin allergy testing in patients with an unconfirmed allergy prior to surgery. LEVEL OF EVIDENCE N/A Laryngoscope, 2022.
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Affiliation(s)
- Matthew Y Liu
- Dell Medical School, The University of Texas at Austin, Austin, Texas, USA.,Department of Otolaryngology - Head and Neck Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Megana Challa
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Edward D McCoul
- Department of Otorhinolaryngology, Ochsner Health System, New Orleans, Louisiana, USA.,Department of Otolaryngology - Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Philip G Chen
- Department of Otolaryngology - Head and Neck Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Chiesa-Estomba CM, Calvo-Henriquez C, Gonçalves N, Lechien JR, Sistiaga-Suarez JA, Mayo-Yanez M, Gonzalez-Garcia JA, Nandhan R, Martinez F, Ayad T. Patterns of practice regarding surgical site infection prevention in head & neck surgery: An international survey. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022. [DOI: 10.1016/j.otorri.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Chiesa-Estomba CM, Calvo-Henriquez C, Gonçalves N, Lechien JR, Sistiaga-Suarez JA, Mayo-Yanez M, Gonzalez-Garcia JA, Nandhan R, Martinez F, Ayad T. Patterns of practice regarding surgical site infection prevention in head & neck surgery: An international survey. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022; 73:225-234. [PMID: 35908816 DOI: 10.1016/j.otoeng.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/29/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Head & neck surgery encompasses a variety of surgical approaches for benign and malignant conditions. Due to the complexity in treating patients with head and neck pathology, it is necessary to adhere to basic surgical principles to decrease complications. Among them, surgical site infection can be prevented using a surgery quality protocol including the correct use of antibiotics and optimization of nutritional status. MATERIALS AND METHODS A survey was sent through the YO-IFOS and SEORL-CCC international mailing list. RESULTS A total of 435 surgeons completed the survey. Of the respondents, 97.7% confirm that they scrub their hands before surgery, 40.9% respondents recommend nutritional support according to sign and symptoms, 60.9% use of antibiotic prophylaxis in clean surgery and just 9.2% use clindamycin in combination. CONCLUSION This survey has broadened the scope regarding H&N surgical safety around the globe. Identifying innovative ways in which surgical care may be improved is mandatory.
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Affiliation(s)
- Carlos Miguel Chiesa-Estomba
- Otorhinolaryngology -Head & Neck Surgery Department, Hospital Universitario Donostia, San Sebastian, Guipuzkoa - Basque Country, Spain; Head & Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France.
| | - Christian Calvo-Henriquez
- Department of Otolaryngology - Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain; Head & Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France
| | - Nicholas Gonçalves
- MBBCh (WITS), FCORL(SA) Division of Otolaryngology, Groote Schuur Hospital, Faculty of Health Science, University of Cape Town (UCT), South Africa; Head & Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France
| | - Jérome R Lechien
- Department of Human Anatomy & Experimental Oncology, University of Mons, Mons, Belgium; Head & Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France
| | - Jon Alexander Sistiaga-Suarez
- Otorhinolaryngology -Head & Neck Surgery Department, Hospital Universitario Donostia, San Sebastian, Guipuzkoa - Basque Country, Spain; Head & Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France
| | - Miguel Mayo-Yanez
- Otorhinolaryngology - Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, Spain; Head & Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France
| | - Jose Angel Gonzalez-Garcia
- Otorhinolaryngology -Head & Neck Surgery Department, Hospital Universitario Donostia, San Sebastian, Guipuzkoa - Basque Country, Spain; Head & Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France
| | - Raghu Nandhan
- Department of ORL-HNS, Madras ENT Research Foundation, Chennai, India; Head & Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France
| | - Federico Martinez
- Otorhinolaryngology - Head & Neck Surgery Department, Hospital Masiel, Montevideo, Uruguay; Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Tareck Ayad
- Division of Otolaryngology - Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Canada; Head & Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), France
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Bernstein JD, Bracken DJ, Abeles SR, Orosco RK, Weissbrod PA. Surgical wound classification in otolaryngology: A state‐of‐the‐art review. World J Otorhinolaryngol Head Neck Surg 2022; 8:139-144. [PMID: 35782398 PMCID: PMC9242420 DOI: 10.1002/wjo2.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 12/05/2021] [Indexed: 12/04/2022] Open
Abstract
Objective To describe the issues related to the assignment of surgical wound classification as it pertains to Otolaryngology—Head & Neck surgery, and to present a simple framework by which providers can assign wound classification. Data Sources Literature review. Conclusion Surgical wound classification in its current state is limited in its utility. It has recently been disregarded by major risk assessment models, likely due to inaccurate and inconsistent reporting by providers and operative staff. However, if data accuracy is improved, this metric may be useful to inform the risk of surgical site infection. In an era of quality‐driven care and reimbursement, surgical wound classification may become an equally important indicator of quality. In its current state, surgical wound classification has been disregarded as a key metric, likely due to habitual inaccuracies in procedure categorization. A new paradigm for surgical wound classification specific to Otolaryngology—Head & Neck Surgery is presented. The possibility of surgical wound classification serving as an important indicator of quality of care is discussed and contextualized in current health care trends.
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Affiliation(s)
- Jeffrey D. Bernstein
- Department of Otolaryngology University of California San Diego La Jolla California USA
| | - David J. Bracken
- Department of Otolaryngology University of California San Diego La Jolla California USA
| | - Shira R. Abeles
- Department of Medicine, Division of Infectious Disease and Global Public Health University of California San Diego San Diego California USA
| | - Ryan K. Orosco
- Department of Otolaryngology University of California San Diego La Jolla California USA
- Moores Cancer Center University of California San Diego La Jolla California USA
| | - Philip A. Weissbrod
- Department of Otolaryngology University of California San Diego La Jolla California USA
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Tamagawa S, Iyo T, Kono M, Sugita G, Takeda S, Kumashiro N, Murakami D, Enomoto K, Ohtani M, Hotomi M. Impact of the practical guideline on appropriate usage of antimicrobial treatments for surgical site infections in reconstructive surgery of head and neck cancer. J Infect Chemother 2021; 28:401-405. [PMID: 34887177 DOI: 10.1016/j.jiac.2021.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 10/23/2021] [Accepted: 11/21/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVES In 2016, Japanese Society of Chemotherapy and Japan Society for Surgical Infection presented the practical guideline for appropriate usage of antimicrobial agents to prevent postoperative infections. This study aims to exhibit the validity of the guideline as a series of effective strategies for prevention of surgical site infections (SSIs) during reconstructive surgery of the head and neck cancer. METHODS We retrospectively evaluated patients who underwent head and neck reconstructive surgery with free or pedicle flaps in a single institute in Japan between July 2010 and July 2020. We evaluated the incidence of SSIs, patient backgrounds, and microbiological characteristics on the basis of antimicrobial prophylaxis recommended by the guideline. RESULTS Enrolled in this study were 102 patients in our institution who underwent head and neck reconstructive surgery with free or pedicle flaps between July 2010 and July 2020. In the period between January 2018 to July 2020 after the SSI guideline was advocated (SSI guideline period), the ratio of administration of sulbactam/ampicillin (SBT/ABPC) was significantly higher (P < 0.001) and the duration of prophylactic antimicrobial treatment was significantly shorter than in the period between July 2010 to December 2017 before the SSI guideline was advocated (Pre-SSI guideline period) (P < 0.001). Incidence of SSIs were similar, even when antibiotic use was changed to be short-term single-agent administration in accordance with the practical guideline. CONCLUSIONS Adherence to the current Japanese practical guideline on appropriate antimicrobial prophylaxis for SSIs can shorten the duration of usage of antimicrobial treatment without increasing the risk for occurrence of SSIs.
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Affiliation(s)
- Shunji Tamagawa
- Department of Otorhinolaryngology Head and Neck Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8510, Japan
| | - Takuro Iyo
- Department of Otorhinolaryngology Head and Neck Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8510, Japan
| | - Masamitsu Kono
- Department of Otorhinolaryngology Head and Neck Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8510, Japan
| | - Gen Sugita
- Department of Otorhinolaryngology Head and Neck Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8510, Japan
| | - Saori Takeda
- Department of Otorhinolaryngology Head and Neck Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8510, Japan
| | - Naoko Kumashiro
- Department of Otorhinolaryngology Head and Neck Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8510, Japan
| | - Daichi Murakami
- Department of Otorhinolaryngology Head and Neck Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8510, Japan
| | - Keisuke Enomoto
- Department of Otorhinolaryngology Head and Neck Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8510, Japan
| | - Makiko Ohtani
- Department of Otorhinolaryngology Head and Neck Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8510, Japan
| | - Muneki Hotomi
- Department of Otorhinolaryngology Head and Neck Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8510, Japan.
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13
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Surgical and remote site infections after reconstructive surgery of the head and neck: A risk factor analysis. J Craniomaxillofac Surg 2021; 50:178-187. [PMID: 34802884 DOI: 10.1016/j.jcms.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 09/27/2021] [Accepted: 11/10/2021] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to identify risk factors for surgical (SSI) and remote site (RSI) infections, pathogens and antibiotic resistances in patients after pedicled and free flap reconstruction in the head and neck area. SSI criteria implicated infections affecting superficial or deep tissue in the flap area with purulent discharge, fistula, abscess formation and local infections signs. RSI criteria were defined as infections remote from the surgical site presenting with systemic symptoms like fever, leucocytosis, increase in C-reactive protein, purulent tracheobronchial secretion or deterioration of blood gases. Focus adequate specimen sampling and aerobic and anaerobic incubation and cultivation was performed. Epidemiological data, factors directly related to surgery or reconstruction, perioperative antibiotic regimen, length of stay, autologous blood transfusion and microbiological aspects were retrospectively analysed in 157 patients. 10.8% of patients presented SSI, 12.7% RSI. Cultivated bacteria were sampled from flap sites, blood cultures, central catheters and sputum including mainly gram-negative bacteria (70.3%) being frequently resistant against penicillin (85%) and third generation cephalosporine derivates (48%). Autologous blood transfusion (p = 0.018) and perioperative clindamycin use (p = 0.002) were independent risk factors for overall (SSI and RSI combined) infections. Prior radiation (p = 0.05), autologous blood transfusion (p = 0.034) and perioperative clindamycin use (p = 0.004) were predictors for SSIs. ASA >2 (p = 0.05) was a risk factor for remote site infections and prolonged ICU stay (p = 0.002) was associated with overall infections, especially in irradiated patients. Efforts need to be made in improving patient blood management, antibiotic stewardship and accurate postoperative care to avoid postoperative infections after head and neck reconstructive surgery.
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14
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Gearing PF, Daly JF, Tang NSJ, Singh K, Ramakrishnan A. Risk factors for surgical site infection in free-flap reconstructive surgery for head and neck cancer: Retrospective Australian cohort study. Head Neck 2021; 43:3417-3428. [PMID: 34409671 DOI: 10.1002/hed.26837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/30/2021] [Accepted: 07/29/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Surgical site infections (SSI) are common complications of free-flap reconstruction for head and neck cancer defects. This study aimed to identify risk factors for SSI following a significant change in local antibiotic prophylaxis practice. METHODS A retrospective cohort study was conducted of 325 patients receiving free-flap reconstruction for head and neck cancer defects at a tertiary hospital in Melbourne, Australia between 2013 and 2019. Charts were queried for recipient SSI (primary outcome), donor SSI, other infections, antibiotic use, hospital length of stay, and mortality. RESULTS Risk factors for SSI included female sex, T-classification, hardware insertion, clindamycin prophylaxis, and operative duration. There was a trend toward increased SSI with shorter ≤24 h prophylaxis (OR: 0.43). CONCLUSION Antibiotic duration and type were associated with SSI. Complexity of surgery, T-classification, hardware use, and operative duration were also independently associated with SSI. A prospective trial is indicated to elicit optimal prophylactic antibiotic duration.
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Affiliation(s)
- Peter Francis Gearing
- The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - John Frederick Daly
- The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Nicholas Shi Jie Tang
- Department of Plastic & Reconstructive Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Kasha Singh
- The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.,Victorian Infectious Diseases Unit, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Anand Ramakrishnan
- Department of Plastic & Reconstructive Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
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15
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Alonso-García M, Toledano-Muñoz A, Aparicio-Fernández JM, De-la-Rosa-Astacio FM, Rodríguez-Villar D, Gil-de-Miguel A, Durán-Poveda M, Rodríguez-Caravaca G. Adequacy of antibiotic prophylaxis and incidence of surgical site infections in neck surgery. Sci Rep 2021; 11:16413. [PMID: 34385521 PMCID: PMC8361086 DOI: 10.1038/s41598-021-95831-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/28/2021] [Indexed: 01/21/2023] Open
Abstract
Health care-related infections are frequent and among them surgical site infection (SSI) are the most frequent in hospitals. The objective was to evaluate the adequacy of antibiotic prophylaxis in patients undergoing neck surgery and its relationship with the incidence of surgical site infection (SSI). Prospective cohort study. The adequacy of antibiotic prophylaxis in patients undergoing neck surgery was evaluated. Antibiotic prophylaxis was considered adequate when it conformed to all items of the protocol (antibiotic used, time of administration, administration route, dose and duration). The cumulative incidence of SSI was calculated, and the relationship between SSI and antibiotic prophylaxis adequacy was determined using adjusted relative risk (RR). Antibiotic prophylaxis was administered in 63 patients and was adequate in 85.7% (95% CI 75.0–92.3) of them. The cumulative incidence of SSI was 6.4% (95% CI 3.4–11.8). There was no significant relationship between antibiotic prophylaxis inadequacy and the incidence of SSI (RR = 2.4, 95% CI 0.6–10.6). Adequacy of antibiotic prophylaxis was high and it did not affect the incidence of SSIs.
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Affiliation(s)
- M Alonso-García
- Department of Preventive Medicine, Alcorcón Foundation University Hospital, C/ Budapest 1, 28922, Alcorcón, Madrid, Spain.,Department of Medical Specialities and Public Health, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - A Toledano-Muñoz
- Department of Medical Specialities and Public Health, Rey Juan Carlos University, Alcorcón, Madrid, Spain.,Department of Otorhinolaryngology, Alcorcón Foundation University Hospital, Alcorcón, Madrid, Spain
| | - J M Aparicio-Fernández
- Department of Otorhinolaryngology, Alcorcón Foundation University Hospital, Alcorcón, Madrid, Spain
| | - F M De-la-Rosa-Astacio
- Department of Otorhinolaryngology, Alcorcón Foundation University Hospital, Alcorcón, Madrid, Spain
| | - D Rodríguez-Villar
- Department of Medical Specialities and Public Health, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - A Gil-de-Miguel
- Department of Medical Specialities and Public Health, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - M Durán-Poveda
- Department of Medical Specialities and Public Health, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - G Rodríguez-Caravaca
- Department of Preventive Medicine, Alcorcón Foundation University Hospital, C/ Budapest 1, 28922, Alcorcón, Madrid, Spain. .,Department of Medical Specialities and Public Health, Rey Juan Carlos University, Alcorcón, Madrid, Spain.
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16
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Nakamura Y, Sasaki K, Ishizuki S, Inoue S, Okune M, Kubota N, Okiyama N, Furuta J, Fujisawa Y. Invasive and in situ lesions of squamous cell carcinoma are independent factors for postoperative surgical-site infection after outpatient skin tumors surgery: A retrospective study of 512 patients. J Dermatol 2021; 48:497-501. [PMID: 33560553 DOI: 10.1111/1346-8138.15782] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/06/2021] [Accepted: 01/18/2021] [Indexed: 11/27/2022]
Abstract
Surgical-site infection (SSI) is one of the major postoperative complications in surgery, which can cause significant morbidity. However, factors associated with SSI in dermatological surgery are not well understood. Here, we retrospectively investigated 512 patients who underwent outpatient surgery for skin tumors at the University of Tsukuba Hospital to analyze factors associated with postoperative SSI. The overall incidence of SSI was 28 (5.5%). Univariate logistic regression analysis revealed that SSI was significantly associated with invasive squamous cell carcinoma (iSCC), Bowen's disease (BD), actinic keratosis (AK), longer diameter of defects, presence of ulcer, reconstruction with full-thickness skin graft and local skin flaps, medical history of diabetes mellitus, and use of immunosuppressive agents. However, in the multivariate analysis only iSCC, BD, and AK retained significance. The frequencies of SSI in iSCC, BD, and AK were 22% (13/58 patients), 15.6% (5/32), and 25% (2/8), respectively; however, the frequency of other non-SCC tumors was only 1.9% (8/414). χ2 -Tests revealed that the frequency of SSI in iSCC, BD, and AK were all significantly higher than in non-SCC tumors, with the frequencies being more than eight times higher. These results suggest that invasive and in situ lesions of SCC are independent risk factors of SSI development after outpatient skin surgery.
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Affiliation(s)
- Yoshiyuki Nakamura
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Katsuhito Sasaki
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Shoichiro Ishizuki
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Sae Inoue
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Mari Okune
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Noriko Kubota
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Naoko Okiyama
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Junichi Furuta
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yasuhiro Fujisawa
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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17
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Head and neck surgical antibiotic prophylaxis in resource-constrained settings. Curr Opin Otolaryngol Head Neck Surg 2020; 28:188-193. [PMID: 32332205 DOI: 10.1097/moo.0000000000000626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Antimicrobial resistance represents a global threat and causes almost 700 000 deaths per year. The rapid dissemination of resistant bacteria is occurring globally, turning this into the primary threat to public health in the 21st century and forcing organizations around the globe to take urgent action. RECENT FINDINGS About risks related to surgical site infection (SSI) in head and neck surgery, surgical limitations in resource-constrained settings, comorbidities and the risk of SSI, evidence about surgical prophylaxis from low and middle-income countries, SSI gap between the developed and developing worlds and how to reduce resistance. SUMMARY Antibiotic protocols can be adjusted to local and regional bacterial resistance profiles, taking into account the availability of antibiotics and cost limitations on each country in order to decrease the SSI risk.
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18
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Vander Poorten V, Uyttebroek S, Robbins KT, Rodrigo JP, de Bree R, Laenen A, F Saba N, Suarez C, Mäkitie A, Rinaldo A, Ferlito A. Perioperative Antibiotics in Clean-Contaminated Head and Neck Surgery: A Systematic Review and Meta-Analysis. Adv Ther 2020; 37:1360-1380. [PMID: 32141017 PMCID: PMC7140756 DOI: 10.1007/s12325-020-01269-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Indexed: 12/31/2022]
Abstract
Background The optimal evidence-based prophylactic antibiotic regimen for surgical site infections following major head and neck surgery remains a matter of debate. Methods Medline, Cochrane, and Embase were searched for the current best evidence. Retrieved manuscripts were screened according to the PRISMA guidelines. Included studies dealt with patients over 18 years of age that underwent clean-contaminated head and neck surgery (P) and compared the effect of an intervention, perioperative administration of different antibiotic regimens for a variable duration (I), with control groups receiving placebo, another antibiotic regimen, or the same antibiotic for a different postoperative duration (C), on surgical site infection rate as primary outcome (O) (PICO model). A systematic review was performed, and a selected group of trials investigating a similar research question was subjected to a random-effects model meta-analysis. Results Thirty-nine studies were included in the systematic review. Compared with placebo, cefazolin, ampicillin–sulbactam, and amoxicillin–clavulanate were the most efficient agents. Benzylpenicillin and clindamycin were clearly less effective. Fifteen studies compared short- to long-term prophylaxis; treatment for more than 48 h did not further reduce wound infections. Meta-analysis of five clinical trials including 4336 patients, where clindamycin was compared with ampicillin–sulbactam, implied an increased infection rate for clindamycin-treated patients (OR = 2.73, 95% CI 1.50–4.97, p = 0.001). Conclusion In clean-contaminated head and neck surgery, cefazolin, amoxicillin–clavulanate, and ampicillin–sulbactam for 24–48 h after surgery were associated with the highest prevention rate of surgical site infection.
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Affiliation(s)
- Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven and Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium.
| | - Saartje Uyttebroek
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven and Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - K Thomas Robbins
- Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annouschka Laenen
- Leuven Biostatistics and Statistical Bioinformatics Centre, KU Leuven, Leuven, Belgium
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Carlos Suarez
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain
- Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain
| | - Antti Mäkitie
- Department of Otorhinolaryngology Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
| | | | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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19
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Vander Poorten V, Uyttebroek S, Robbins KT, Rodrigo JP, de Bree R, Laenen A, F Saba N, Suarez C, Mäkitie A, Rinaldo A, Ferlito A. Perioperative Antibiotics in Clean-Contaminated Head and Neck Surgery: A Systematic Review and Meta-Analysis. Adv Ther 2020. [PMID: 32141017 DOI: 10.1007/s12325‐020‐01269‐2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The optimal evidence-based prophylactic antibiotic regimen for surgical site infections following major head and neck surgery remains a matter of debate. METHODS Medline, Cochrane, and Embase were searched for the current best evidence. Retrieved manuscripts were screened according to the PRISMA guidelines. Included studies dealt with patients over 18 years of age that underwent clean-contaminated head and neck surgery (P) and compared the effect of an intervention, perioperative administration of different antibiotic regimens for a variable duration (I), with control groups receiving placebo, another antibiotic regimen, or the same antibiotic for a different postoperative duration (C), on surgical site infection rate as primary outcome (O) (PICO model). A systematic review was performed, and a selected group of trials investigating a similar research question was subjected to a random-effects model meta-analysis. RESULTS Thirty-nine studies were included in the systematic review. Compared with placebo, cefazolin, ampicillin-sulbactam, and amoxicillin-clavulanate were the most efficient agents. Benzylpenicillin and clindamycin were clearly less effective. Fifteen studies compared short- to long-term prophylaxis; treatment for more than 48 h did not further reduce wound infections. Meta-analysis of five clinical trials including 4336 patients, where clindamycin was compared with ampicillin-sulbactam, implied an increased infection rate for clindamycin-treated patients (OR = 2.73, 95% CI 1.50-4.97, p = 0.001). CONCLUSION In clean-contaminated head and neck surgery, cefazolin, amoxicillin-clavulanate, and ampicillin-sulbactam for 24-48 h after surgery were associated with the highest prevention rate of surgical site infection.
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Affiliation(s)
- Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven and Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium.
| | - Saartje Uyttebroek
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven and Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - K Thomas Robbins
- Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annouschka Laenen
- Leuven Biostatistics and Statistical Bioinformatics Centre, KU Leuven, Leuven, Belgium
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Carlos Suarez
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain
| | - Antti Mäkitie
- Department of Otorhinolaryngology Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
| | | | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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20
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Isaacson G, Doyle W, Summer D. Reducing Surgical Site Infections During Otolaryngology Surgical Missions. Laryngoscope 2019; 130:1388-1395. [PMID: 31755991 DOI: 10.1002/lary.28418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/21/2019] [Accepted: 10/24/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To determine what measures an otolaryngology-head and neck surgery team might adopt to decrease the incidence of surgical site infection (SSI) on a short-term surgical mission. Despite concerns about safety and efficacy, short-term surgical missions remain the predominant structure for humanitarian surgical care in low- and middle-income countries (LMIC). Hospitals in high-income countries strive to improve surgical outcomes through implementation of World Health Organization (WHO) safe surgery guidelines. Reduction of SSI risk is a key part of this effort. METHODS Literature review and practical experience. RESULTS WHO recommendations for reducing SSI are based largely on research done in the North America and Europe. LMIC populations are younger; comorbidities are fewer; infectious disease and trauma are prevalent; and delays in access to care are common. SSI are much more frequent in resource-limited settings. Recommendations regarding preoperative assessment, operating room environment, instrument sterilization, surgical antibiotic prophylaxis, surgical site preparation, gloving, draping, and postsurgical care are reviewed in the context of a surgical mission at a typical LMIC government hospital. CONCLUSION Many of the WHO guidelines on reduction of SSI are logical and applicable to the short-term surgical missions; others may need to be modified. Careful prospective data collection and clinical trials are needed to learn which interventions are valid and which should be changed. LEVEL OF EVIDENCE 5 Laryngoscope, 130:1388-1395, 2020.
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Affiliation(s)
- Glenn Isaacson
- Departments of Otolaryngology-Head & Neck Surgery and Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, U.S.A
| | - Winifred Doyle
- Departments of Otolaryngology-Head & Neck Surgery and Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, U.S.A
| | - Deborah Summer
- Departments of Otolaryngology-Head & Neck Surgery and Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, U.S.A
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