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Liu Y, Zhu H, Bao X, Qin Y, He Z, Zheng L, Shi H. When is surgical intervention needed in oral and maxillofacial space infection patients? A retrospective case control study in 46 patients. BMC Oral Health 2024; 24:973. [PMID: 39169339 PMCID: PMC11340201 DOI: 10.1186/s12903-024-04737-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 08/13/2024] [Indexed: 08/23/2024] Open
Abstract
OBJECTIVE Patients with mild oral and maxillofacial space infection (OMSI) usually need only antimicrobial therapy. However, surgical intervention is eventually needed after using antibiotics for a period. The objective of this study was to explore the risk factors for drug therapy failure in OMSI. SUBJECTS AND METHODS A retrospective case‒control study was designed. From August 2020 to September 2022, patients at Shanghai Jiao Tong University Affiliated Ninth People's Hospital who were diagnosed with OMSI were retrospectively reviewed. The outcome variable was surgical intervention after the use of antibiotics. We collected common biological factors, including demographic characteristics, routine blood test results, C-reactive protein (CRP) levels and composite indicators, such as neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR). The χ2 test and binary logistic regression were used to examine the association between biological factors and the outcome variable. RESULTS Forty-six patients were included in this study. Further surgical intervention was needed in 20 patients (43.5%). The NLR showed a significant association with further surgical drainage (p = 0.01). A binary logistic regression equation was found by using stepwise regression based on the Akaike information criterion (R2 = 0.443), which was associated with sex (odds ratio [OR], 0.216; p = 0.092), NLR (OR, 1.258; p = 0.045), red blood cell (RBC) count (OR, 4.372; p = 0.103) and monocyte (MONO) count (OR, 9.528, p = 0.023). Receiver operating characteristic analysis produced an area under the curve for NLR of 0.725 (p = 0.01) and for the binary logistic regression model of 0.8365 (p < 0.001). CONCLUSION Surgical interventions are needed in some mild OMSI patients when antimicrobial therapy fails to stop the formation of abscesses. The binary logistic regression model shows that NLR can be used as an ideal prognostic factor to predict the outcome of antimicrobial therapy and the possibility of requiring surgical intervention. STATEMENT OF CLINICAL RELEVANCE Using simple, inexpensive, and easily achieved biological parameters (such as routine blood test results) and composite indicators calculated by them (such as NLR) to predict whether surgical intervention is needed in the future provides a reference for clinical doctors and enables more cost-effective and efficient diagnosis and treatment.
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Affiliation(s)
- Yimin Liu
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, ZhiZaoJu Road, Shanghai, 200011, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Hanyi Zhu
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, ZhiZaoJu Road, Shanghai, 200011, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Xin Bao
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, ZhiZaoJu Road, Shanghai, 200011, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yingyi Qin
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Zhiyuan He
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, ZhiZaoJu Road, Shanghai, 200011, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Lingyan Zheng
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, ZhiZaoJu Road, Shanghai, 200011, China.
- National Center for Stomatology, Shanghai, China.
- National Clinical Research Center for Oral Diseases, Shanghai, China.
- Shanghai Key Laboratory of Stomatology, Shanghai, China.
- Shanghai Research Institute of Stomatology, Shanghai, China.
| | - Huan Shi
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.
- Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, ZhiZaoJu Road, Shanghai, 200011, China.
- National Center for Stomatology, Shanghai, China.
- National Clinical Research Center for Oral Diseases, Shanghai, China.
- Shanghai Key Laboratory of Stomatology, Shanghai, China.
- Shanghai Research Institute of Stomatology, Shanghai, China.
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Longchamp G, Ferrari R, Essig H. Predictors of length of stay following maxillofacial abscess surgery: A 10-year retrospective cohort. J Craniomaxillofac Surg 2024; 52:931-936. [PMID: 38876956 DOI: 10.1016/j.jcms.2024.05.001] [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: 08/15/2023] [Revised: 01/23/2024] [Accepted: 05/26/2024] [Indexed: 06/16/2024] Open
Abstract
The aim of this study was to identify predictors of length of stay (LOS) after surgical therapy of maxillofacial abscess. Patients diagnosed with a maxillofacial abscess who underwent extraoral incision and drainage under general anesthesia between January 1st, 2012 and January 1st, 2022 were retrospectively reviewed Univariable and multivariable linear regressions were performed to identify the association between pre- and perioperative variables and the LOS. In total, 228 patients were included. In the forward stepwise multivariable analysis, all factors with a p-value <0.2 in the univariable model were included. Ultimately, six independent predictors of increased LOS were identified: female (coef. 0.14, 95% CI 0.03-0.25), immunosuppression (coef. 0.37, 95%CI 0.13-0.61), penicillin allergy (coef. 0.25, 95% CI 0.04-0.46), C-reactive protein (coef. 0.0008, 95% CI 0.0001-0.0014), multiple spaces involvement (coef. 0.36, 95% CI 0.13-0.59), and time to operation (coef. 0.005, 95% CI 0.002-0.008). In conclusion, our study provides new insights into predicting LOS for patients admitted with maxillofacial abscesses. The identification of these markers not only enhances the ability to forecast LOS, but also lays the groundwork for optimizing resource planning and potentially integrating them into a primary prevention algorithm.
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Affiliation(s)
- Gregoire Longchamp
- Department of Cranio-Maxillofacial and Oral Surgery, University Hospital of Zurich, Zurich, Switzerland.
| | - Raphael Ferrari
- Department of Cranio-Maxillofacial and Oral Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Harald Essig
- Department of Cranio-Maxillofacial and Oral Surgery, University Hospital of Zurich, Zurich, Switzerland
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Mahmoud R, Arbel S, Ianculovici C, Peleg O, Kleinman S, Shuster A. Antimicrobial therapy in the management of odontogenic infections: the penicillin-allergic patient. Int J Oral Maxillofac Surg 2024; 53:251-257. [PMID: 37758642 DOI: 10.1016/j.ijom.2023.09.001] [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: 05/16/2023] [Revised: 08/12/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023]
Abstract
This retrospective analysis was performed to investigate whether clindamycin remains the preferred antibiotic for penicillin-allergic patients with odontogenic infections. The medical records of 311 patients admitted to the study department with odontogenic infections between 2018 and 2022 and treated with either intravenous amoxicillin-clavulanic acid (Augmentin) or intravenous clindamycin were analyzed. The Augmentin-treated group included 268 patients (86.2%) and the clindamycin-treated group included 43 patients (13.8%). Severity parameters did not differ significantly between the two groups, except for a higher prevalence of abscesses in the clindamycin-treated group (58.1% vs 41.0% in the Augmentin-treated group; P = 0.035). The clindamycin-treated group required a longer duration of intravenous antibiotics (P = 0.001) and had a higher rate of treatment failure (14.0% vs 2.2%; P = 0.002) when compared to the Augmentin-treated group, with a seven-fold increased risk of treatment failure. Moreover, significantly more isolated organisms in the clindamycin-treated group were resistant to clindamycin (P = 0.015); these were all Streptococcus anginosus group. Given the higher risk of treatment failure with clindamycin, it is necessary to choose the antibiotic treatment for penicillin-allergic patients carefully. A detailed history and allergy testing followed by combination therapy is recommended, especially in severe cases.
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Affiliation(s)
- R Mahmoud
- Department of Oral and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - S Arbel
- Department of Oral and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - C Ianculovici
- Department of Oral and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - O Peleg
- Department of Oral and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - S Kleinman
- Department of Oral and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - A Shuster
- Department of Oral and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Oral and Maxillofacial Surgery, Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
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Mire D, Chapple AG, Christensen BJ. Does Preoperative Surgical Delay Lead to Increased Postsurgical Length of Stay or Reoperation in Patients With Severe Odontogenic Infections? J Oral Maxillofac Surg 2023; 81:1161-1169. [PMID: 37348841 DOI: 10.1016/j.joms.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND While severe odontogenic infections can be life-threatening and emergent surgery can be required more often, surgical management in the operating room (OR) is completed as soon as feasible. However, provider schedules and OR availability can occasionally lead to longer delays before surgery, but their effect on outcomes is unknown. PURPOSE The purpose of this study was to determine the association of preoperative surgical delay with postsurgical length of stay (LOS) and reoperation in patients with severe odontogenic infections. STUDY DESIGN, SETTING, SAMPLE The authors conducted a retrospective cohort study consisting of all adult patients treated in the OR with incision and drainage for odontogenic infections from 1/1/2015 to 7/30/2021 at a large, urban academic hospital. PREDICTOR VARIABLE The primary predictor variable was the length of presurgical delay-the number of hours between arrival in the emergency department and the start of surgery. MAIN OUTCOME VARIABLES The primary outcome variable was the postsurgical LOS and the secondary outcome variable was the rate of reoperation. COVARIATES Demographics, medical history, exam findings, diagnosis, and treatment-related variables were also analyzed. ANALYSES Descriptive and bivariate analyses were performed along with multivariable linear and logistic regression. A P value of < .05 was considered significant. RESULTS There were 401 patients included in the study with 50.9% men and a mean age of 39.1 years. Increased length of presurgical delay (hours) was associated with a decreased postsurgical LOS (β = -0.05 days, P = .01) and length of presurgical delay was not associated with reoperation (P = .51) in the unadjusted analyses. However, length of presurgical delay was not found to be associated with either LOS (β = -0.02, 95% confidence interval (CI) -0.05 to 0.01, P = .12) or reoperation (adjusted odds ratio (aOR) 1.0, 95% CI 0.96 to 1.02, P = .67) in the adjusted analyses. CONCLUSIONS AND RELEVANCE The association of decreased length of presurgical delay with increased postsurgical LOS in the unadjusted analysis could reflect the practice of rapid intervention for the most ill patients. After adjusting for number of spaces, a primary indicator of infection severity, length of presurgical delay was not associated with either LOS or return to the operating room.
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Affiliation(s)
- Dylan Mire
- Dental Student, School of Dentistry, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Andrew G Chapple
- Assistant Professor, Department of Interdisciplinary Oncology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Brian J Christensen
- Associate Professor, Department of Oral Medicine and Maxillofacial Surgery, Geisinger Health System, Danville, PA.
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Bigus S, Russmüller G, Starzengruber P, Reitter H, Sacher CL. Antibiotic resistance of the bacterial spectrum of deep space head and neck infections in oral and maxillofacial surgery - a retrospective study. Clin Oral Investig 2023; 27:4687-4693. [PMID: 37294354 DOI: 10.1007/s00784-023-05095-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 05/23/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the current resistance situation concerning routinely used antibiotics for treatment in odontogenic abscesses. MATERIALS AND METHODS This retrospective study assessed patients with deep space head and neck infections who were treated by surgical intervention under general anesthesia at our department. The target parameter was the ascertainment of the resistance rates in order to identify the bacterial spectrum, sites in the body, length of inpatient stay, and the age and sex of the patients. RESULTS A total of 539 patients, 268 (49.7%) males and 271 (50.3%) females were included in the study. The mean age was 36.5 ± 22.1 years. There was no significant difference between the two sexes with regard to the mean duration of hospitalization (p = 0.574). The predominant bacteria in the aerobic spectrum were streptococci of the viridans group and staphylococci, in the anaerobic spectrum Prevotella and Propionibacteria spp. Rates of resistance to clindamycin were between 34 and 47% in both the facultative and obligate anaerobic spectrum. Increased resistance was likewise found in the facultative anaerobic spectrum, with 94% resistance to ampicillin and 45% to erythromycin. CONCLUSION Due to the increasing levels of resistance to clindamycin, their use in empiric antibiotic treatment for deep space head and neck infections should be viewed critically. CLINICAL RELEVANCE Resistance rates continue to increase compared to previous studies. The use of these antibiotic groups in patients with a penicillin allergy needs to be called into question and alternative medications sought.
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Affiliation(s)
- Simon Bigus
- Department of Oral and Maxillofacial Surgery, Campus Virchow-Klinikum, Charité - University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Günter Russmüller
- Department of Oral and Maxillofacial Surgery, University Hospital Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Peter Starzengruber
- Department of Laboratory Medicine, University Hospital Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Hannah Reitter
- Austrian Public Health Insurance, Wienerbergstrasse 13, 1100, Vienna, Austria
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Evolution of the treatment of severe odontogenic infections over 50 years: A comprehensive review. J Taibah Univ Med Sci 2022; 18:225-233. [PMID: 36817218 PMCID: PMC9926117 DOI: 10.1016/j.jtumed.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/25/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives Severe odontogenic infections remain a challenge for maxillofacial surgeons. The aim of this work is to review the literature to provide an update of knowledge on the topic. Methods A comprehensive review of articles in PubMed, Web of Science and Africa Journals Online was performed through searching for "severe odontogenic infections." No language restrictions were applied. Only articles pertaining to treatment options were retrieved. Articles from the past 50 years were included. Results A total of 84 articles from 39 countries worldwide were included. Severe odontogenic infections are not unique to low- and middle-income countries but also pose challenges in developed countries. Surgical management and antibiotic therapy for this type of infection is discussed. Some immunocompromised patients have high risks of complications and mortality rates. A world map of publications on the topic is provided. Conclusions Several important aspects of managing severe odontogenic infections are discussed. Predictors of severity in addition to recommended antibiotic choice have been debated. Diabetes mellitus is a poor predictor of the prognosis of odontogenic infections.
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Comparison of three antibiotic protocols for prevention of infection in dental implant surgery: A randomized clinical trial. J Craniomaxillofac Surg 2022; 50:293-297. [DOI: 10.1016/j.jcms.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 03/01/2022] [Accepted: 03/09/2022] [Indexed: 11/19/2022] Open
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Parara E, Krasadakis C, Toursounidis I, Tsekoura K, Mourouzis C, Rallis G. Significant rise in neck infections progressing to descending necrotizing mediastinitis during the COVID-19 pandemic quarantine. J Craniomaxillofac Surg 2021; 49:1182-1186. [PMID: 34246538 PMCID: PMC8254394 DOI: 10.1016/j.jcms.2021.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/05/2021] [Accepted: 06/30/2021] [Indexed: 12/23/2022] Open
Abstract
To present five patients with DNM, who were treated during the first quarantine for Coronavirus disease 2019 (Covid-19). Five patients with DNM were treated in our department during the first lockdown. The mean age of the patients was 42,2 years and four were male. Two patients were immunocompromised. Repeated surgical drainage was performed in all patients, whereas four were also subjected to elective tracheostomy during their first operation. The mean hospitalization duration was 55,4 days and mortality was 40%. During the first lockdown for the Covid-19, a rise in the ratio of DNM cases to the overall incidence of cervicofacial infections was observed in our department. All patients with DNM were operated on an emergency basis and were subsequently admitted to the ICU. We consider the effect of the quarantine as a decisive factor for this escalation, because according to the department archives, there had not been any cases of DNM originating from a dental infection, for the past 5 years. Additionally, past studies from the same department reported no more than 6 cases over a 10 year period.
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Affiliation(s)
- Eleni Parara
- Oral and Maxillofacial Surgery Department, KAT General Hospital of Attica, 2 Nikis street, 14561, Attica, Greece.
| | - Christos Krasadakis
- Oral and Maxillofacial Surgery Department, KAT General Hospital of Attica, 2 Nikis street, 14561, Attica, Greece
| | - Iordanis Toursounidis
- Oral and Maxillofacial Surgery Department, KAT General Hospital of Attica, 2 Nikis street, 14561, Attica, Greece
| | - Konstantina Tsekoura
- Oral and Maxillofacial Surgery Department, KAT General Hospital of Attica, 2 Nikis street, 14561, Attica, Greece
| | - Constantinos Mourouzis
- Oral and Maxillofacial Surgery Department, KAT General Hospital of Attica, 2 Nikis street, 14561, Attica, Greece
| | - George Rallis
- Oral and Maxillofacial Surgery Department, KAT General Hospital of Attica, 2 Nikis street, 14561, Attica, Greece
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Escobedo MF, Junquera LM, Megias J, García-San Narciso L, Fernández MJ, Junquera S. Mediastinitis of odontogenic origin. A serious complication with 80 years of history. Br J Oral Maxillofac Surg 2020; 59:683-689. [PMID: 34001379 DOI: 10.1016/j.bjoms.2020.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/03/2020] [Indexed: 11/26/2022]
Abstract
We performed a systematic review of the literature about descending necrotising mediastinitis (DNM) of odontogenic origin. In parallel, a retrospective review of this pathology was carried out in an Oral and Maxillofacial Surgery Service of a reference hospital for a population of 1,100,000 inhabitants. The main objectives were to determine changes in mortality and prevalence of this serious complication. The systematic review included 51 articles with 89 patients and our study comprised seven patients. The period of time with the highest number of cases was between 2000-2009 (38 patients). The percentage of mortality observed was 20.2% in diffuse DNM and 4.9% in localised DNM. Thirty-one patients with DNM in our review were admitted for more than 41 days. Despite evidence of a decrease in DNM cases, publications have increased over the years, but it does not appear to be due to an increase in those of odontogenic origin. The survival of DNM has improved since 1998 and remained stable since then. Despite the low prevalence of this disease, multicentre control studies are needed to achieve better evidence about this entity.
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Affiliation(s)
- M F Escobedo
- School of Dentistry, University of Oviedo, Oviedo, Spain.
| | - L M Junquera
- Department of Maxillofacial Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - J Megias
- Department of Maxillofacial Surgery, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | - S Junquera
- Department of Radiology, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
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Christensen BJ, Racha D, Hinkle R, Sahebi M. Risk Factors for Reoperation in Patients Hospitalized for Odontogenic Infections. J Oral Maxillofac Surg 2020; 79:141-151. [PMID: 32717213 DOI: 10.1016/j.joms.2020.06.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/21/2020] [Accepted: 06/23/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE One of the most common adverse events after treatment of severe odontogenic infections is the need for a second procedure. The identification of risk factors for reoperation could help surgeons predict the need for reoperation or even tailor treatment to avoid this complication altogether. The purpose of this study was to identify risk factors associated with reoperation in patients hospitalized with odontogenic infections. PATIENTS AND METHODS We designed a retrospective cohort study from an eligible population of all patients treated at our institution for an odontogenic infection with incision and drainage under general anesthesia from August 1, 2015, to June 30, 2019. The primary outcome variable was a return to the operating room because of treatment failure. The potential predictor variables included demographic characteristics, history or physical examination findings from admission, admission laboratory values, initial computed tomography results, and medications provided during treatment. Statistical analysis was performed using the χ2 test and logistic regression, and from these results, a multiple logistic regression model was created. RESULTS A total of 223 patients were included in the study. Men comprised 50.7% of the study population, and the average age was 38.9 ± 13.3 years. The mean number of involved spaces was 2.6 ± 1.7 spaces. Reoperation was performed in 25 patients (11.2%). In the adjusted model, an increased number of involved spaces (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.3 to 2.7) and increased age (OR, 1.05; 95% CI, 1.004 to 1.09) were associated with increased odds of reoperation, and antibiotic therapy with a penicillin-type antibiotic (OR, 0.1; 95% CI, 0.04 to 0.5) and dexamethasone use (OR, 0.9; 95% CI, 0.8 to 0.98) were negatively associated with reoperation. CONCLUSIONS Further studies could be directed at determining whether certain timing or dosing regimens of dexamethasone could be helpful in reducing adverse outcomes in patients with odontogenic infections or determining feasible strategies when penicillin allergies are reported.
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Affiliation(s)
- Brian J Christensen
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.
| | - Dylan Racha
- Resident, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Ryan Hinkle
- Chief Resident, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Mishaun Sahebi
- Resident, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
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