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Elfayeg M, Suleiman A, Eltohami Y. Frequency and Risk Factors of Surgical Site Infection among Sudanese Patients with Oral Squamous Cell Carcinoma. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2024; 2024:7525831. [PMID: 38361763 PMCID: PMC10869196 DOI: 10.1155/2024/7525831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Abstract
Background In Sudan, patients with oral squamous cell carcinoma (OSCC) presented lately in advanced stages. Surgical site infection (SSI) is one of the most common complications of surgical treatment of OSCC which significantly affects the clinical outcomes. The present study aimed to assess the frequency and risk factors of postoperative surgical site infection among OSCC patients underwent surgery at Khartoum Teaching Dental Hospital (KTDH). Methods This is a prospective, analytical, hospital-based study conducted at KTDH during the period from 2022 to 2023. Patients with OSCC were surgically treated and assessed carefully for the development of the SSI. Results Sixty patients were enrolled in the present study. Twenty-nine (48.3%) patients were above 61 years, with the predominance of males with 42 (70%) patients. The most involved site of OSCC was the lower gingivolabial region in 35 (39.3%) patients. Forty-seven (78%) patients were in advanced stages III and IV. Forty-five (80%) patients had modified radical neck dissection. Blood transfusion was administered in 50 (83.3%) patients. Twenty-six (43.4%) patients developed SSI; 15 (57.7%) patients of them were Toombak dippers. Development of SSI was found to be significantly associated with the tumour site (P value 0.9), clinical stage (P value 0.6), the number of transfused blood units (P value 0.04), and the duration of hospital stay (P value 0.04). In contrast, use of sutures for wound closure was associated with a reduced risk of developing SSI (P value 0.005). Conclusion Surgical site infection was found in 43.4% of the OSCC patients. It was associated with advanced clinical stage and tumour site. Minimizing the number of blood units transfused intraoperatively, we decrease the duration of hospital stay and the use of sutures for wound closure decreases the risk of SSI significantly.
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Affiliation(s)
| | - Ahmed Suleiman
- Faculty of Dentistry, University of Khartoum, Khartoum, Sudan
| | - Yousif Eltohami
- Faculty of Dentistry, University of Khartoum, Khartoum, Sudan
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Ricciardi C, Orabona GD, Picone I, Latessa I, Fiorillo A, Sorrentino A, Triassi M, Improta G. A Health Technology Assessment in Maxillofacial Cancer Surgery by Using the Six Sigma Methodology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9846. [PMID: 34574768 PMCID: PMC8469470 DOI: 10.3390/ijerph18189846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/06/2021] [Accepted: 09/15/2021] [Indexed: 12/15/2022]
Abstract
Squamous cell carcinoma represents the most common cancer affecting the oral cavity. At the University of Naples "Federico II", two different antibiotic protocols were used in patients undergoing oral mucosa cancer surgery from 2006 to 2018. From 2011, there was a shift; the combination of Cefazolin plus Clindamycin as a postoperative prophylactic protocol was chosen. In this paper, a health technology assessment (HTA) is performed by using the Six Sigma and DMAIC (Define, Measure, Analyse, Improve, Control) cycle in order to compare the performance of the antibiotic protocols according to the length of hospital stay (LOS). The data (13 variables) of two groups were collected and analysed; overall, 136 patients were involved. The American Society of Anaesthesiologist score, use of lymphadenectomy or tracheotomy and the presence of infections influenced LOS significantly (p-value < 0.05) in both groups. Then, the groups were compared: the overall difference between LOS of the groups was not statistically significant, but some insights were provided by comparing the LOS of the groups according to each variable. In conclusion, in light of the insights provided by this study regarding the comparison of two antibiotic protocols, the utilization of DMAIC cycle and Six Sigma tools to perform HTA studies could be considered in future research.
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Affiliation(s)
- Carlo Ricciardi
- Department of Electrical Engineering and Information Technology, University of Naples “Federico II”, 80125 Naples, Italy;
- Bioengineering Unit, Institute of Care and Scientific Research Maugeri, 27100 Pavia, Italy
| | - Giovanni Dell’Aversana Orabona
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Hospital of Naples “Federico II”, 80131 Napoli, Italy; (G.D.O.); (A.S.)
| | - Ilaria Picone
- Department of Advanced Biomedical Sciences, University Hospital of Naples “Federico II”, 80131 Naples, Italy; (I.P.); (A.F.)
| | - Imma Latessa
- Department of Public Health, University Hospital of Naples “Federico II”, 80131 Naples, Italy; (I.L.); (M.T.)
| | - Antonella Fiorillo
- Department of Advanced Biomedical Sciences, University Hospital of Naples “Federico II”, 80131 Naples, Italy; (I.P.); (A.F.)
| | - Alfonso Sorrentino
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Hospital of Naples “Federico II”, 80131 Napoli, Italy; (G.D.O.); (A.S.)
| | - Maria Triassi
- Department of Public Health, University Hospital of Naples “Federico II”, 80131 Naples, Italy; (I.L.); (M.T.)
- Interdepartmental Center for Research in Healthcare Management and Innovation in Healthcare (CIRMIS), University of Naples “Federico II”, 80131 Naples, Italy
| | - Giovanni Improta
- Department of Public Health, University Hospital of Naples “Federico II”, 80131 Naples, Italy; (I.L.); (M.T.)
- Interdepartmental Center for Research in Healthcare Management and Innovation in Healthcare (CIRMIS), University of Naples “Federico II”, 80131 Naples, Italy
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Caputo MP, Shabani S, Mhaskar R, McMullen C, Padhya TA, Mifsud MJ. Diabetes mellitus in major head and neck cancer surgery: Systematic review and
meta‐analysis. Head Neck 2020; 42:3031-3040. [DOI: 10.1002/hed.26349] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/10/2020] [Accepted: 06/09/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- Mathew P. Caputo
- Department of Otolaryngology—Head & Neck Surgery University of South Florida Morsani College of Medicine Tampa Florida USA
| | - Sepehr Shabani
- Department of Otolaryngology—Head & Neck Surgery University of South Florida Morsani College of Medicine Tampa Florida USA
| | - Rahul Mhaskar
- Department of Internal Medicine University of South Florida Morsani College of Medicine Tampa Florida USA
| | - Caitlin McMullen
- Department of Head and Neck and Endocrine Oncology H. Lee Moffitt Cancer Center & Research Institute Tampa Florida USA
| | - Tapan A. Padhya
- Department of Otolaryngology—Head & Neck Surgery University of South Florida Morsani College of Medicine Tampa Florida USA
- Department of Head and Neck and Endocrine Oncology H. Lee Moffitt Cancer Center & Research Institute Tampa Florida USA
| | - Matthew J. Mifsud
- Department of Otolaryngology—Head & Neck Surgery University of South Florida Morsani College of Medicine Tampa Florida USA
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Lin P, Kuo P, Kuo SCH, Chien P, Hsieh C. Risk factors associated with postoperative complications of free anterolateral thigh flap placement in patients with head and neck cancer: Analysis of propensity score‐matched cohorts. Microsurgery 2020; 40:538-544. [DOI: 10.1002/micr.30587] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 02/26/2020] [Accepted: 03/27/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Pi‐Chieh Lin
- Department of Plastic SurgeryKaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine Kaohsiung Taiwan
| | - Pao‐Jen Kuo
- Department of Plastic SurgeryKaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine Kaohsiung Taiwan
| | - Spencer C. H. Kuo
- Department of Plastic SurgeryKaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine Kaohsiung Taiwan
| | - Peng‐Chen Chien
- Department of Plastic SurgeryKaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine Kaohsiung Taiwan
| | - Ching‐Hua Hsieh
- Department of Plastic SurgeryKaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine Kaohsiung Taiwan
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Kuo SCH, Kuo PJ, Yen YH, Chien PC, Hsieh HY, Hsieh CH. Association between operation- and operator-related factors and surgical complications among patients undergoing free-flap reconstruction for head and neck cancers: A propensity score-matched study of 1,865 free-flap reconstructions. Microsurgery 2019; 39:528-534. [PMID: 31183901 DOI: 10.1002/micr.30477] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/01/2019] [Accepted: 05/24/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Efforts have been devoted to clarify the possible factors related to postoperative complications in free-flap reconstruction. While patient-related factors have been widely discussed, studies regarding the operation/operator-related factors are rather limited in the literature. This study was designed to investigate the relationship between operation/operator-related factors and the surgical complications in free-flap reconstruction following head and neck cancer resection. METHODS Data of 1,841 patients with a total of 1,865 free-flap reconstructions (24 double free-flap reconstructions) between March 2008 and February 2017 were retrieved from the registered microsurgery database of the hospital. The association of operation/operator-related factors (including flap length and length-width ratio, flap types, use of vein graft, opposite side microanastomosis, number of microanastomoses, operators, operator experience, and operation time) with surgical complications was assessed by 1:1 propensity score-matched study groups. RESULTS After propensity score matching of the patient-related factors, the rate of vein grafting was significantly higher (0.6% vs. 2.2%, p = .038) and the operation time was longer (7.0 [5.8-8.5] vs. 7.4 [6.1-8.8] hr, p = .006) in the complication group. In addition, flap length and length-width ratio, flap types, opposite side microanastomosis, number of microanastomoses, operators, and operator experience were not associated with surgical complications. CONCLUSIONS In a hospital that consisted of surgeons with high-volume or very-high-volume experience, the operators or operation experience were not significantly associated with the surgical complications. Only a longer operation time was associated with surgical complications in the patients who underwent free-flap reconstruction for head and neck cancer.
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Affiliation(s)
- Spencer C H Kuo
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pao-Jen Kuo
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yuan-Hao Yen
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Peng-Chen Chien
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsiao-Yun Hsieh
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Hua Hsieh
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Guo Z, Zhang J, Gong Z, Jing S. Correlation of factors associated with postoperative infection in patients with malignant oral and maxillofacial tumours: a logistic regression analysis. Br J Oral Maxillofac Surg 2019; 57:460-465. [DOI: 10.1016/j.bjoms.2019.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 04/04/2019] [Indexed: 11/25/2022]
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Risk Factors for Surgical Site Infection in Patients Undergoing Free and Pedicled Myocutaneous Flap Reconstruction After Oral Cancer Resection. J Oral Maxillofac Surg 2019; 77:1075-1081. [DOI: 10.1016/j.joms.2018.12.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 12/25/2018] [Accepted: 12/25/2018] [Indexed: 01/16/2023]
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Gambotti L, Schwob E, Schouman T, Murcier G, Goudot P, Mallet A, Bertolus C. Are elderly patients presenting with squamous cell carcinoma of the oral cavity given the appropriate treatment? Surg Oncol 2018; 27:715-721. [PMID: 30449498 DOI: 10.1016/j.suronc.2018.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 12/11/2017] [Accepted: 04/30/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES There is no consensus for the specific management of elderly patients presenting with oral cavity squamous cell carcinomas (OC SCC). We report our findings in the treatment of primary OC SCC, for patients of 70 years of age or more, in a French university hospital center. PATIENTS AND METHODS One hundred and twenty five patients diagnosed between 2000 and 2010, were included retrospectively. Independent risk factors of post-operative complications were identified using a logistic regression. The overall survival (OS) was estimated using the Kaplan Meier method. Independent factors of survival were calculated using a Cox model. RESULTS The patient's median age was 78. Women presented significantly more premalignant lesions, less alcohol intoxication, and less tobacco consumption. Half of the population sample was staged T4 in the TNM classification. Eighty eight percent of the patients received a curative treatment. The independent risk factors for post-operative complications were T3/T4 stages (OR 4.3 [1.3-14.4]), lymph node metastasis (OR 6.9 [2.1-22.7]), and alcohol abuse (OR 3.5 [1.1-11.0]). The median OS was 14.0 months. The independent negative prognostic factors for OS for patients treated curatively were: age >79 years (HR 1.9 [1.2-3.2]), stage T2/T3/T4 tumor vs. T1 (HR = 3.0 [1.5-6.0], P = 0.001) and substandard surgery (HR = 1.8 [1.1-2.9], P = 0.03). CONCLUSIONS The management of OC SCC in elderly patients is complex and requires collaboration among gerontologists, surgeons and oncologists. The treatment choice is related to the disease extent and preoperative morbid conditions.
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Affiliation(s)
- Laetitia Gambotti
- Clinical Research Unit, Universitary Hospital Pitié Salpêtrière, AP-HP, 47-83 boulevard de l'hôpital, 75 651 Paris Cedex 13, France.
| | - Emilie Schwob
- Universitary Hospital Pitié Salpêtrière, AP-HP, Department of Maxillo-facial Surgery, 47-83 boulevard de l'hôpital, 75 651 Paris Cedex 13, France; Pierre & Marie Curie University, 4 Place Jussieu 75252 Paris Cedex 05, France
| | - Thomas Schouman
- Universitary Hospital Pitié Salpêtrière, AP-HP, Department of Maxillo-facial Surgery, 47-83 boulevard de l'hôpital, 75 651 Paris Cedex 13, France
| | - Gregory Murcier
- Universitary Hospital Pitié Salpêtrière, AP-HP, Department of Maxillo-facial Surgery, 47-83 boulevard de l'hôpital, 75 651 Paris Cedex 13, France; Pierre & Marie Curie University, 4 Place Jussieu 75252 Paris Cedex 05, France
| | - Patrick Goudot
- Universitary Hospital Pitié Salpêtrière, AP-HP, Department of Maxillo-facial Surgery, 47-83 boulevard de l'hôpital, 75 651 Paris Cedex 13, France; Pierre & Marie Curie University, 4 Place Jussieu 75252 Paris Cedex 05, France
| | - Alain Mallet
- Clinical Research Unit, Universitary Hospital Pitié Salpêtrière, AP-HP, 47-83 boulevard de l'hôpital, 75 651 Paris Cedex 13, France; Pierre & Marie Curie University, 4 Place Jussieu 75252 Paris Cedex 05, France; Department of Biostatistics, Universitary Hospital Pitié Salpêtrière, AP-HP, 47-83 boulevard de l'hôpital, 75 651 Paris Cedex 13, France
| | - Chloé Bertolus
- Universitary Hospital Pitié Salpêtrière, AP-HP, Department of Maxillo-facial Surgery, 47-83 boulevard de l'hôpital, 75 651 Paris Cedex 13, France; Pierre & Marie Curie University, 4 Place Jussieu 75252 Paris Cedex 05, France
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Lin SC, Chang TS, Yang KC, Lin YS, Lin YH. Factors contributing to surgical site infection in patients with oral cancer undergoing microvascular free flap reconstruction. Eur Arch Otorhinolaryngol 2018; 275:2101-2108. [DOI: 10.1007/s00405-018-5035-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 06/06/2018] [Indexed: 01/22/2023]
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10
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Kuo PJ, Wu SC, Chien PC, Chang SS, Rau CS, Tai HL, Peng SH, Lin YC, Chen YC, Hsieh HY, Hsieh CH. Artificial neural network approach to predict surgical site infection after free-flap reconstruction in patients receiving surgery for head and neck cancer. Oncotarget 2018; 9:13768-13782. [PMID: 29568393 PMCID: PMC5862614 DOI: 10.18632/oncotarget.24468] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 02/03/2018] [Indexed: 12/22/2022] Open
Abstract
Background The aim of this study was to develop an effective surgical site infection (SSI) prediction model in patients receiving free-flap reconstruction after surgery for head and neck cancer using artificial neural network (ANN), and to compare its predictive power with that of conventional logistic regression (LR). Materials and methods There were 1,836 patients with 1,854 free-flap reconstructions and 438 postoperative SSIs in the dataset for analysis. They were randomly assigned tin ratio of 7:3 into a training set and a test set. Based on comprehensive characteristics of patients and diseases in the absence or presence of operative data, prediction of SSI was performed at two time points (pre-operatively and post-operatively) with a feed-forward ANN and the LR models. In addition to the calculated accuracy, sensitivity, and specificity, the predictive performance of ANN and LR were assessed based on area under the curve (AUC) measures of receiver operator characteristic curves and Brier score. Results ANN had a significantly higher AUC (0.892) of post-operative prediction and AUC (0.808) of pre-operative prediction than LR (both P<0.0001). In addition, there was significant higher AUC of post-operative prediction than pre-operative prediction by ANN (p<0.0001). With the highest AUC and the lowest Brier score (0.090), the post-operative prediction by ANN had the highest overall predictive performance. Conclusion The post-operative prediction by ANN had the highest overall performance in predicting SSI after free-flap reconstruction in patients receiving surgery for head and neck cancer.
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Affiliation(s)
- Pao-Jen Kuo
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shao-Chun Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Peng-Chen Chien
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shu-Shya Chang
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Shyuan Rau
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsueh-Ling Tai
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shu-Hui Peng
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Chun Lin
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Chun Chen
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsiao-Yun Hsieh
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Hua Hsieh
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Troeltzsch M, Probst FA, Rominger A, Müller-Lisse U, Probst M, Obermeier K, Ehrenfeld M, Otto S. Comorbidity Assessment in Patients With Oral Squamous Cell Carcinoma: Can Imaging Techniques (Fludeoxyglucose Positron-Emission Tomographic Computed Tomography and Contrast-Enhanced Computed tomography) Provide Additional Information? J Oral Maxillofac Surg 2018. [PMID: 28646645 DOI: 10.1016/j.joms.2017.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Matthias Troeltzsch
- Resident, Department of Oral and Maxillofacial Surgery, Ludwig Maximilians University of Munich, Munich, Germany.
| | - Florian Andreas Probst
- Fellow, Department of Oral and Maxillofacial Surgery, Ludwig Maximilians University of Munich, Munich, Germany
| | - Axel Rominger
- Associate Professor, Department of Nuclear Medicine, Ludwig Maximilians University of Munich, Munich, Germany
| | - Ulrich Müller-Lisse
- Associate Professor, Department of Radiology, Ludwig Maximilians University of Munich, Munich, Germany
| | - Monika Probst
- Resident, Department of Neuroradiology, Technical University of Munich, Munich, Germany
| | - Katharina Obermeier
- Graduate Student, Department of Oral and Maxillofacial Surgery, Ludwig Maximilians University of Munich, Munich, Germany
| | - Michael Ehrenfeld
- Professor and Department Chair, Department of Oral and Maxillofacial Surgery, Ludwig Maximilians University of Munich, Munich, Germany
| | - Sven Otto
- Associate Professor, Department of Oral and Maxillofacial Surgery, Ludwig Maximilians University of Munich, Munich, Germany
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Belusic-Gobic M, Zubovic A, Cerovic R, Dekanic A, Marzic D, Zamolo G. Multivariate analysis of risk factors for postoperative wound infection following oral and oropharyngeal cancer surgery. J Craniomaxillofac Surg 2018; 46:135-141. [DOI: 10.1016/j.jcms.2017.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 10/07/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022] Open
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Cheng H, Chen BPH, Soleas IM, Ferko NC, Cameron CG, Hinoul P. Prolonged Operative Duration Increases Risk of Surgical Site Infections: A Systematic Review. Surg Infect (Larchmt) 2017; 18:722-735. [PMID: 28832271 PMCID: PMC5685201 DOI: 10.1089/sur.2017.089] [Citation(s) in RCA: 431] [Impact Index Per Article: 61.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: The incidence of surgical site infection (SSI) across surgical procedures, specialties, and conditions is reported to vary from 0.1% to 50%. Operative duration is often cited as an independent and potentially modifiable risk factor for SSI. The objective of this systematic review was to provide an in-depth understanding of the relation between operating time and SSI. Patients and Methods: This review included 81 prospective and retrospective studies. Along with study design, likelihood of SSI, mean operative times, time thresholds, effect measures, confidence intervals, and p values were extracted. Three meta-analyses were conducted, whereby odds ratios were pooled by hourly operative time thresholds, increments of increasing operative time, and surgical specialty. Results: Pooled analyses demonstrated that the association between extended operative time and SSI typically remained statistically significant, with close to twice the likelihood of SSI observed across various time thresholds. The likelihood of SSI increased with increasing time increments; for example, a 13%, 17%, and 37% increased likelihood for every 15 min, 30 min, and 60 min of surgery, respectively. On average, across various procedures, the mean operative time was approximately 30 min longer in patients with SSIs compared with those patients without. Conclusions: Prolonged operative time can increase the risk of SSI. Given the importance of SSIs on patient outcomes and health care economics, hospitals should focus efforts to reduce operative time.
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Affiliation(s)
| | | | | | - Nicole C Ferko
- 2 Cornerstone Research Group , Burlington, Ontario, Canada
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14
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Haidar YM, Tripathi PB, Tjoa T, Walia S, Zhang L, Chen Y, Nguyen DV, Mahboubi H, Armstrong WB, Goddard JA. Antibiotic prophylaxis in clean-contaminated head and neck cases with microvascular free flap reconstruction: A systematic review and meta-analysis. Head Neck 2017; 40:417-427. [PMID: 29083525 DOI: 10.1002/hed.24988] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 05/08/2017] [Accepted: 09/15/2017] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Optimal antibiotic prophylaxis duration in head and neck clean-contaminated free-flap cases is unknown. METHODS A systematic review/meta-analysis was conducted using PubMed/MEDLINE, Cochrane Library, Web-of-Science, and Scopus databases. RESULTS Of the 3755 searched articles, 5 articles were included for a total of 861 patients. The recipient surgical site infection risk was significantly higher in patients receiving prophylactic antibiotics for ≤24 hours compared to >24 hours (relative risk [RR] 1.56; 95% confidence interval [CI] 1.13-2.14). In the post hoc multivariate analysis based on available individual-level data on 697 patients from 3 studies, the risk of surgical site infection for ≤24 hours versus >24 hours was not significant after adjusting for antibiotic type (RR 1.09; 95% CI 0.78-1.55). When compared to ampicillin-sulbactam, patients who received clindamycin prophylaxis had an increased likelihood of recipient surgical site infection (RR 2.85; 95% CI 1.95-4.17). CONCLUSION Less than or equal to 24 hours of antibiotic prophylaxis in head and neck clean-contaminated free-flap is likely sufficient but a strong conclusion remains elusive. Clindamycin prophylaxis increases the risk of recipient surgical site infection. Further prospective trials are necessary to clarify.
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Affiliation(s)
- Yarah M Haidar
- Department of Otolaryngology - Head and Neck Surgery, University of California - Irvine, Irvine, California
| | - Prem B Tripathi
- Department of Otolaryngology - Head and Neck Surgery, University of California - Irvine, Irvine, California
| | - Tjoson Tjoa
- Department of Otolaryngology - Head and Neck Surgery, University of California - Irvine, Irvine, California
| | - Sartaaj Walia
- Department of Otolaryngology - Head and Neck Surgery, University of California - Irvine, Irvine, California
| | - Lishi Zhang
- Institute for Clinical and Translational Science, University of California, Irvine, Irvine, California
| | - Yanjun Chen
- Institute for Clinical and Translational Science, University of California, Irvine, Irvine, California
| | - Danh V Nguyen
- Department of Medicine, University of California - Irvine School of Medicine, Irvine, California
| | - Hossein Mahboubi
- Department of Otolaryngology - Head and Neck Surgery, University of California - Irvine, Irvine, California
| | - William B Armstrong
- Department of Otolaryngology - Head and Neck Surgery, University of California - Irvine, Irvine, California
| | - Julie A Goddard
- Department of Otolaryngology - Head and Neck Surgery, University of Colorado, Boulder, Colorado
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Akashi M, Kusumoto J, Sakakibara A, Hashikawa K, Furudoi S, Komori T. Literature Review of Criteria for Defining Recipient-Site Infection after Oral Oncologic Surgery with Simultaneous Reconstruction. Surg Infect (Larchmt) 2017; 18:755-764. [PMID: 28792850 DOI: 10.1089/sur.2017.101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The lack of uniformity of criteria for defining recipient-site infection after oral oncologic surgery with simultaneous reconstruction is problematic despite numerous studies on this issue. This study aimed to investigate the difference in the criteria for defining recipient-site infection after oral oncologic surgery with reconstruction. METHODS A Medline search was performed via PUBMED using the following combinations of key terms that were tagged in the title, abstract, or both: "surgical site infection-head neck," "surgical site infection-oral cancer," "antibiotic prophylaxis-head neck," and "surgical site infection-oral carcinoma." Search results were filtered between 2005 and 2017. Articles in which there was no mention of the criteria for definition of surgical-site infection were excluded. RESULTS The number of articles that met the inclusion criteria was 24. The lack of uniformity in the criteria for defining recipient-site infection in each article appeared to be attributable mainly to differences in whether an orocutaneous fistula and superficial incisional infection were regarded as recipient-site infection. CONCLUSION Reconsideration of the categorization of orocutaneous fistula as infection, regardless of the etiology, and differentiation of superficial and deep incisional infections are necessary for correct assessment of recipient-site infection in oral oncologic surgery.
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Affiliation(s)
- Masaya Akashi
- 1 Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine , Kobe, Japan
| | - Junya Kusumoto
- 1 Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine , Kobe, Japan
| | - Akiko Sakakibara
- 1 Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine , Kobe, Japan
| | - Kazunobu Hashikawa
- 2 Department of Plastic Surgery, Kobe University Graduate School of Medicine , Kobe, Japan
| | - Shungo Furudoi
- 1 Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine , Kobe, Japan
| | - Takahide Komori
- 1 Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine , Kobe, Japan
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Khan MN, Russo J, Spivack J, Pool C, Likhterov I, Teng M, Genden EM, Miles BA. Association of Body Mass Index With Infectious Complications in Free Tissue Transfer for Head and Neck Reconstructive Surgery. JAMA Otolaryngol Head Neck Surg 2017; 143:574-579. [PMID: 28301644 PMCID: PMC5824233 DOI: 10.1001/jamaoto.2016.4304] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/13/2016] [Indexed: 12/15/2022]
Abstract
Importance Elevated body mass index (BMI) has been proposed as a risk factor for morbidity and mortality among patients undergoing surgery. Conversely, an elevated BMI may confer a protective effect on perioperative morbidity. Objective To examine whether an elevated BMI is an independent risk factor for perioperative and postoperative infectious complications after free tissue transfer in head and neck reconstructive surgery. Design, Setting, and Participants This cohort study included patients undergoing major head and neck surgery requiring free tissue transfer at a tertiary care center. Data were collected for 415 patients treated from January 1, 2007, through December 31, 2014. Main Outcomes and Measures The outcome of interest was postoperative infection and complications after head and neck surgery using free flaps. Covariates considered for adjustment in the statistical model included alcohol consumption (defined as >5 drinks per day [eg, 360 mL of beer, 150 mL of wine, or 45 mL of 80-proof spirits]), type 2 diabetes, prior radiotherapy, anesthesia time, hypothyroidism, smoking, American Society of Anesthesiologists classification, antibiotic regimen received (defined as a standard regimen of a first- or second-generation cephalosporin with or without metronidazole hydrochloride vs an alternative antibiotic regimen for patients allergic to penicillin), and primary surgeon. A multiple logistic regression model was developed for the incidence of the infection end point as a function of elevated BMI (>30.0). Results Among the 415 patients included in this study (277 men [66.7%] and 138 women [33.2%]; mean [SD] age, 61.5 [13.9] years), type 2 diabetes and use of an alternative antibiotic regimen were found to be independently associated with increased infectious complications after free flap surgery of the head and neck, with estimated odds ratios of 2.78 (95% CI, 1.27-6.09) and 2.67 (95% CI, 1.14-6.25), respectively, in the multiple logistic regression model. However, a high BMI was not found to be statistically significant as an independent risk factor for postoperative infectious complication (estimated odds ratio, 1.19; 95% CI, 0.48-2.92). Conclusions and Relevance Elevated BMI does not seem to play a role as an independent risk factor in postoperative complications in free tissue transfer in head and neck surgery.
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Affiliation(s)
- Mohemmed N. Khan
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jack Russo
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John Spivack
- Department of Health Policy and Statistics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Christopher Pool
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ilya Likhterov
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marita Teng
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eric M. Genden
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brett A. Miles
- Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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18
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Eder-Czembirek C, Czembirek C, Braun P, Perisanidis C, Seemann R. Surgical site infection in clean-contaminated wounds after multimodal treatment of advanced oral squamous cell carcinoma. J Craniomaxillofac Surg 2016; 44:1957-1962. [PMID: 27810163 DOI: 10.1016/j.jcms.2016.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 08/16/2016] [Accepted: 09/23/2016] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess the incidence rate for surgical site infections (SSI), patient- and therapy-related risk factors in UICC stage III and IV oral squamous cell carcinoma patients treated with preoperative radiochemotherapy, ablative surgery and immediate microvascular free flap reconstruction. MATERIAL AND METHODS This retrospective analysis included 85 patients with oral squamous cell carcinoma treated by neoadjuvant radiochemotherapy, tumor surgery and immediate free flap reconstruction. Patient-, therapy-related factors and blood parameters were collected for this selective cohort. RESULTS The incidence for SSI was 44.7% and for transplant loss 14.1%. Minor BMI changes (p = 0.010), diabetes (p = 0.003), edentulous status (p = 0.006) and cessation of alcohol consumption (0.034) showed to be significant patient-related risk factors. No therapy-related factors were found to be significantly influencing the risk for SSI. Neutrophil counts (p = 0.027) and GGT (p = 0.002) were found to be significantly linked to SSI. CONCLUSION The not so common treatment option for oral squamous cell carcinomas showed no more risk for SSI compared to standard treatment options. Preserving the ability for healthy nutrition has a significant impact on the development of SSI. This applies not only to the presented and particular treatment option.
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Affiliation(s)
- Christina Eder-Czembirek
- University Clinic of Cranio, Maxillofacial and Oral Surgery (Head: Prof. E. Nkenke), Medical University Vienna, Vienna General Hospital, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
| | - Cornelia Czembirek
- Center of Excellence of Cranio, Maxillofacial and Oral Surgery and Pediatric Dentistry, Sozialmedizinisches Zentrum Ost - Donauspital, Langobardenstraβe 122, 1220 Vienna, Austria
| | - Pamela Braun
- University Clinic of Cranio, Maxillofacial and Oral Surgery (Head: Prof. E. Nkenke), Medical University Vienna, Vienna General Hospital, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Christos Perisanidis
- University Clinic of Cranio, Maxillofacial and Oral Surgery (Head: Prof. E. Nkenke), Medical University Vienna, Vienna General Hospital, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Rudolf Seemann
- University Clinic of Cranio, Maxillofacial and Oral Surgery (Head: Prof. E. Nkenke), Medical University Vienna, Vienna General Hospital, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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19
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Hwang K, Lee JP, Yoo SY, Kim H. Relationships of comorbidities and old age with postoperative complications of head and neck free flaps: A review. J Plast Reconstr Aesthet Surg 2016; 69:1627-1635. [PMID: 27697538 DOI: 10.1016/j.bjps.2016.08.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 07/29/2016] [Accepted: 08/31/2016] [Indexed: 11/16/2022]
Abstract
The aim of this study was to determine the relationships between free flap complications and old age or comorbidities. In a PubMed and Scopus search, the search terms (1) free flap OR microvascular anastomosis AND (2) elderly OR old age AND (3) complications OR comorbidity OR co-morbidity were used. Among the 62 full-text articles from 241 abstracts, 31 papers without sufficient content were excluded and 10 mined papers were added. Subsequently, 41 papers were reviewed. Overall complication rates of free flap increased significantly with age (p < 0.001; y = 0.457x + 13.464; 40.9% at 60 years, 45.5% at 70 years, and 50.0% at 80 years). Flap survival rates increased significantly (p < 0.001; y = 0.025x + 93.876). Donor site complication rates also increased significantly with age (p < 0.001; y = 1.238x - 63.700; 10.9% at 60 years, 23.0% at 70 years, and 35.3% at 80 years). The Kaplan-Feinstein index (KFI, OR = 7.944, 9.563), the Adult Comorbidity Evaluation-27 (ACE-27, OR = 5.854), the American Society of Anesthesiologists score (ASA, OR = 4.397), and the Index of Coexistent Diseases score (ICED, OR = 3.584) had statistically significant impacts on flap survival (p < 0.05). Diabetes (OR = 4.562) and chronic obstructive pulmonary disease (OR = 2.300) had statistically significant negative impacts on the flap survival rate (p < 0.05). Elderly patients had significantly higher Charlson Comorbidity Index (CCI) and ASA scores (p < 0.001). Similarly, elderly patients exhibited a significantly higher prevalence of dementia (p < 0.001) and use of aspirin at the time of surgery (p < 0.001). On the basis of these results, we suggest that the incidence of complications is directly related to the preoperative medical condition of an individual patient rather than to age.
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Affiliation(s)
- Kun Hwang
- Department of Plastic Surgery, Inha University School of Medicine, Incheon, South Korea.
| | - Jin Pyo Lee
- Inha University School of Medicine, Incheon, South Korea.
| | - Si Yoon Yoo
- Inha University School of Medicine, Incheon, South Korea.
| | - Hun Kim
- Department of Plastic Surgery, Inha University School of Medicine, Incheon, South Korea.
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Wagner JL, Kenney RM, Vazquez JA, Ghanem TA, Davis SL. Surgical prophylaxis with gram-negative activity for reduction of surgical site infections after microvascular reconstruction for head and neck cancer. Head Neck 2016; 38:1449-54. [PMID: 27458902 DOI: 10.1002/hed.24178] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 02/12/2015] [Accepted: 06/11/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine the incidence of and risk factors for surgical site infections in microvascular reconstruction for patients with head and neck cancer. METHODS One hundred seventeen patients with head and neck cancer undergoing microvascular reconstruction received postoperative surgical infection prophylaxis and were followed for 30 days. Surgical infection prophylaxis was categorized by empiric spectrum of activity. Risk factors for surgical site infection development and cumulative incidence of surgical site infections were characterized. RESULTS Thirty-seven patients developed surgical site infection (cumulative surgical site infection incidence of 31.6%). Risk factors identified in logistic regression include alcohol use (odds ratio [OR] = 2.704; 95% confidence interval [CI] = 1.029-7.106), increased surgical duration (OR = 1.403; 95% CI = 1.185-1.661), American Society of Anesthesiologists (ASA) class IV (OR = 3.075; 95% CI = 1.000-9.459), and lack of postoperative gram-negative coverage (OR = 15.139; 95% CI = 3.083-74.347). CONCLUSION Alcohol use, longer surgical duration, and lack of gram-negative postoperative prophylactic coverage are modifiable risk factors for surgical site infection development. © 2016 Wiley Periodicals, Inc. Head Neck 38: First-1454, 2016.
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Affiliation(s)
- Jamie L Wagner
- Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, USA.,Pharmacy Administration, Henry Ford Hospital, Detroit, Michigan.,Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan
| | - Rachel M Kenney
- Pharmacy Administration, Henry Ford Hospital, Detroit, Michigan
| | - Jose A Vazquez
- Department of Infectious Diseases, Georgia Regents University, Augusta, Georgia
| | - Tamer A Ghanem
- Pharmacy Administration, Henry Ford Hospital, Detroit, Michigan
| | - Susan L Davis
- Pharmacy Administration, Henry Ford Hospital, Detroit, Michigan. .,Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan.
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Comorbidity Assessment in Skin Cancer Patients: A Pilot Study Comparing Medical Interview with a Patient-Reported Questionnaire. J Skin Cancer 2015; 2015:953479. [PMID: 26180643 PMCID: PMC4477200 DOI: 10.1155/2015/953479] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 05/21/2015] [Accepted: 05/24/2015] [Indexed: 01/14/2023] Open
Abstract
Background. Comorbidities are conditions that occur simultaneously but independently of another disorder. Among skin cancer patients, comorbidities are common and may influence management. Objective. We compared comorbidity assessment by traditional medical interview (MI) and by standardized patient-reported questionnaire based on the Adult Comorbidity Evaluation-27 (ACE-27). Methods. Between September 2011 and October 2013, skin cancer patients underwent prospective comorbidity assessment by a Mohs surgeon (MI) and a radiation oncologist (using a standardized patient-reported questionnaire based on the ACE-27, the PRACE-27). Comorbidities were identified and graded according to the ACE-27 and compared for agreement. Results. Forty-four patients were evaluated. MI and PRACE-27 identified comorbidities in 79.5% and 88.6% (p = 0.12) of patients, respectively. Among 27 comorbid ailments, the MI identified 9.9% as being present, while the PRACE-27 identified 12.5%. When there were discordant observations, PRACE-27 was more likely than MI to identify the comorbidity (OR = 5.4, 95% CI = 2.4–14.4, p < 0.001). Overall comorbidity scores were moderate or severe in 43.2% (MI) versus 59.1% (PRACE-27) (p = 0.016). Limitations. Small sample size from a single institution. Conclusion. Comorbidities are common in skin cancer patients, and a standardized questionnaire may better identify and grade them. More accurate comorbidity assessments may help guide skin cancer management.
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Early Modification in Drainage of Interleukin-1β and Tumor Necrosis Factor-α Best Predicts Surgical-Site Infection After Cervical Neck Dissection for Oral Cancer. J Oral Maxillofac Surg 2015; 73:1189-98. [DOI: 10.1016/j.joms.2014.12.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 12/10/2014] [Accepted: 12/12/2014] [Indexed: 11/20/2022]
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23
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Shih YH, Chang KW, Yu CC, Kao MC, Chen MY, Wang TH, Chi TY, Chen YL, Shieh TM. Hinokitiol suppressed pan-histone expression and cell growth in oral squamous cell carcinoma cells. J Funct Foods 2015. [DOI: 10.1016/j.jff.2015.03.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Jain U, Somerville J, Saha S, Hackett NJ, Ver Halen JP, Antony AK, Samant S. Oropharyngeal Contamination Predisposes to Complications after Neck Dissection. Otolaryngol Head Neck Surg 2015; 153:71-8. [DOI: 10.1177/0194599815581808] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 03/24/2015] [Indexed: 12/13/2022]
Abstract
Objective While neck dissection is important in the treatment of head and neck cancer, there is a paucity of studies evaluating outcomes. We sought to compare preoperative variables and outcomes between clean and contaminated neck dissections, using the 2006-2011 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data sets. Study Design Retrospective review of prospectively maintained database. Setting Multicenter (university hospitals; tertiary referral centers). Subjects and Methods A retrospective review was performed of the NSQIP database to identify patients undergoing neck dissection in clean vs oropharyngeal contaminated cases. Clinical factors, comorbidities, epidemiologic factors, and procedural characteristics were analyzed to identify factors associated with 30-day postoperative adverse events, including medical and surgical complications, unplanned reoperation, and mortality. Bivariate and multivariable analyses were performed for the outcome of one or more adverse events. Results In total, 8890 patients had clean neck dissections, while 572 patients had neck wound contamination with oropharyngeal flora. On multivariable regression analysis, oropharyngeal contamination was a significant risk factor for surgical complications (odds ratio [OR], 3.42; 95% confidence interval [CI], 1.96-5.96; P < .001). However, medical complications and mortality were not significantly different between the 2 cohorts. This finding persisted after subgroup analysis, with removal of all thyroidectomy patients from analysis (OR, 2.33; 95% CI, 1.25-4.36; P = .008). Conclusion Using the ACS-NSQIP data set, this study found an increased risk of surgical complications in the setting of contaminated neck dissections. These data should be used for patient risk stratification, informed consent, and to guide further research.
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Affiliation(s)
- Umang Jain
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jessica Somerville
- Department of Otolaryngology–Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Sujata Saha
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Jon P. Ver Halen
- Department of Plastic, Reconstructive, and Hand Surgery, Baptist Cancer Center–Vanderbilt Ingram Cancer Center, Memphis, Tennessee, USA
| | - Anuja K. Antony
- Division of Plastic and Reconstructive Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sandeep Samant
- Department of Otolaryngology–Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Durand ML, Yarlagadda BB, Rich DL, Lin DT, Emerick KS, Rocco JW, Deschler DG. The time course and microbiology of surgical site infections after head and neck free flap surgery. Laryngoscope 2014; 125:1084-9. [PMID: 25425457 DOI: 10.1002/lary.25038] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 10/02/2014] [Accepted: 10/28/2014] [Indexed: 01/10/2023]
Abstract
OBJECTIVES/HYPOTHESIS Determine the time of onset and microbiology of surgical site infections (SSIs) following head and neck free flap reconstructive surgeries. STUDY DESIGN Retrospective cohort study. METHODS All 504 free flap surgical cases (484 patients) performed April 1, 2009 to September 30, 2013 were reviewed; SSIs occurring ≤30 days postoperatively were evaluated. Admission screening for methicillin-resistant Staphylococcus aureus (MRSA) colonization was performed on all patients. RESULTS Flap-recipient site infections (flap SSIs) occurred in 67 cases (13.3%), one-third week 1 postoperatively, one-third week 2, one-third days 15 to 30; 45% occurred after hospital discharge. Wound cultures were polymicrobial, but 25% grew only normal oral flora, whereas 75% grew pathogens not part of normal oral flora, such as gram-negative bacilli (44% of cases), MRSA (20%), and methicillin-sensitive S aureus (MSSA) (16%). The frequency of these pathogens did not vary significantly by the time of SSI onset. In 67%, cultures included at least one pathogen resistant to the prophylactic antibiotic used. Clindamycin prophylaxis was a significant risk factor for flap SSI and for early partial or complete flap loss from infection. Donor SSIs occurred in 22 cases (4.4%), 95% >1 week postoperatively, and MRSA or MSSA were the primary pathogens in 89%. Of the 25 patients colonized with MRSA on admission, 40% developed a flap or donor SSI, a rate significantly higher than in non-colonized patients. CONCLUSIONS Gram-negative bacilli, MRSA, and MSSA were significant SSI pathogens, and late onset of infection was common. Better screening, decolonization, and prophylaxis may reduce SSI rates. LEVEL OF EVIDENCE 2b
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Affiliation(s)
- Marlene L Durand
- Infectious Disease Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
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