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Cheng Y, Tang Q, Li X, Ma L, Yuan J, Hou X. Meta-lasso: new insight on infection prediction after minimally invasive surgery. Med Biol Eng Comput 2024; 62:1703-1715. [PMID: 38347344 DOI: 10.1007/s11517-024-03027-w] [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: 10/06/2023] [Accepted: 01/09/2024] [Indexed: 05/09/2024]
Abstract
Surgical site infection (SSI) after minimally invasive lung cancer surgery constitutes an important factor influencing the direct and indirect economic implications, patient prognosis, and the 5-year survival rate for early-stage lung cancer patients. In the realm of predictive healthcare, machine learning algorithms have been instrumental in anticipating various surgical outcomes, including SSI. However, accurately predicting infection after minimally invasive surgery remains a clinical challenge due to the multitude of physiological and surgical factors associated with it. Furthermore, clinical patient data, in addition to being high-dimensional, often exists the long-tail problem, posing difficulties for traditional machine learning algorithms in effectively processing such data. Based on this insight, we propose a novel approach called meta-lasso for infection prediction following minimally invasive surgery. Our approach leverages the sparse learning algorithm lasso regression to select informative features and introduces a meta-learning framework to mitigate bias towards the dominant class. We conducted a retrospective cohort study on patients who had undergone minimally invasive surgery for lung cancer at Shanghai Chest Hospital between 2018 and 2020. The evaluation encompassed key performance metrics, including sensitivity, specificity, precision (PPV), negative predictive value (NPV), and accuracy. Our approach has surpassed the performance of logistic regression, random forest, Naive Bayes classifier, gradient boosting decision tree, ANN, and lasso regression, with sensitivity at 0.798, specificity at 0.779, precision at 0.789, NPV at 0.798, and accuracy at 0.788 and has greatly improved the classification performance of the inferior class.
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Affiliation(s)
- Yuejia Cheng
- Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, 241 West Huaihai Road, 200030, Shanghai, China
| | - Qinhua Tang
- Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, 241 West Huaihai Road, 200030, Shanghai, China
| | - Xiang Li
- School of Computer Science, Shanghai University, 99 Shangda Road, 200044, Shanghai, China
| | - Liyan Ma
- School of Computer Science, Shanghai University, 99 Shangda Road, 200044, Shanghai, China
| | - Junyi Yuan
- Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, 241 West Huaihai Road, 200030, Shanghai, China
| | - Xumin Hou
- Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, 241 West Huaihai Road, 200030, Shanghai, China.
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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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Chang VKO, See L, Griffin A, Breik O, Batstone MD, Liu TPJ. Impact of dental state and surgical factors on postoperative neck infection in oral cancer patients. Br J Oral Maxillofac Surg 2024; 62:51-57. [PMID: 38044253 DOI: 10.1016/j.bjoms.2023.10.013] [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: 06/04/2023] [Revised: 08/29/2023] [Accepted: 10/17/2023] [Indexed: 12/05/2023]
Abstract
Postoperative neck infection (PONI) is a known complication of neck dissection. In this study we explored the impact of dental status on the development of PONI, using orthopantomograms to assess edentulism, periodontal health, and caries status. Retrospective analysis was performed for all new oral cancer patients who had neck dissection between January 2008 and January 2020 in a tertiary head and neck centre. PONI risk factors assessed included patient characteristics, dental status, tumour, and surgical factors. Development of PONI was the primary outcome. Edentulous patients had lower risk of PONI (OR 0.06, p = 0.026) compared to those with 21 or more teeth. Periodontitis and dental caries were not statistically significant. Current smokers (OR 2.09, p = 0.044) and free flap reconstruction (OR 5.41, p < 0.001) were also significant predictors for development of PONI. This study highlights the presence of teeth as a potential source of infection post neck dissection and that orthopantomogram assessment may be inadequate to identify at risk patients. Future studies are required on direct clinical assessment of dentition to evaluate the impact of dental optimisation in prevention of PONI.
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Affiliation(s)
- Victor K O Chang
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia.
| | - Lydia See
- Metro North Oral Health Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; School of Dentistry, University of Queensland, Brisbane, Queensland, Australia; Adjunct Research Fellow School of Dentistry, University of Western Australia, Perth, Australia
| | - Alison Griffin
- Statistics Unit, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Queensland, Australia
| | - Omar Breik
- Oral and Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Martin D Batstone
- Oral and Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Timothy P J Liu
- Metro North Oral Health Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; School of Dentistry, University of Queensland, Brisbane, Queensland, Australia; Adjunct Research Fellow School of Dentistry, University of Western Australia, Perth, Australia
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Gugliotta Y, Rubattino S, Fasolis M, Ramieri G, Copelli C. Postoperative infections associated with microvascular free flaps in head and neck reconstruction: Analysis of risk factors and results with a standardized prophylaxis protocol. J Plast Reconstr Aesthet Surg 2023; 87:61-68. [PMID: 37812845 DOI: 10.1016/j.bjps.2023.09.046] [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: 12/16/2022] [Revised: 08/23/2023] [Accepted: 09/12/2023] [Indexed: 10/11/2023]
Abstract
Currently, large defects of the head and neck regions are mainly reconstructed using microvascular free flap. Postoperative infections, including surgical site infections (SSIs) and medical postoperative infections (MPI), are important causes of morbidity and worsening of surgical outcomes. The authors aimed to analyze the results obtained using a standardized prophylaxis protocol in a series of 100 consecutive patients who underwent microvascular reconstruction surgery between 2016 and 2021 at a single institution, to identify the risk factors, which could be overcome, to minimize the incidence of infectious complications. In this study, 24 patients developed infectious complications. Higher American Society of Anesthesiologists (ASA) score was statistically associated with higher risk of infectious complications (p = 0.01), need for postoperative transfusions (p = 0.01), and higher T and N stage (p = 0.03 and p = 0.02, respectively) in patients with cancer. We also found a correlation between the increase in surgery duration, hospitalization, and intensive care unit (ICU) stay with higher risk of infection (p = 0.03, p = 0.01, and p = 0.001, respectively). Nine patients reported partial or total flap necrosis and in this group of patients, a higher incidence of infectious complication was recorded (p = 0.001). Our experience shows that SSIs and MPIs affect the global and surgical outcomes of patients and both their incidences can be reduced by correcting potential risk factors preoperatively (e.g., anemia), intraoperatively (amount of blood loss and duration of surgery), and postoperatively (duration of hospitalization and ICU stay and early elimination of potential sources of infection).
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Affiliation(s)
- Y Gugliotta
- Department of Surgical Sciences, Maxillo-Facial Surgery Unit, AOU Città della Salute e della Scienza, University of Turin, Italy
| | - S Rubattino
- Department of Surgical Sciences, Maxillo-Facial Surgery Unit, AOU Città della Salute e della Scienza, University of Turin, Italy.
| | - M Fasolis
- Department of Surgical Sciences, Maxillo-Facial Surgery Unit, AOU Città della Salute e della Scienza, University of Turin, Italy
| | - G Ramieri
- Department of Surgical Sciences, Maxillo-Facial Surgery Unit, AOU Città della Salute e della Scienza, University of Turin, Italy
| | - C Copelli
- Maxillo-Facial Surgery, Interdisciplinary Department of Medicine, University of Bari, Italy
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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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McLoughlin LC, Perlis N, Lajkosz K, Boasie A, Esmail T, Nielson C, Lavrencic N, Jackson T, Kulkarni GS. Surgical Site Infections During the Pandemic: The Impact of the "COVID Bundle". World J Surg 2023; 47:2310-2318. [PMID: 37488332 DOI: 10.1007/s00268-023-07112-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND A reduction in surgical site infections (SSIs) has been reported in several discrete patient populations during the COVID-19 pandemic. Herein, this study evaluates the impact of the COVID-19 pandemic on SSI in a large patient cohort incorporating multiple surgical disciplines. We hypothesize that enhanced infection control and heightened awareness of such measures is analogous to an SSI care bundle, the hypothetical "COVID bundle", and may impact SSI rates. METHOD Data collected for the American College of Surgeons National Surgical Quality Improvement Program between January 1, 2015, and April 1, 2021, were retrospectively analyzed. SSI rates were compared among time-dependent patient cohorts: Cohort A (pre-pandemic, N = 24,060, 87%) and Cohort B (pandemic, N = 3698, 13%). Time series and multivariable analyses predicted pre-pandemic and pandemic SSI trends and tested for association with timing of surgery. RESULTS The overall SSI incidence was reduced in Cohort B versus Cohort A (2.8% vs. 4.5%, p < 0.001). Multivariable analysis indicated a downward SSI trend before pandemic onset (IRR 0.997, 95% CI 0.994, 1). At pandemic onset, the trend reduced by a relative factor of 39% (IRR 0.601, 95% CI 0.338, 1.069). SSI then trended upward during the pandemic (IRR 1.035, 95% CI 0.965, 1.111). SSI rates significantly trended downward in general surgical patients at pandemic onset (IRR 0.572, 95% CI 0.353, 0.928). CONCLUSION Although overall SSI incidence was reduced during the pandemic, a statistically significant decrease in the predicted SSI rate only occurred in general surgical patients at pandemic onset. This trend may suggest a positive impact of the "COVID bundle" on SSI rates in these patients.
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Affiliation(s)
- Louise Catherine McLoughlin
- Division of Surgical Oncology (Urology), Department of Surgery, University Health Network, University of Toronto, Toronto, Canada.
- Department of Urology, St. James's Hospital, Dublin 8, Ireland.
- Department of Surgery, Trinity College Dublin, Dublin, Ireland.
| | - Nathan Perlis
- Division of Surgical Oncology (Urology), Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - Katherine Lajkosz
- Division of Surgical Oncology (Urology), Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - Alexandra Boasie
- Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - Tariq Esmail
- Department of Anesthesiology and Pain Management, University Health Network, University of Toronto, Toronto, Canada
| | - Chantelle Nielson
- Department of Quality, Safety and Clinical Adoption, University of Toronto, Toronto, Canada
| | - Natalia Lavrencic
- Department of Quality, Safety and Clinical Adoption, University of Toronto, Toronto, Canada
| | - Timothy Jackson
- Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - Girish S Kulkarni
- Division of Surgical Oncology (Urology), Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
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Nassar AA. Mapping the Risk Factors of Pharyngocutaneous Fistula After Salvage Laryngectomies. Indian J Otolaryngol Head Neck Surg 2022; 74:5954-5958. [PMID: 36742734 PMCID: PMC9895164 DOI: 10.1007/s12070-021-02603-y] [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: 03/12/2021] [Accepted: 05/03/2021] [Indexed: 02/07/2023] Open
Abstract
To evaluate the postoperative surgical wound infection prevalence rates of patients undergoing SL, identify the causative organism and determine predisposing factors leading to infection. A retrospective study of all consecutive patients who underwent salvage total laryngectomy at our unit between 2015 and 2020 was performed. The following parameters were also analyzed: age, smoking history, pre and postoperative albumin level, history of radio and chemo-radiotherapy, reconstruction with pectoralis flap, intraoperative tracheoesophageal puncture, and tumor stage. A total of 12 of the 21 patients (57%) experienced a postoperative infection after SL during the study period. 82% of those patients whose preoperative albumin level below 3gm/dl developed postoperative infection. There is a significant increase (p < 0.01) in infection in patients with N1 and 2 stage tumor (68%) compared with the N0 stage tumors (40%). Multivariate analysis showed that preoperative albumin and nodal stage were significant risk factors for postoperative infection. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-021-02603-y.
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Affiliation(s)
- Ahmed Amin Nassar
- The Otolaryngology Department, Faculty of Medicine, Cairo University, Cairo, Arab Republic of Egypt
- 4 Mohamed Yousef Othman ST, Omraneya, Giza, 12552 Al zohour district Egypt
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Length of the Most Distal End of Head and Neck Defect to Axilla Affects Survival of Pedicled Latissimus Dorsi Flap. J Craniofac Surg 2022; 33:2482-2485. [PMID: 35905387 DOI: 10.1097/scs.0000000000008737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 03/30/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The objective of this study was to determine factors affecting the survival of pedicled latissimus dorsi (LD) flap. MATERIALS AND METHODS Medical records of 20 pedicled LD flap patients for head and neck reconstruction by a single operator from 2015 to 2019 in a tertiary hospital were reviewed. Factors including flap size and pedicle's length from the most distal end of the flap to the axilla (Fp) and from the most distal end of the defect to the axilla (Dfp) were assessed. Partial flap loss requiring procedures and total loss were considered as failure. Descriptive statistics, the Pearson χ 2 test, and linear-by-linear association analysis were performed. RESULTS Seventy percent of patients showed success. There was no significant difference in various factors including preoperative body mass index, underlying diseases such as hypertension and diabetes, preoperative treatment either radiation or chemotherapy, lab results, and operation time between the survival and the failure group. Rotation arc (Dfp/Fp) showed significant difference between 2 groups ( P =0.001). Unlike Fp, Dfp tend to be shorter on the success group ( P =0.053). CONCLUSIONS Low rotation arc through shorter Dfp affects survival of pedicled LD flap significantly.
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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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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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Clindamycin use in head and neck surgery elevates the rate of infections in tracheostomies. Eur Arch Otorhinolaryngol 2022; 279:3581-3586. [PMID: 35333962 PMCID: PMC9130157 DOI: 10.1007/s00405-022-07349-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/08/2022] [Indexed: 11/18/2022]
Abstract
Background Surgical site infection (SSI) in open surgical tracheostomy (ST) occurs in up to 33% of the cases. SSI can be reduced by a postoperative antibiotic prophylaxis (POAP). The effect of Clindamycin on SSIs in head and neck surgery (HNS) is discussed controversially in the literature. Methods An 8 year single-center retrospective comparative analysis of 441 STs (Visor-ST and Bjoerk-flap technique) performed within major HNS was evaluated due to the event of a SSI within 7 days and analyzed descriptively. Logistic regression model evaluated the impact of POAP with Clindamycin on SSIs. Results The use of Clindamycin showed twice the rate of ST-SSI as all patients that did not receive Clindamycin, treated with other perioperative antibiotics. (Fisher’s p = 0.008) The logistic regression model could not prove a statistically significant impact. (OR = 2.91, p = 0.04). Conclusion We recommend that Clindamycin should be reconsidered as a POAP regimen in ST. Further studies should evaluate alternatives for Penicillin-allergic patients. Level of evidence III Comparative retrospective monocentric study.
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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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Gan C, Wang Y, Tang Y, Wang K, Sun B, Wang M, Zhu F. Risk factors for surgical site infection in head and neck cancer. Support Care Cancer 2021; 30:2735-2743. [PMID: 34825984 DOI: 10.1007/s00520-021-06687-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 11/07/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE Surgical site infection (SSI) frequently occurs in patients with head and neck cancer (HNC) after tumor resection and can lead to death in severe cases. Moreover, there is no definitive conclusion about the risk factors of SSI. Therefore, it is of great clinical significance to study the factors affecting the SSI. METHODS The HNC patients included in this study were all from the Department of Oral and Maxillofacial Surgery of the Second Xiangya Hospital of Central South University (CSU), and these patients received surgical treatment in the department from January 2018 to December 2019. The cross tabulation with chi-squared testing and multivariate regression analysis were applied to determine the risk factors of SSI. To identify the key risk factors of SSI, the caret package was used to construct three different machine learning models to investigate important features involving 26 SSI-related risk factors. RESULTS Participants were 632 HNC patients who underwent surgery in our department from January 2018 to December 2019. During the postoperative period, 82 patients suffered from SSI, and surgical site infection rate (SSIR) was about 12.97%. Multivariate logistic regression analysis shows that diabetes mellitus, primary tumor site (floor of mouth), preoperative radiotherapy, flap failure, and neck dissection (bilateral) are risk factors for SSI of HNC. Machine learning indicated that diabetes mellitus, primary tumor site (floor of mouth), and flap failure were consistently ranked the top three in the 26 SSI-related risk factors. CONCLUSION Diabetes mellitus, primary tumor site (floor of mouth), flap failure, preoperative radiotherapy, and neck dissection (bilateral) are risk factors for SSI of HNC.
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Affiliation(s)
- Chengwen Gan
- Department of Oral and Maxillofacial Surgery, Hainan Provincial People's Hospital, Haikou, Hainan, China
| | - Yannan Wang
- Department of Plastic Surgery, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Yan Tang
- Department of Nursing, The Second Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Kai Wang
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, Hunan, China
| | - Bincan Sun
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, Hunan, China
| | - Mengxue Wang
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, Hunan, China
| | - Feiya Zhu
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, Hunan, China.
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14
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Pantvaidya G, Joshi S, Nayak P, Kannan S, DeSouza A, Poddar P, Prakash G, Vijaykumaran P, Nair D, Vaish R, Patkar S, Niyogi D, Joshi P, Chaudhari V, Singh V, Mathews S, Pramesh CS, Badwe RA, Puri A. Surgical Site Infections in patients undergoing major oncological surgery during the COVID-19 paNdemic (SCION): A propensity-matched analysis. J Surg Oncol 2021; 125:327-335. [PMID: 34729779 PMCID: PMC8661874 DOI: 10.1002/jso.26738] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 10/23/2021] [Indexed: 11/10/2022]
Abstract
Background and Objectives There are reports of outcomes of elective major cancer surgery during the COVID‐19 pandemic. We evaluated if reinforcement of hand hygiene, universal masking, and distancing as a part of pandemic precautions led to a decrease in the incidence of surgical site infections (SSIs) in major oncologic resections. Methods Propensity score matching using the nearest neighbor algorithm was performed on 3123 patients over seven covariates (age, comorbidities, surgery duration, prior treatment, disease stage, reconstruction, and surgical wound type) yielding 2614 matched (pre‐COVID 1612 and COVID 1002) patients. Conditional logistic regression was used to identify if SSI incidence was lower amongst patients operated during the pandemic. Results There was a 4.2% (p = 0.006) decrease in SSI in patients operated during the pandemic. On multivariate regression, surgery during the COVID‐19 period (odds ratio [OR] = 0.77; 95% confidence interval [CI] = 0.61–0.98; p = 0.03), prior chemoradiation (OR = 2.46; CI = 1.45–4.17; p < 0.001), duration of surgery >4 h (OR = 2.17; 95%CI = 1.55–3.05; p < 0.001) and clean contaminated wounds (OR = 2.50; 95% CI = 1.09–2.18; p = 0.012) were significantly associated with SSI. Conclusion Increased compliance with hand hygiene, near‐universal mask usage, and social distancing during the COVID‐19 pandemic possibly led to a 23% decreased odds of SSI in major oncologic resections. Extending these low‐cost interventions in the post‐pandemic era can decrease morbidity associated with SSI in cancer surgery.
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Affiliation(s)
- Gouri Pantvaidya
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Shalaka Joshi
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Prakash Nayak
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Sadhana Kannan
- Clinical Research Secreteriat, Advanced Centre for Treatment, Research and Education in Cancer, Mumbai, India
| | - Ashwin DeSouza
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Pabashi Poddar
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Gagan Prakash
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Preeti Vijaykumaran
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Deepa Nair
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Richa Vaish
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Shraddha Patkar
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Devayani Niyogi
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Poonam Joshi
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Vikram Chaudhari
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Vikas Singh
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Saumya Mathews
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - C S Pramesh
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Rajendra A Badwe
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
| | - Ajay Puri
- Department of Surgery, Tata Memorial Hospital and Homi Bhabha National Institute, Mumbai, India
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15
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Pai K, Baaklini C, Cabrera CI, Tamaki A, Fowler N, Maronian N. The Utility of Comorbidity Indices in Assessing Head and Neck Surgery Outcomes: A Systematic Review. Laryngoscope 2021; 132:1388-1402. [PMID: 34661923 DOI: 10.1002/lary.29905] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the utility of comorbidity index (CI) scores in predicting outcomes in head and neck surgery (HNS). The CIs evaluated were the Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Index (ECI), Kaplan-Feinstein Index (KFI), American Society of Anesthesiologists Physical Status (ASA-PS), Adult Comorbidity Evaluation-27 (ACE-27), National Cancer Institute Comorbidity Index (NCI-CI), and the Washington University Head and Neck Comorbidity Index (WUHNCI). METHODS We report a systematic review according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Electronic databases (PubMed, Cochrane, and Embase) and manual search of bibliographies identified manuscripts addressing how CI scores related to HNS outcomes. RESULTS A total of 116 studies associated CI scores with HNS outcomes. CIs were represented in the literature as follows: ASA-PS (70/116), CCI (39/116), ACE-27 (24/116), KFI (7/116), NCI-CI (3/116), ECI (2/116), and WUHNCI (1/116). The most frequently cited justification for calculating each CI (if provided) was: CCI for its validation in other studies, ACE-27 for its utility in cancer patients, and ECI for its comprehensive design. In general, the CCI and ACE-27 were predictive of mortality in HNS. The ECI was most consistent in predicting >1-year mortality. The ACE-27 and KFI were most consistent in predicting medical complications. CONCLUSION Despite inconsistencies in the literature, CIs provide insights into the impact of comorbidities on outcomes in HNS. These scores should be employed as an adjunct in the preoperative assessment of HNS patients. Comparative studies are needed to identify indices that are most reliable in predicting HNS outcomes. LEVEL OF EVIDENCE NA Laryngoscope, 2021.
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Affiliation(s)
- Kavya Pai
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, U.S.A
| | - Carla Baaklini
- Northeast Ohio Medical University, Rootstown, Ohio, U.S.A
| | - Claudia I Cabrera
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Akina Tamaki
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Nicole Fowler
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Nicole Maronian
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
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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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Shi M, Han Z, Qin L, Su M, Liu Y, Li M, Cheng L, Huang X, Sun Z. Risk factors for surgical site infection after major oral oncological surgery: the experience of a tertiary referral hospital in China. J Int Med Res 2021; 48:300060520944072. [PMID: 32841576 PMCID: PMC7463046 DOI: 10.1177/0300060520944072] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective To identify risk factors associated with surgical site infection (SSI) after
major oral oncological surgery. Methods This retrospective study reviewed data from patients that underwent major
surgery for oral cancer at a tertiary referral hospital in China between
January 2005 and July 2016. SSI was diagnosed within 30 days. Demographic,
cancer-related, preoperative, perioperative and postoperative data were
analysed using descriptive statistics and univariate and multivariate
analyses of the risk factors for SSI. Results A total of 786 patients were enrolled, of whom 125 had SSI (15.9%), which
were all incisional. Independent risk factors for SSI, identified by
multivariate analysis, were diabetes mellitus (odds ratio [OR] 2.147, 95%
confidence interval [CI] 1.240, 3.642), prior radiotherapy (OR 4.595, 95% CI
1.293, 17.317) and oral–neck communication (OR 2.838, 95% CI 1.263, 7.604);
and factors reflecting large extent resections were tracheostomy (OR 2.235,
95% CI 1.435, 3.525), anterolateral thigh flap (OR 1.971, 95% CI 1.103,
3.448) and latissimus dorsi flap (OR 4.178, 95% CI 1.325, 13.189). Conclusions Multiple risk factors were associated with SSI after major oral oncological
surgery. To minimize SSI risk, surgeons managing oral cancer patients should
have a better understanding of the risk factors, including diabetes
mellitus, prior radiotherapy, tracheostomy, oral–neck communication and flap
reconstruction.
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Affiliation(s)
- Menghan Shi
- Department of Oral and Maxillofacial Surgery, Beijing Stomatological Hospital & School of Stomatology, Capital Medical University, Beijing, China.,Department of Oral Medicine, Beijing Stomatological Hospital & School of Stomatology, Capital Medical University, Beijing, China
| | - Zhengxue Han
- Department of Oral and Maxillofacial Surgery, Beijing Stomatological Hospital & School of Stomatology, Capital Medical University, Beijing, China
| | - Lizheng Qin
- Department of Oral and Maxillofacial Surgery, Beijing Stomatological Hospital & School of Stomatology, Capital Medical University, Beijing, China
| | - Ming Su
- Department of Oral and Maxillofacial Surgery, Beijing Stomatological Hospital & School of Stomatology, Capital Medical University, Beijing, China
| | - Yanbin Liu
- Department of Oral and Maxillofacial Surgery, Beijing Stomatological Hospital & School of Stomatology, Capital Medical University, Beijing, China
| | - Man Li
- Department of Oral and Maxillofacial Surgery, Beijing Stomatological Hospital & School of Stomatology, Capital Medical University, Beijing, China
| | - Long Cheng
- Department of Oral and Maxillofacial Surgery, Beijing Stomatological Hospital & School of Stomatology, Capital Medical University, Beijing, China
| | - Xin Huang
- Department of Oral and Maxillofacial Surgery, Beijing Stomatological Hospital & School of Stomatology, Capital Medical University, Beijing, China
| | - Zheng Sun
- Department of Oral Medicine, Beijing Stomatological Hospital & School of Stomatology, Capital Medical University, Beijing, China
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18
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Bartochowska A, Tomczak H, Wierzbicka M. Acinetobacter: An Enemy after Head and Neck Cancer Operations with Microvascular Free Flap Reconstruction? Surg Infect (Larchmt) 2020; 22:442-446. [PMID: 32915713 DOI: 10.1089/sur.2020.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Patients after head and neck cancer reconstructive surgical procedures are predisposed to have post-operative surgical site infections (SSI) develop. They are very often caused by multi-drug resistant strains, including Acinetobacter baumannii as the most common one. Methods: The aim of the study was to determine important risk factors contributing to SSI of A. baumannii origin. The analysis included 134 head and neck cancer patients after salvage operations with microvascular free flap reconstruction. The A. baumannii was cultured in 27 of all 48 infected patients. Results: The following risk factors were significantly associated with A. baumannii infection: re-hospitalization before reconstructive operation (p = 0.00011), massive blood loss (p = 0.00277), and need of revision surgical procedure (p = 0.00419). Of patients with A. baumannii infection, 48% were hospitalized in a general intensive care unit (ICU) after operation that, together with prolonged intubation, constituted a strong risk factor of that infection (p = 0.01077). Mean time of hospital stay was significantly longer in the A. baumannii group (58 days vs. 35 days; p = 0.02697). Conclusions: Our analysis identified a subset of head and neck cancer patients after salvage operation with microvascular free flap reconstruction who are at high risk of A. baumannii infection developing. Previously hospitalized patients with extensive blood loss and need of surgical revision necessitate increased monitoring for the development of this complication. Mechanical ventilation and hospital stay in an ICU should be shortened maximally or avoided in that challenging group of patients. Early recognition of patients at high risk remains a key point to prevent or limit the spread of A. baumannii infections.
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Affiliation(s)
- Anna Bartochowska
- Department of Otolaryngology, Head, and Neck Surgery, Poznań University of Medical Sciences, Poznań, Poland
| | - Hanna Tomczak
- Central Microbiological Laboratory, Heliodor Święcicki Hospital, Poznań University of Medical Sciences, Poznań, Poland.,Department of Dermatology and Venereology, Poznań University of Medical Sciences, Poznań, Poland
| | - Małgorzata Wierzbicka
- Department of Otolaryngology, Head, and Neck Surgery, Poznań University of Medical Sciences, Poznań, Poland.,Institute of Human Genetics, Polish Academy of Sciences, Poznań, Poland
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19
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Belusic-Gobic M, Zubovic A, Predrijevac A, Harmicar D, Cerovic R, Udovic Gobic S, Zubovic L. Microbiology of wound infection after oral cancer surgery. J Craniomaxillofac Surg 2020; 48:700-705. [PMID: 32522395 DOI: 10.1016/j.jcms.2020.05.011] [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: 06/28/2019] [Revised: 05/06/2020] [Accepted: 05/27/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The aim of present study is to investigate the most common infection pathogen found in the postoperative wounds, following surgical treatment of oral and oropharyngeal cancer, in order to identify the most suitable antibiotic treatment. PATIENTS AND METHODS We analyzed patients with squamous cell cancer of oral and oropharyngeal region. In patients who developed postoperative wound infection, wound swabs were taken from three different sites: the cannula, wounds on the neck and wounds in the oral cavity. RESULTS In total 195 patients were included. The postoperative wound infection was detected in 115 patients (59%). In average, the swabs were taken 8 days after the surgery. The similar bacterial species from all three sites were detected in 24 patients (12,3%). In comparison, we found that there was statistically significant difference in the bacteria abundance from all three sites (p=0,031). There were significantly more bacteria in the wounds of the neck than cannula (p=0,007) and in the wounds in the oral cavity than cannula (p=0,002). No statistically significant difference between the wound on the neck and in the oral cavity was found. The most frequently isolated bacterial family was Enterobacteriaceae. Other more commonly isolated bacteria species were Staphylococcus spp. (G+), Pseudomonas aeruginosa (G-), Corynebacteruim spp. (G +) and Acinetobacter baumanii (G-). CONCLUSION Based on the most commonly isolated groups of pathogens we concluded that probably the best empiric antibiotic treatment of wound infections until antibiogram is completed might be achieved from the group of aminoglycosides or quinolones. Antibiotic therapy should be reviewed if necessary when antibiogram is completed.
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Affiliation(s)
| | - Arijan Zubovic
- Clinic for Maxillofacial Surgery, University Hospital Center Rijeka, Croatia.
| | - Anamarija Predrijevac
- Department of Anesthesiology, Reanimatology and Intensive Care, University of Rijeka, Rijeka, Croatia
| | - David Harmicar
- Clinic for Maxillofacial Surgery, University Hospital Center Rijeka, Croatia
| | - Robert Cerovic
- Clinic for Maxillofacial Surgery, University Hospital Center Rijeka, Croatia
| | - Silvana Udovic Gobic
- Teaching Institute of Public Health of Primorsko - Goranska Country, Mycrobiological Department, Specialist of Medical Microbiology and Parasitology, Croatia
| | - Lorena Zubovic
- Laboratory of Molecular and Cellular Neurobiology, Department of Cellular, Computational and Integrative Biology - CIBIO, University of Trento, Italy
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20
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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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21
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Lindeborg MM, Puram SV, Sethi RK, Abt N, Emerick KS, Lin D, Deschler DG. Predictive factors for prolonged operative time in head and neck patients undergoing free flap reconstruction. Am J Otolaryngol 2020; 41:102392. [PMID: 31918856 DOI: 10.1016/j.amjoto.2020.102392] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/28/2019] [Accepted: 01/03/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE Defining the predictive factors associated with prolonged operative time may reduce post-operative complications, improve patient outcomes, and decrease cost of care. The aims of this study are to 1) analyze risk factors associated with prolonged operative time in head and neck free flap patients and 2) determine the impact of lengthier operative time on surgical outcomes. METHODS This retrospective cohort study evaluated 282 head and neck free flap reconstruction patients between 2011 and 2013 at a tertiary care center. Perioperative factors investigated by multivariate analyses included gender, age, American Society of Anesthesiologists class, tumor subsite, stage, flap type, preoperative comorbidities, and perioperative hematocrit nadir. Association was explored between operative times and complications including flap take back, flap survival, transfusion requirement, flap site hematoma, and surgical site infection. RESULTS Mean operative time was 418.2 ± 88.4 (185-670) minutes. Multivariate analyses identified that ASA class III (beta coefficient + 24.5, p = .043), stage IV tumors (+34.8, p = .013), fibular free flaps (-44.8, p = .033 for RFFF vs. FFF and - 67.7, p = .023 for ALT vs FFF) and COPD (+36.0, p = .041) were associated with prolonged operative time. History of CAD (-43.5, p = .010) was associated with shorter operative time. There was no statistically significant association between longer operative time and adverse flap outcomes or complications. CONCLUSION As expected, patients who were medically complex, had advanced cancer, or underwent complex flap reconstruction had longer operative times. Surgical planning should pay special attention to certain co-morbidities such as COPD, and explore innovative ways to minimize operative time. Future research is needed to evaluate how these factors can help guide planning algorithms for head and neck patients.
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The effect of preventive oral care on postoperative infections after head and neck cancer surgery. Auris Nasus Larynx 2020; 47:643-649. [PMID: 32037040 DOI: 10.1016/j.anl.2020.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/23/2019] [Accepted: 01/14/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to investigate the incidence of postoperative pneumonia (PP) and surgical site infection (SSI) in head and neck cancer (HNC) patients and clarify the relationship between oral care and postoperative infection. METHODS We conducted a retrospective observation survey based on the medical records of 209 HNC surgery patients managed at a University Hospital in 2016-2018. The incidence of PP and SSI were assessed in patients who underwent operations of the nose and paranasal sinuses to the larynx. Factors associated with PP and SSI in a univariate analysis were included in a multiple logistic regression analysis. A Cox proportional hazards model was used analyze the incidence of PP according to time after surgery. The present study was approved by the ethical review board of our Institute. RESULTS The rates of PP and SSI in our study population were 20.5% and 23.0%. Operative time (P < 0.01), blood loss (P = 0.004), tracheostomy (P < 0.01), reconstruction (P < 0.01), and preoperative plaque control record (PCR) (P < 0.01) were significantly associated with PP. The PCR depicted the oral hygiene based on the percentage of plaque attached to the tooth neck. A multiple logistic regression analysis indicated that the incidence of PP was significantly higher in patients with PCR values of ≥50% after preoperative oral care (OR=10.174, 95% CI 2.14-48.32, P = 0.004). Tracheostomy (P < 0.01), reconstruction (P = 0.044), a lower preoperative albumin level (P = 0.019), and a lower preoperative hemoglobin level (P < 0.01) were significantly associated with SSI. CONCLUSIONS The incidence of PP among patients who received oral care was high in those patients with high PCR values, indicating the importance of increasing compliance to preoperative oral care.
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Goel AN, Raghavan G, St John MA, Long JL. Risk Factors, Causes, and Costs of Hospital Readmission After Head and Neck Cancer Surgery Reconstruction. JAMA FACIAL PLAST SU 2020; 21:137-145. [PMID: 30418467 DOI: 10.1001/jamafacial.2018.1197] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Thirty-day hospital readmissions have substantial direct costs and are increasingly used as a measure of quality care. However, data regarding the risk factors and reasons for readmissions in head and neck cancer surgery reconstruction are lacking. Objective To describe the rate, risk factors, and causes of 30-day readmission in patients with head and neck cancer following free or pedicled flap reconstruction. Design, Setting, and Participants This retrospective, population-based cohort study analyzed medical records from the Nationwide Readmissions Database of 9487 patients undergoing pedicled or free flap reconstruction of head and neck oncologic defects between January 1, 2010, and December 31, 2014. Data analysis was performed in October 2017. Exposures Pedicled or free flap reconstruction of an oncologic head and neck defect. Main Outcomes and Measures The primary outcome was 30-day all-cause readmissions. Secondary outcomes included risk factors, causes, and costs of readmission. Multivariate regression analyses were conducted to determine factors independently associated with 30-day readmissions. Results Among 9487 patients included in the study (6798 male; 71.7%), the median age was 63 years (interquartile range, 55-71 years), and the 30-day readmission rate was 19.4% (n = 1839), with a mean cost per readmission of $15 916 (standard error of the mean, $785). The most common indication for readmission was wound complication (26.5%, n = 487). On multivariate regression, significant risk factors for 30-day readmission were median household income in the lowest quartile (vs highest quartile: odds ratio [OR], 1.58; 95% CI, 1.18-2.11), congestive heart failure (OR, 1.68; 95% CI, 1.14-2.47), liver disease (OR, 2.02; 95% CI, 1.22- 3.33), total laryngectomy (OR, 1.40; 95% CI, 1.12-1.75), pharyngectomy (OR, 1.47; 95% CI, 1.08-2.01), blood transfusion (OR, 1.30; 95% CI, 1.04-1.64), discharge to home with home health care (vs routine: OR, 1.32; 95% CI, 1.04-1.67), and discharge to a nursing facility (vs routine: OR, 1.77; 95% CI, 1.30-2.40). Conclusions and Relevance Using the Nationwide Readmissions Database, we demonstrate that approximately 1 in 5 patients undergoing head and neck cancer surgery reconstruction is readmitted within 30 days of surgery. Readmissions are most commonly associated with wound complications. Socioeconomic status, complex ablative procedures, and patient comorbidities are independent risk factors for readmission. These findings may be useful to clinicians in developing perioperative interventions aimed to reduce hospital readmissions and improve quality of patient care.
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Affiliation(s)
- Alexander N Goel
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles (UCLA)
| | - Govind Raghavan
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles (UCLA)
| | - Maie A St John
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles (UCLA).,Jonsson Comprehensive Cancer Center, UCLA Medical Center, Los Angeles, California.,UCLA Head and Neck Cancer Program, UCLA Medical Center, Los Angeles, California
| | - Jennifer L Long
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles (UCLA).,Research Service, Department of Veterans Affairs, Los Angeles, California
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De Alencar GP, Sabino J, Gonçalves JL, Chang MR. Bacterial, Fungal and Viral Infections in Surgical Site: Clinical, Diagnostic and Epidemiological Aspects. JOURNAL OF HEALTH SCIENCES 2019. [DOI: 10.17921/2447-8938.2019v21n3p219-224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
AbstractSurgical Site Infections (SSI) are infections related to surgical procedures in inpatients and outpatients, indicated with high prevalence in relation to infections linked to preventable health care. Thus, the objective of the study is to perform a review on bacterial, fungal and viral infections in surgical site in relation to clinical, diagnostic and epidemiological aspects. A bibliographic and exploratory research was carried out and the Virtual Health Library (VHL), Capes Periodicals and the Pubmed to search the articles were consulted. As for the clinical aspects, the phlogistic signs that allow to identify an inflammatory picture, being a response of the organism to some aggressive agent. Among the bacterial diagnostic methods, the most used ones are the color smear examination, cultural and biochemical characteristics, ELISA, PCR and SAR. As for the detection of fungi and yeasts are the production of the germ tube, micro-culture in agar-tween 80 agar, assimilation of carbohydrates or nitrogen and fermentation of carbohydrates. For viruses, virus isolation, cell culture, laboratory animals and embryonated eggs may be used. Although bacterial infections account for most surgical infections, fungal and viral infections can also be seen in hospital settings and their diagnosis needs to be performed as soon as possible for proper treatment, reducing costs for medical services and length of stay of the patient in the hospital environment, also reducing other risks of infection.Keywords: Surgical Wound Infection. Bacterial Infections. Mycoses. Virus Diseases.ResumoAs Infecções do Sítio Cirúrgico (ISC) são infecções relacionadas a procedimentos cirúrgicos em pacientes internados e ambulatoriais, indicadas com alta prevalência em relação às infecções ligadas aos cuidados em saúde evitáveis. Neste sentido, o objetivo do estudo é realizar uma revisão sobre as infecções bacterianas, fúngicas e virais em sítio cirúrgico em relação aos aspectos clínicos, diagnósticos e epidemiológicos. Foi realizada uma pesquisa bibliográfica e exploratória e consultada a Biblioteca Virtual em Saúde (BVS), os Periódicos Capes e o Pubmed para busca dos artigos. Quanto aos aspectos clínicos, os sinais flogísticos que permitem identificar um quadro inflamatório, sendo uma resposta do organismo frente a algum agente agressor. Dentre os métodos diagnósticos bacterianos, os mais utilizados são o Exame de esfregaços corados, Características culturais e bioquímicas, ELISA, PCR e o SAR. Quanto à detecção de fungos e leveduras estão a produção do tubo germinativo, micro cultivo em ágar fubá-tween 80, assimilação de carboidratos ou de nitrogênio e fermentação dos carboidratos. Em relação aos vírus, podem ser utilizadas o isolamento dos vírus, a cultura de células, os animais de laboratório e os ovos embrionados. Apesar das infecções bacterianas representarem a maior parte das infecções cirúrgicas, as infecções fúngicas e virais também podem ser vistas em ambientes hospitalares e seu diagnóstico precisa ser realizado o mais rápido possível para um tratamento adequado, reduzindo os custos com serviços médicos e o tempo de permanência do paciente no ambiente hospitalar, diminuindo também outros riscos de infecção.Palavras-chave: Infecção da Ferida Cirúrgica. Infecções Bacterianas. Micoses. Viroses.
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Chiesa-Estomba CM, Lechien JR, Fakhry N, Melkane A, Calvo-Henriquez C, de Siati D, Gonzalez-Garcia JA, Fagan JJ, Ayad T. Systematic review of international guidelines for perioperative antibiotic prophylaxis in Head & Neck Surgery. A YO-IFOS Head & Neck Study Group Position Paper. Head Neck 2019; 41:3434-3456. [PMID: 31282061 DOI: 10.1002/hed.25856] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/10/2019] [Accepted: 06/12/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Surgical site infection (SSI) is defined as an infection that occurs after a surgical incision or organ manipulation during surgery. The frequency reported for clean head and neck surgical procedures without antimicrobial prophylaxis is <1%. In contrast, infection rates in patients undergoing complicated cancer surgery are high, ranging from 24% to 87% of patients without antimicrobial prophylaxis. METHODS Guidelines and recommendations about the use of antibiotics in head and neck surgery from 2004 to 2019 were reviewed. RESULTS Four guidelines from Oceania, 5 from South America, 5 from North America, 2 from the United Kingdom, 11 from Europe, 1 from Africa, 1 from the Middle East, and 3 from Asia were included. A total of 118 papers were included for analysis and recommendation. CONCLUSION Antibiotic prophylaxis can decrease the incidence of SSI. However, the risks associated with antibiotic exposure and the risk of antibiotic resistance need to be taken into consideration.
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Affiliation(s)
| | - Jérome R Lechien
- Department of Human Anatomy & Experimental Oncology, University of Mons, Mons, Belgium
| | - Nicolas Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Universitary Hospital of la Conception, Marseille, France
| | - Antoine Melkane
- Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Christian Calvo-Henriquez
- Department of otolaryngology-Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Daniele de Siati
- Department of Otorhinolaryngology-Centre d'AudioPhonologie des Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Jose Angel Gonzalez-Garcia
- Department of Otorhinolaryngology-Head & Neck Surgery, Hospital Universitario Donostia, San Sebastian, Spain
| | | | - Tareck Ayad
- Division of Otolaryngology-Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
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Al-Qurayshi Z, Walsh J, Owen S, Kandil E. Surgical Site Infection in Head and Neck Surgery: A National Perspective. Otolaryngol Head Neck Surg 2019; 161:52-62. [PMID: 30935264 DOI: 10.1177/0194599819832858] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To examine trend, prevalence, and outcomes of surgical site infection (SSI) in head and neck surgery. STUDY DESIGN Retrospective cross-sectional analysis. SETTING The Nationwide Readmissions Database (2010-2014), which represents 56.6% of all US hospitalization. SUBJECTS Adult patients (≥18 years) who underwent head and neck surgery. Patients with SSI were compared with controls. METHODS Analysis included chi-square test and multivariate logistic and linear regression models. RESULTS A total of 427 cases and 116,921 controls were identified. SSI prevalence among patients who underwent head and neck surgery was 0.37%, of which 41.0% was reported within the initial admission while the remaining 59.0% was reported on readmission within 30 days of first surgery. SSI was associated with a higher mortality risk (odds ratio, 3.95; 95% CI, 1.25-12.50; P = .019). Multivariate analysis demonstrated that a higher risk of SSI was associated with major surgery of the ear, nose and paranasal sinuses, mouth and tonsil, salivary glands and ducts, maxillofacial bones and mandible, and pharynx and larynx (P < .05 each). However, a lower risk of SSI was reported in thyroid and parathyroid and nonmajor procedures (P < .05 each). Other factors associated with a higher risk of SSI included multiple comorbidities, smoking, cancer diagnosis, concomitant neck dissection, and tracheostomy (P < .05 each). SSI was associated with a mean ± SE additional hospital stay of 8.1 ± 0.8 days per case (P < .001) and an additional cost on the health system of $20,953.00 ± $186.3 per case (P < .001). CONCLUSIONS SSI is associated with a significant mortality risk and burden on the health system. More than half of SSI cases were identified on readmission.
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Affiliation(s)
- Zaid Al-Qurayshi
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Jarrett Walsh
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Scott Owen
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Emad Kandil
- 2 Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
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Abstract
The literature for prevention of surgical infection related primarily to foot and ankle surgery is sparse, with most attention on total joint replacement and abdominal surgery. Attention should be paid to preoperative, intraoperative, and postoperative elements, which can have an effect on the development of postoperative infection. Although antibiotic prophylaxis typically is discussed in isolation, inclusion of this step into the process enhances the overall evaluation of surgery with respect to infection. This evolution provides for better patient outcomes and decreases the likelihood of an infection incurred after foot and ankle surgery.
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Affiliation(s)
- John Boyd
- Section of Podiatry, Department of Surgery, St. Vincent Charity Medical Center, 2322 East 22nd Street, Cleveland, OH 44115, USA.
| | - Richard Chmielewski
- Section of Podiatry, Department of Surgery, St. Vincent Charity Medical Center, 2322 East 22nd Street, Cleveland, OH 44115, USA
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Haque M, McKimm J, Godman B, Abu Bakar M, Sartelli M. Initiatives to reduce postoperative surgical site infections of the head and neck cancer surgery with a special emphasis on developing countries. Expert Rev Anticancer Ther 2018; 19:81-92. [DOI: 10.1080/14737140.2019.1544497] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Mainul Haque
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Judy McKimm
- Swansea University School of Medicine, Grove Building, Swansea University, Swansea, Wales, UK
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, United Kingdom
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sasako Makgatho Health Sciences University, Garankuwa, South Africa
| | - Muhamad Abu Bakar
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Massimo Sartelli
- Department of Surgery, Macerata Hospital, Via Santa Lucia 2, 62100 Macerata, Italy
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29
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Panuganti B, Qiu Y, Messing B, Lee G, Fakhry C, Blanco R, Ha P, Messer K, Califano JA. Effects of a Comprehensive Performance Improvement Strategy on Postoperative Adverse Events in Head and Neck Surgery. Otolaryngol Head Neck Surg 2018; 160:799-809. [DOI: 10.1177/0194599818793887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives We aimed to demonstrate the efficacy of a multifaceted performance improvement regimen to reduce the incidence of adverse events following a spectrum of head and neck surgical procedures. Methods We conducted a chart review of patients who underwent a head and neck procedure between January 1, 2013, and October 30, 2015, at our institution, including 392 patients (450 procedures) before the quality improvement regimen was implemented (October 1, 2013) and 942 patients (1136 procedures) after implementation. Multivariate statistical models were used to investigate the association of clinical parameters and the intervention with postoperative adverse event rate. Results The incidence of adverse events decreased from 12.9% to 7.2% (95% CI, 2.46%-9.38%) after the intervention. Male sex (adjusted odds ratio [ORadj] = 1.57; 95% CI, 1.06-2.31) and the intervention (ORadj = 0.51; 95% CI, 0.35-0.74) were predictive of overall adverse event incidence by univariate and multivariate analyses. Although patient comorbid status, quantified with the Charlson Comorbidity Index, was not found to affect overall adverse event risk, each 1-point increase in index score was associated with a 17% relative increase (ORadj = 1.17; 95% CI, 1.03-1.33) in the odds of a high-grade adverse event. Discussion Comprehensive performance improvement programs can improve perioperative adverse event risk in head and neck surgery. Patient comorbid status and sex are considerations during assessment of the likelihood of high-grade and overall adverse event risk, respectively. Implications for Practice Given the cost of surgical complications, a comprehensive approach to perioperative risk mitigation is warranted.
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Affiliation(s)
- Bharat Panuganti
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California–San Diego, San Diego, CA, USA
| | - Yuqi Qiu
- Division of Biostatistics and Bioinformatics, University of California–San Diego, San Diego, California, USA
| | - Barbara Messing
- Milton J. Dance Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland, USA
| | - Gregory Lee
- Milton J. Dance Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland, USA
| | - Carole Fakhry
- Milton J. Dance Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland, USA
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Raymond Blanco
- Milton J. Dance Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland, USA
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Patrick Ha
- Milton J. Dance Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland, USA
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Department of Otolaryngology–Head and Neck Surgery, University of California–San Francisco, San Francisco, California, USA
| | - Karen Messer
- Division of Biostatistics and Bioinformatics, University of California–San Diego, San Diego, California, USA
| | - Joseph A. Califano
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California–San Diego, San Diego, CA, USA
- Milton J. Dance Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland, USA
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Moores Cancer Center, University of California–San Diego, San Diego, California, USA
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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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Veve MP, Greene JB, Williams AM, Davis SL, Lu N, Shnayder Y, Li DX, Noureldine SI, Richmon JD, Lin LO, Hanasono MM, Pipkorn P, Jackson RS, Hornig JD, Light T, Wax MK, Yiu Y, Bekeny J, Old M, Hernandez D, Patel UA, Ghanem TA. Multicenter Assessment of Antibiotic Prophylaxis Spectrum on Surgical Infections in Head and Neck Cancer Microvascular Reconstruction. Otolaryngol Head Neck Surg 2018. [DOI: 10.1177/0194599818756299] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objective To characterize and identify risk factors for 30-day surgical site infections (SSIs) in patients with head and neck cancer who underwent microvascular reconstruction. Study Design Cross-sectional study with nested case-control design. Setting Nine American tertiary care centers. Subjects and Methods Hospitalized patients were included if they underwent head and neck cancer microvascular reconstruction from January 2003 to March 2016. Cases were defined as patients who developed 30-day SSI; controls were patients without SSI at 30 days. Postoperative antibiotic prophylaxis (POABP) regimens were categorized by Gram-negative (GN) spectrum: no GN coverage, enteric GN coverage, and enteric with antipseudomonal GN coverage. All POABP regimens retained activity against anaerobes and Gram-positive bacteria. Thirty-day prevalence of and risk factors for SSI were evaluated. Results A total of 1307 patients were included. Thirty-day SSI occurred in 189 (15%) patients; median time to SSI was 11.5 days (interquartile range, 7-17). Organisms were isolated in 59% of SSI; methicillin-resistant Staphylococcus aureus (6%) and Pseudomonas aeruginosa (9%) were uncommon. A total of 1003 (77%) patients had POABP data: no GN (17%), enteric GN (52%), and antipseudomonal GN (31%). Variables independently associated with 30-day SSI were as follows: female sex (adjusted odds ratio [aOR], 1.6; 95% CI, 1.1-2.2), no GN POABP (aOR, 2.2; 95% CI, 1.5-3.3), and surgical duration ≥11.8 hours (aOR, 1.9; 95% CI, 1.3-2.7). Longer POABP durations (≥6 days) or antipseudomonal POABP had no association with SSI. Conclusions POABP without GN coverage was significantly associated with SSI and should be avoided. Antipseudomonal POABP or longer prophylaxis durations (≥6 days) were not protective against SSI. Antimicrobial stewardship interventions should be made to limit unnecessary antibiotic exposures, prevent the emergence of resistant organisms, and improve patient outcomes.
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Affiliation(s)
- Michael P. Veve
- Wayne State University, Detroit, Michigan, USA
- Henry Ford Health System, Detroit, Michigan, USA
| | | | | | - Susan L. Davis
- Wayne State University, Detroit, Michigan, USA
- Henry Ford Health System, Detroit, Michigan, USA
| | - Nina Lu
- Department of Otolaryngology, School of Medicine, University of Kansas, Kansas City, Kansas, USA
| | - Yelizaveta Shnayder
- Department of Otolaryngology, School of Medicine, University of Kansas, Kansas City, Kansas, USA
| | - David X. Li
- Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | - Lawrence O. Lin
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Patrik Pipkorn
- Washington University School of Medicine, St Louis, Missouri, USA
| | - Ryan S. Jackson
- Washington University School of Medicine, St Louis, Missouri, USA
| | - Joshua D. Hornig
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Tyler Light
- Oregon Health Sciences University, Portland, Oregon, USA
| | - Mark K. Wax
- Oregon Health Sciences University, Portland, Oregon, USA
| | - Yin Yiu
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James Bekeny
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Matthew Old
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | | | - Tamer A. Ghanem
- Wayne State University, Detroit, Michigan, USA
- Henry Ford Health System, Detroit, Michigan, USA
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Patro A, Guerrini CJ, Huang AT, Sikora AG. The Patient Who Continues to Smoke On-Treatment: An Ethical Dilemma. Otolaryngol Head Neck Surg 2018; 158:469-472. [PMID: 29337655 DOI: 10.1177/0194599817752634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ankita Patro
- 1 Bobby R. Alford Department of Otolaryngology-Head & Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Christi J Guerrini
- 2 Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Andrew T Huang
- 1 Bobby R. Alford Department of Otolaryngology-Head & Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Andrew G Sikora
- 1 Bobby R. Alford Department of Otolaryngology-Head & Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
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Ren Y, Deschler DG, Sajed D, Durand ML. Case of late-onset, relapsing surgical site infection related to a venous coupler placed during free flap reconstruction for major head and neck cancer. Head Neck 2018; 40:E29-E32. [PMID: 29328540 DOI: 10.1002/hed.25043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/07/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Venous coupling devices are widely used during reconstructive surgery involving microvascular anastomosis but have not served as foreign bodies in head and neck surgical site infections. METHODS We conducted a case report. RESULTS A patient underwent resection and free flap reconstruction for recurrent tongue squamous cell carcinoma. She developed a neck abscess due to Streptococcus intermedius 7 weeks postoperatively, days after starting chemoradiotherapy. The surgical site infection healed with drainage and antibiotics. Two surgical site infection relapses due to S. intermedius occurred 3 and 8 weeks after completing radiation, the second relapse after a prolonged course of i.v. antibiotics. Surgical exploration revealed a venous coupler within granulation tissue. The device was removed and no further surgical site infection relapses occurred. CONCLUSION To the best of our knowledge, this is the first report of a delayed-onset head and neck surgical site infection in which a venous coupler served as a foreign body. An infected foreign body should be suspected in relapsing surgical site infections due to a single organism.
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Affiliation(s)
- Yin Ren
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Daniel G Deschler
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Dipti Sajed
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Marlene L Durand
- Department of Medicine, Infectious Disease Unit, Massachusetts General Hospital, and Infectious Disease Service, Massachusetts Eye and Ear, Boston, Massachusetts
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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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Baskin RM, Zhang J, Dirain C, Lipori P, Fonseca G, Sawhney R, Boyce BJ, Silver NL, Dziegielewski PT. Predictors of returns to the emergency department after head and neck surgery. Head Neck 2017; 40:498-511. [DOI: 10.1002/hed.25019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 07/30/2017] [Accepted: 10/10/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- R. Michael Baskin
- Department of Otolaryngology; University of Florida; Gainesville Florida
| | - Jingnan Zhang
- Department of Biostatistics; University of Florida; Gainesville Florida
| | - Carolyn Dirain
- Department of Otolaryngology; University of Florida; Gainesville Florida
| | - Paul Lipori
- College of Medicine; University of Florida; Gainesville Florida
| | - Gileno Fonseca
- College of Medicine; University of Florida; Gainesville Florida
| | - Raja Sawhney
- Department of Otolaryngology; University of Florida; Gainesville Florida
| | - Brian J. Boyce
- Department of Otolaryngology; University of Florida; Gainesville Florida
| | - Natalie L. Silver
- Department of Otolaryngology; University of Florida; Gainesville Florida
| | - Peter T. Dziegielewski
- Department of Otolaryngology; University of Florida; Gainesville Florida
- University of Florida Health Cancer Center; Gainesville Florida
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Carvalho RLRD, Campos CC, Franco LMDC, Rocha ADM, Ercole FF. Incidence and risk factors for surgical site infection in general surgeries. Rev Lat Am Enfermagem 2017; 25:e2848. [PMID: 29211190 PMCID: PMC5738868 DOI: 10.1590/1518-8345.1502.2848] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 10/28/2016] [Indexed: 11/24/2022] Open
Abstract
Objective: to estimate the incidence of surgical site infection in general surgeries at a
large Brazilian hospital while identifying risk factors and prevalent
microorganisms. Method: non-concurrent cohort study with 16,882 information of patients undergoing general
surgery from 2008 to 2011. Data were analyzed by descriptive, bivariate and
multivariate analysis. Results: the incidence of surgical site infection was 3.4%. The risk factors associated
with surgical site infection were: length of preoperative hospital stay more than
24 hours; duration of surgery in hours; wound class clean-contaminated,
contaminated and dirty/infected; and ASA index classified into ASA II, III and
IV/V. Staphyloccocus aureus and Escherichia coli
were identified. Conclusion: the incidence was lower than that found in the national studies on general
surgeries. These risk factors corroborate those presented by the National
Nosocomial Infection Surveillance System Risk Index, by the addition of the length
of preoperative hospital stay. The identification of the actual incidence of
surgical site infection in general surgeries and associated risk factors may
support the actions of the health team in order to minimize the complications
caused by surgical site infection.
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Affiliation(s)
- Rafael Lima Rodrigues de Carvalho
- Doctoral student, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil. Professor, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Camila Cláudia Campos
- Doctoral student, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil. Professor, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Adelaide De Mattia Rocha
- PhD, Associate Professor, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Flávia Falci Ercole
- PhD, Associate Professor, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Funahara M, Yanamoto S, Ueda M, Suzuki T, Ota Y, Nishimaki F, Kurita H, Yamakawa N, Kirita T, Okura M, Mekaru Y, Arakaki K, Umeda M. Prevention of surgical site infection after oral cancer surgery by topical tetracycline: Results of a multicenter randomized control trial. Medicine (Baltimore) 2017; 96:e8891. [PMID: 29310375 PMCID: PMC5728776 DOI: 10.1097/md.0000000000008891] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In a pilot study, we showed that topical administration of a tetracycline could decrease oral bacteria levels for 6 hours in patients who underwent oral cancer surgery combined with tracheotomy and flap reconstruction. This multicenter, randomized control trial aimed to investigate the effectiveness of topical application of tetracycline ointment for prevention of surgical site infection (SSI) associated with major oral cancer surgery. METHODS One hundred seventeen patients who underwent oral cancer resection combined with neck dissection, flap reconstruction, and tracheotomy were divided randomly into an intervention group (n = 56) and a control group (n = 61). The intervention consisted of topical administration of tetracycline ointment on the dorsum of the tongue every 6 hours for 48 hours postoperatively. Factors relating to the occurrence of SSI in both groups were subjected to logistic regression analysis. RESULTS SSI occurred in 11 patients (19.6%) in the intervention group and 22 patients (36.1%) in the control group. Multivariate analysis showed that a longer operating time and not receiving topical tetracycline were independent risk factors for development of SSI. CONCLUSION Administration of topical tetracycline for 48 hours postoperatively is an effective way of preventing SSI after oral cancer surgery.
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Affiliation(s)
- Madoka Funahara
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki
| | - Souichi Yanamoto
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki
| | - Michihiro Ueda
- Department of Dentistry and Oral Surgery, Hokkaido Cancer Center, Hokkaido
| | - Takatsugu Suzuki
- Department of Oral and Maxillofacial Surgery, Division of Surgery, Tokai University School of Medicine, Kanagawa
| | - Yoshihide Ota
- Department of Oral and Maxillofacial Surgery, Division of Surgery, Tokai University School of Medicine, Kanagawa
| | - Fumihiro Nishimaki
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Nagano
| | - Hiroshi Kurita
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Nagano
| | - Nobuhiro Yamakawa
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Nara
| | - Tadaaki Kirita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Nara
| | - Masaya Okura
- First Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Osaka
| | - Yasuaki Mekaru
- Department of Dentistry and Oral Surgery, Okinawa Prefectural Chubu Hospital, Okinawa, Japan
| | - Keiichi Arakaki
- Department of Dentistry and Oral Surgery, Okinawa Prefectural Chubu Hospital, Okinawa, Japan
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki
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Rosenblatt J, Reitzel RA, Viola GM, Vargas-Cruz N, Selber J, Raad I. Sodium Mercaptoethane Sulfonate Reduces Collagenolytic Degradation and Synergistically Enhances Antimicrobial Durability in an Antibiotic-Loaded Biopolymer Film for Prevention of Surgical-Site Infections. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3149536. [PMID: 29238713 PMCID: PMC5697372 DOI: 10.1155/2017/3149536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 10/09/2017] [Indexed: 11/26/2022]
Abstract
Implant-associated surgical-site infections can have significant clinical consequences. Previously we reported a method for prophylactically disinfecting implant surfaces in surgical pockets, where an antibiotic solution containing minocycline (M) and rifampin (R) was applied as a solid film in a crosslinked biopolymer matrix that partially liquefied in situ to provide extended prophylaxis. Here we studied the effect of adding sodium 2-mercaptoethane sulfonate (MeSNA) on durability of prophylaxis in an in vitro model of implant-associated surgical-site infection. Adding MeSNA to the M/R biopolymer, antimicrobial film extended the duration for which biofilm formation by multidrug-resistant Pseudomonas aeruginosa (MDR-PA) was prevented on silicone surfaces in the model. M/R films with and without MeSNA were effective in preventing colonization by methicillin-resistant Staphylococcus aureus. Independent experiments revealed that MeSNA directly inhibited proteolytic digestion of the biopolymer film and synergistically enhanced antimicrobial potency of M/R against MDR-PA. Incubation of the MeSNA containing films with L929 fibroblasts revealed no impairment of cellular metabolic activity or viability.
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Affiliation(s)
- Joel Rosenblatt
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ruth A. Reitzel
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - George M. Viola
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Nylev Vargas-Cruz
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jesse Selber
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Issam Raad
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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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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Abstract
Three therapeutic principles most substantially improve organ dysfunction and survival in sepsis: early, appropriate antimicrobial therapy; restoration of adequate cellular perfusion; timely source control. The new definitions of sepsis and septic shock reflect the inadequate sensitivity, specify, and lack of prognostication of systemic inflammatory response syndrome criteria. Sequential (sepsis-related) organ failure assessment more effectively prognosticates in sepsis and critical illness. Inadequate cellular perfusion accelerates injury and reestablishing perfusion limits injury. Multiple organ systems are affected by sepsis and septic shock and an evidence-based multipronged approach to systems-based therapy in critical illness results in improve outcomes.
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Affiliation(s)
- Bracken A Armstrong
- Division of Trauma and Surgical Critical Care, Department of Surgery, Vanderbilt University Medical Center, 1211 21st Ave S Medical Arts Building 404, Nashville, TN 37212, USA.
| | - Richard D Betzold
- Division of Trauma and Surgical Critical Care, Department of Surgery, Vanderbilt University Medical Center, 1211 21st Ave S Medical Arts Building 404, Nashville, TN 37212, USA
| | - Addison K May
- Division of Trauma and Surgical Critical Care, Department of Surgery, Vanderbilt University Medical Center, 1211 21st Ave S Medical Arts Building 404, Nashville, TN 37212, USA
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Veve MP, Davis SL, Williams AM, McKinnon JE, Ghanem TA. Considerations for antibiotic prophylaxis in head and neck cancer surgery. Oral Oncol 2017; 74:181-187. [PMID: 28943204 DOI: 10.1016/j.oraloncology.2017.09.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 09/13/2017] [Indexed: 02/06/2023]
Abstract
Peri/post-operative antibiotic prophylaxis (POABP) has become standard practice for preventing surgical site infections (SSI) in head and neck cancer patients undergoing microvascular reconstruction, but few data exist on optimal POABP regimens. Current surgical prophylaxis guideline recommendations fail to account for the complexity of microvascular reconstruction relative to other head and neck procedures, specifically regarding wound classification and antibiotic duration. Selection of POABP spectrum is also controversial, and must balance the choice between too narrow, risking subsequent infection, or too broad, and possible unwanted effects (e.g. antibiotic resistance, Clostridium difficile-associated diarrhea). POABP regimens should retain activity against bacteria expected to colonize the upper respiratory/salivary tracts, which include Gram-positive organisms and facultative anaerobes. However, Gram-negative bacilli also contribute to SSI in this setting. POABP doses should be optimized in order to achieve therapeutic tissue concentrations at the surgical site. Antibiotics targeted towards methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa are not warranted for all patients. Prolonged POABP durations have shown no differences in SSI when compared to short POABP durations, but prolonged durations provide unnecessarily antibiotic exposure and risk for adverse effects. Given the lack of standardization behind antibiotic POABP in this setting and the potential for poor patient outcomes, this practice necessitates an additional focus of surgeons and antimicrobial stewardship programs. The purpose of this review is to provide an overview of POABP evidence and discuss pertinent clinical implications of appropriate use.
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Affiliation(s)
- Michael P Veve
- University of Tennessee Health Science Center, College of Pharmacy, Knoxville, TN, USA; University of Tennessee Medical Center, Knoxville, TN, USA.
| | - Susan L Davis
- Wayne State University, Detroit, MI, USA; Henry Ford Health System, Detroit, MI, USA
| | | | | | - Tamer A Ghanem
- Wayne State University, Detroit, MI, USA; Henry Ford Health System, Detroit, MI, USA
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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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Validity of the American College of Surgeons' National Surgical Quality Improvement Program risk calculator in South Australian glossectomy patients. The Journal of Laryngology & Otology 2017; 132:173-179. [DOI: 10.1017/s0022215117001451] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Appropriate selection of tongue cancer patients considering surgery is critical in ensuring optimal outcomes. The American College of Surgeons' National Surgical Quality Improvement Program (‘ACS-NSQIP’) risk calculator was developed to assess patients' 30-day post-operative risk, providing surgeons with information to guide decision making.Method:A retrospective review of 30-day actual mortality and morbidity of tongue cancer patients was undertaken to investigate the validity of this tool for South Australian patients treated from 2005 to 2015.Results:One hundred and twenty patients had undergone glossectomy. Predicted length of stay using the risk calculator was significantly different from actual length of stay. Predicted mortality and other complications were found to be similar to actual outcomes.Conclusion:The American College of Surgeons' National Surgical Quality Improvement Program risk calculator was found to be effective in predicting post-operative complication rates in South Australian tongue cancer patients. However, significant discrepancies in predicted and actual length of stay may limit its use in this population.
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Lin S, Melki S, Lisgaris MV, Ahadizadeh EN, Zender CA. Post-operative MRSA infections in head and neck surgery. Am J Otolaryngol 2017; 38:417-421. [PMID: 28478091 DOI: 10.1016/j.amjoto.2017.03.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 03/31/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE Surgical site infection (SSI) with methicillin-resistant Staphylococcus aureus (MRSA) is a serious post-operative complication, with head and neck cancer patients at greater risk due to the nature of their disease. Infection with MRSA has been shown to be costly and impart worse outcomes on patients who are affected. This study investigates incidence and risks for MRSA SSIs at a tertiary medical institution. MATERIALS AND METHODS This study reviewed 577 head and neck procedures from 2008 to 2013. Twenty-one variables (i.e. tumor characteristics, patient demographics, operative course, cultures) were analyzed with SPSS to identify trends. A multivariate analysis controlled for confounders (age, BMI, ASA class, length of stay) was completed. RESULTS We identified 113 SSIs of 577 procedures, 24 (21.23%) of which were MRSA. Of all analyzed variables, hospital exposure within the preceding year was a significant risk factor for MRSA SSI development (OR 2.665, 95% CI: 1.06-6.69, z statistic 2.086, p=0.0369). Immunosuppressed patients were more prone to MRSA infections (OR 14.1250, 95%CI: 3.8133-52.3217, p<0.001), and patients with a history of chemotherapy (OR 3.0268, 95% CI: 1.1750-7.7968, p=0.0218). Furthermore, MRSA SSI resulted in extended post-operative hospital stays (20.8±4.72days, p=0.031). CONCLUSIONS Patients who have a history of chemotherapy, immunosuppression, or recent hospital exposure prior to their surgery are at higher risk of developing MRSA-specific SSI and may benefit from prophylactic antibiotic therapy with appropriate coverage. Additionally, patients who develop MRSA SSIs are likely to have an extended postoperative inpatient stay.
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Affiliation(s)
- Sharon Lin
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Sami Melki
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Michelle V Lisgaris
- Department of Medicine - Infectious Diseases, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Emily N Ahadizadeh
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States; Case Western Reserve University, School of Medicine, 10900 Euclid Avenue, Cleveland, OH, United States
| | - Chad A Zender
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.
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45
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Yao CM, Ziai H, Tsang G, Copeland A, Brown D, Irish JC, Gilbert RW, Goldstein DP, Gullane PJ, de Almeida JR. Surgical site infections following oral cavity cancer resection and reconstruction is a risk factor for plate exposure. J Otolaryngol Head Neck Surg 2017; 46:30. [PMID: 28390434 PMCID: PMC5385089 DOI: 10.1186/s40463-017-0206-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 03/27/2017] [Indexed: 01/01/2023] Open
Abstract
Background Plate-related complications following head and neck cancer ablation and reconstruction remains a challenging problem often requiring further management and reconstructive surgeries. We aim to identify an association between surgical site infections (SSI) and plate exposure. Methods A retrospective study between 1997 and 2014 was performed to study the association between postoperative SSI and plate exposures. Eligible patients included those with a history of oral squamous cell carcinoma who underwent surgical resection, neck dissection, and free tissue reconstruction. Demographic and treatment related information was collected. SSI were classified based on CDC definition and previously published literature. Univariable analysis on demographic factors, smoking history, diabetes, radiation, surgical and hardware related factors; while multivariable analysis on SSI, plate height, segmental mandibulectomy defects and radiation were conducted such as using cox proportional hazard models. Results Three hundred sixty-five patients were identified and included in our study. The mean age of the study group was 59.2 (+/−13.8), with a predominance of male patients (61.9%). 10.7% of our patient cohort had diabetes, and another 63.8% had post-operative radiation therapy. Patients with SSI were more likely to have plate exposure (25 vs. 6.4%, p <0.001). Post-operative SSI, mandibulectomy defects, and plate profile/thickness were associated with plate exposure on univariable analysis (OR = 5.72, p < 0.001; OR = 2.56, p = 0.014; OR = 1.44, p = 0.003 respectively) and multivariable analysis (OR = 5.13, p < 0.001; OR = 1.36, p = 0.017; OR = 2.58, p = 0.02 respectively). Conclusion Surgical site infections are associated with higher rates of plate exposure. Plate exposure may require multiple procedures to manage and occasionally free flap reconstruction.
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Affiliation(s)
- Christopher M Yao
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 3-955, Toronto, ON, M5G 2 M9, Canada
| | - Hedyeh Ziai
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 3-955, Toronto, ON, M5G 2 M9, Canada
| | - Gordon Tsang
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 3-955, Toronto, ON, M5G 2 M9, Canada
| | - Andrea Copeland
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 3-955, Toronto, ON, M5G 2 M9, Canada
| | - Dale Brown
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 3-955, Toronto, ON, M5G 2 M9, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 3-955, Toronto, ON, M5G 2 M9, Canada
| | - Ralph W Gilbert
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 3-955, Toronto, ON, M5G 2 M9, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 3-955, Toronto, ON, M5G 2 M9, Canada
| | - Patrick J Gullane
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 3-955, Toronto, ON, M5G 2 M9, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, 3-955, Toronto, ON, M5G 2 M9, Canada.
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46
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Balekouzou A, Yin P, Pamatika CM, Bekolo CE, Nambei SW, Djeintote M, Kota K, Mossoro-Kpinde CD, Shu C, Yin M, Fu Z, Qing T, Yan M, Zhang J, Chen S, Li H, Xu Z, Koffi B. Reproductive risk factors associated with breast cancer in women in Bangui: a case-control study. BMC WOMENS HEALTH 2017; 17:14. [PMID: 28264686 PMCID: PMC5340027 DOI: 10.1186/s12905-017-0368-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 02/04/2017] [Indexed: 12/26/2022]
Abstract
Background Breast cancer (breast Ca) is recognised as a major public health problem in the world. Data on reproductive factors associated with breast Ca in the Central African Republic (CAR) is very limited. This study aimed to identify reproductive variables as risk factors for breast Ca in CAR women. Methods A case–control study was conducted among 174 cases of breast Ca confirmed at the Pathology Unit of the National Laboratory in Bangui between 2003 and 2015 and 348 age-matched controls. Data collection tools included a questionnaire, interviews and a review of medical records of patients. Data were analysed using SPSS software version 20. Odd ratios and 95% confidence intervals (CI) for the likelihood of developing breast Ca were obtained using unconditional logistic regression. Results In total, 522 women with a mean age of 45.8 (SD = 13.4) years were enrolled. Women with breast Ca were more likely to have attained little or no education (AOR = 11.23, CI: 4.65–27.14 and AOR = 2.40, CI: 1.15–4.99), to be married (AOR = 2.09, CI: 1.18–3.71), to have had an abortion (AOR = 5.41, CI: 3.47–8.44), and to be nulliparous (AOR = 1.98, CI: 1.12–3.49). Decreased odds of breast Ca were associated with being employed (AOR = 0.32, CI: 0.19–0.56), living in urban areas (AOR = 0.16, CI: 0.07–0.37), late menarche (AOR = 0.18, CI: 0.07–0.44), regular menstrual cycles (AOR = 0.44, CI: 0.23–0.81), term pregnancy (AOR = 0.26, CI: 0.13–0.50) and hormonal contraceptive use (AOR = 0.62, CI: 0.41–0.93). Conclusion Breast Ca risk factors in CAR did not appear to be significantly different from that observed in other populations. This study highlighted the risk factors of breast Ca in women living in Bangui to inform appropriate control measures.
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Affiliation(s)
- Augustin Balekouzou
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College of Huazhong University of Sciences and Technology, Hangkong Road 13, Wuhan City, Hubei Province, China.,National Laboratory of Clinical Biology and Public Health, Bangui, Central African Republic
| | - Ping Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College of Huazhong University of Sciences and Technology, Hangkong Road 13, Wuhan City, Hubei Province, China.
| | | | - Cavin Epie Bekolo
- Ministry of Public Health, Centre Medical d'Arrondissement de Bare, Nkongsamba, Cameroon
| | - Sylvain Wilfrid Nambei
- Faculty of Health Sciences, University of Bangui, Avenue of the Martyrs, Bangui, Central African Republic
| | - Marceline Djeintote
- National Laboratory of Clinical Biology and Public Health, Bangui, Central African Republic
| | - Komlan Kota
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College of Huazhong University of Sciences and Technology, Hangkong Road 13, Wuhan City, Hubei Province, China
| | | | - Chang Shu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College of Huazhong University of Sciences and Technology, Hangkong Road 13, Wuhan City, Hubei Province, China
| | - Minghui Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College of Huazhong University of Sciences and Technology, Hangkong Road 13, Wuhan City, Hubei Province, China
| | - Zhen Fu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College of Huazhong University of Sciences and Technology, Hangkong Road 13, Wuhan City, Hubei Province, China
| | - Tingting Qing
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College of Huazhong University of Sciences and Technology, Hangkong Road 13, Wuhan City, Hubei Province, China
| | - Mingming Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College of Huazhong University of Sciences and Technology, Hangkong Road 13, Wuhan City, Hubei Province, China
| | - Jianyuan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College of Huazhong University of Sciences and Technology, Hangkong Road 13, Wuhan City, Hubei Province, China
| | - Shaojun Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College of Huazhong University of Sciences and Technology, Hangkong Road 13, Wuhan City, Hubei Province, China
| | - Hongyu Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College of Huazhong University of Sciences and Technology, Hangkong Road 13, Wuhan City, Hubei Province, China
| | - Zhongyu Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College of Huazhong University of Sciences and Technology, Hangkong Road 13, Wuhan City, Hubei Province, China
| | - Boniface Koffi
- National Laboratory of Clinical Biology and Public Health, Bangui, Central African Republic
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47
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van Deudekom FJ, Schimberg AS, Kallenberg MH, Slingerland M, van der Velden LA, Mooijaart SP. Functional and cognitive impairment, social environment, frailty and adverse health outcomes in older patients with head and neck cancer, a systematic review. Oral Oncol 2017; 64:27-36. [DOI: 10.1016/j.oraloncology.2016.11.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/24/2016] [Accepted: 11/24/2016] [Indexed: 12/13/2022]
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48
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Wiegand S. Evidence and evidence gaps of laryngeal cancer surgery. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2016; 15:Doc03. [PMID: 28025603 PMCID: PMC5169076 DOI: 10.3205/cto000130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Surgical treatment of laryngeal cancer has been established for decades. In addition to total laryngectomy, which was first performed in 1873, a large number or organ preservation surgical techniques, like open partial laryngectomy, transoral laser microsurgery, and transoral robotic surgery have been developed. Studies on laryngeal cancer surgery are mainly retrospective case series and cohort studies. The evolution of chemoradiation protocols and their analysis in prospective randomized trials have led to an increasing acceptance of non-surgical treatment procedures. In addition to an improvement of prognosis, in recent years the preservation of function and maintenance of life quality after primary therapy of laryngeal cancer has increasingly become the focus of therapy planning. Significant late toxicity after chemoradiation has been identified as an important issue. This leads to a reassessment of surgical concepts and initiation of studies on laryngeal cancer surgery which was additionally stimulated by the advent of transoral robotic surgery in the US. Improving the evidence base of laryngeal cancer surgery by successful establishment of surgical trials should be the future goal.
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Affiliation(s)
- Susanne Wiegand
- Department of Otolaryngology, Head & Neck Surgery, University Hospital of Leipzig, Germany
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49
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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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50
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Park SY, Kim MS, Eom JS, Lee JS, Rho YS. Risk factors and etiology of surgical site infection after radical neck dissection in patients with head and neck cancer. Korean J Intern Med 2016; 31:162-9. [PMID: 26767870 PMCID: PMC4712421 DOI: 10.3904/kjim.2016.31.1.162] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 05/21/2015] [Accepted: 05/26/2015] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND/AIMS Surgical site infection (SSI) is a major complication after radical neck dissection (RND) in patients with head and neck cancer (HNC). We investigated the incidence, risk factors, and etiology of SSI among patients who underwent RND. METHODS A retrospective cohort study was performed on HNC patients, excluding those with thyroid cancer, who underwent first RND at a teaching hospital between January 2006 and June 2010. Medical records were collected and analyzed to evaluate the risk factors and microbiological etiologies. RESULTS A total of 370 patients underwent first RND. The overall incidence of SSI was 19.7% (73/370). Multivariate analysis showed that male sex (odds ratio [OR], 4.281; p = 0.004), cardiovascular diseases (OR, 1.941; p = 0.020), large amount of blood loss during surgery (OR, 4.213; p = 0.001), and surgery lasting longer than 6 hours (OR, 4.213; p = 0.002) were significantly associated with SSI. The most common causative pathogen was Staphylococcus aureus (32.6%), and 93.2% of S. aureus isolates were methicillin-resistant. Klebsiella pneumoniae (13/92, 14.1%), Pseudomonas aeruginosa (11/92, 12.0%), and Enterococcus species (11/92, 12.0%) were also frequently detected. CONCLUSIONS Based on our results, we predict that certain groups of patients are at high risk for SSIs after major HNC surgery. Preventive measures or close monitoring in these patients may be required to reduce the likelihood of postoperative SSIs. Furthermore, even though additional research is required, we would consider changing the prophylactic antibiotic regimens according to the causative organisms.
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Affiliation(s)
- So Yeon Park
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Mi Suk Kim
- Department of Nursing, Kyungbuk College, Youngju, Korea
| | - Joong Sik Eom
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
- Correspondence to Joong Sik Eom, M.D. Division of Infectious Diseases, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, 150 Seongan-ro, Gangdong-gu, Seoul 05355, Korea Tel: +82-2-2224-2693 Fax: +82-2-475-7852 E-mail:
| | - Jin Seo Lee
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Young Soo Rho
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsong Memorial Institute of Head and Neck Cancer, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
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