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Hu Y, Yan A, Jiang F. Effect of Clindamycin compared with Ampicillin-Sulbactam as prophylactic antibiotics for wound infections following major surgery for head and neck cancer: A meta-analysis. Int Wound J 2023; 20:4151-4158. [PMID: 37483017 PMCID: PMC10681415 DOI: 10.1111/iwj.14312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 06/28/2023] [Accepted: 07/01/2023] [Indexed: 07/25/2023] Open
Abstract
A meta-analysis examination was implemented to review the effect of Clindamycin compared with Ampicillin-Sulbactam as prophylactic antibiotics (PAs) management for surgical site wound infections (SSWIs) following major surgery (MS) for head and neck cancer (H&NC). A comprehensive literature examination till May 2023 was done and 1296 interrelated examinations were reviewed. The six elected examinations, enclosed 4293 personals with MS for H&NC were in the utilized examinations' starting point, 1722 of them were utilizing Clindamycin, and 2571 were utilizing Ampicillin-Sulbactam. Odds ratio (OR) and 95% confidence intervals (CIs) were utilized to appraise the consequence of Clindamycin compared with Ampicillin-Sulbactam as PAs management for SSWIs following MS for H&NC by the dichotomous approach and a fixed or random model. Clindamycin had significantly higher SSWI compared with Ampicillin-Sulbactam (OR, 2.65; 95% CI, 1.40-5.02, p = 0.003) in personals with MS for H&NC. Clindamycin had significantly higher SSWI compared with Ampicillin-Sulbactam in personals with MS for H&NC. However, caution needs to be taken when interacting with its values because there was a low sample size of some of the chosen examinations and a low number of examinations found for the comparisons in the meta-analysis.
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Affiliation(s)
- Yue Hu
- Department of OtorhinolaryngologyThe First Hospital of China Medical UniversityShenyangLiaoningChina
| | - Aihui Yan
- Department of OtorhinolaryngologyThe First Hospital of China Medical UniversityShenyangLiaoningChina
| | - Feifei Jiang
- Department of OtorhinolaryngologyThe First Hospital of China Medical UniversityShenyangLiaoningChina
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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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Gill GPS, Chitale P, Bakshi R, Yadav A, Gill VJS. Microvasular Free Flap Reconstruction in Head and Neck Surgery: Complication and Outcome of 80 Flaps. Indian J Otolaryngol Head Neck Surg 2022; 74:6246-6250. [PMID: 36742725 PMCID: PMC9895627 DOI: 10.1007/s12070-021-02958-2] [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: 09/26/2021] [Accepted: 10/19/2021] [Indexed: 02/07/2023] Open
Abstract
Head and neck carcinoma can prompt destroying cosmetic and functional deformities with resultant mental, physical and nourishing burden. Regardless of ongoing advances in medication and surgical procedure, the general endurance for patients with head and neck malignant growth has stayed still for as long as 35 years. This endurance rate has prompted the foundation of the standards of tumor extraction with most extreme tissue saving and more up to date endoscopic laser-helped methods for auto-digestive region malignant growths targeting diminishing operational morbidity without influencing the general endurance. This retrospective and prospective study contained 80 patients who went through miniature vascular free flap remaking following a significant head and neck oncosurgery procedure from 01/01/2017-to-31/12/2019. Three kinds of free flaps were fundamentally utilized. The current study was directed to assess the clinical result in patients going through miniature vascular free flap reproduction and to decide the viability after head and neck onco-surgical procedure method. Despite the fact that miniature vascular free flaps are today viewed as cutting edge in head and neck remaking after composite resection with predominant effective and stylish rebuilding, it is as yet not basic in India at numerous focuses. This retrospective and prospective study were conducted for a time of 3 years to know the clinical result, decide the adequacy and assess the occurrence and reasons for pre- and post-surgical intricacies in patients going through miniature vascular free flap recreation after head and neck onco-surgical procedure method. It was inferred that the free flaps were dependable in accomplishing effective reproduction of the head and neck following an effective onco-surgical procedure methodology. Despite the fact that there is a critical loss of delicate tissue and bone however after an effective acknowledgment of free flap, close to ordinary anatomical and physiological capacities can be accomplished in larger part of the patients. The frequency of complexities was straightforwardly related to the co-morbidity level and specialist's working experience.
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Balagopal PG, Suresh S, Nath SR, Sagila SG, George NA. Pattern of Post-Operative Infections Among Oral Cavity Cancer Patients in a Tertiary Care Cancer Centre: A Prospective Study. Indian J Otolaryngol Head Neck Surg 2022; 74:2002-2007. [PMID: 36452549 PMCID: PMC9701943 DOI: 10.1007/s12070-020-01963-1] [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: 05/11/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022] Open
Abstract
Surgical site infections (SSIs) constitute a major problem among patients who undergo surgery for oral cancer and remain a substantial cause of morbidity, prolonged hospitalization and death. The aim of this study was to assess the microbial spectrum of post-operative wound infections and to assess the outcome of appropriate antibiotic usage in patients who underwent surgery for oral cancer. This was a prospective observational study done in a tertiary care cancer hospital. Patients who underwent surgery for cancers of the oral cavity during the period January 2014 to December 2016 were included in the study. The spectrum of infections, risk factors, microbial profile, antibiotic susceptibility pattern, treatment given and outcome were assessed. A total of 1431 patients who underwent surgery for cancers of the oral cavity during the study period were followed up. SSIs were noticed in 118 (8%) post-operative cases. This included 55 (76.4%) incisional SSIs and 17 (23.6%) organ/space SSIs. Culture of the surgical site in 72 infected patients yielded a total of 122 isolates. Thirty patients (41.6%) had polymicrobial infections. Gram-negative bacterial isolates (70.5%) outnumbered gram-positive bacterial isolates (27%). Majority of the patients (48 patients-66.6%) were in stage IV disease. Successful management of patients with bacterial infections depends on early identification of bacterial pathogens and selection of an effective antibiotic against the organism. Judicial use of antibiotics is also very essential to prevent the development of drug resistance.
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Affiliation(s)
- P. G. Balagopal
- Department of Head and Neck Surgery, Regional Cancer Centre, Thiruvananthapuram, Kerala 695011 India
| | - Sandeep Suresh
- Department of Head and Neck Surgery, Regional Cancer Centre, Thiruvananthapuram, Kerala 695011 India
| | - Swapna R. Nath
- Department of Microbiology, Regional Cancer Centre, Thiruvananthapuram, Kerala India
| | - S. G. Sagila
- Department of Microbiology, Regional Cancer Centre, Thiruvananthapuram, Kerala India
| | - Nebu Abraham George
- Department of Head and Neck Surgery, Regional Cancer Centre, Thiruvananthapuram, Kerala 695011 India
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Sittitrai P, Ruenmarkkaew D, Klibngern H. Pedicled Flaps versus Free Flaps for Oral Cavity Cancer Reconstruction: A Comparison of Complications, Hospital Costs, and Functional Outcomes. Int Arch Otorhinolaryngol 2022; 27:e32-e42. [PMID: 36714904 PMCID: PMC9879635 DOI: 10.1055/s-0042-1751001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 08/04/2021] [Indexed: 02/01/2023] Open
Abstract
Introduction Free flaps have been the preferred method for reconstruction after resection of oral cavity cancer. However, pedicled flaps remain valuable alternatives in appropriate settings. Objective The main objective of the present study was to compare surgical complications, hospital costs, and functional outcomes of oral cavity cancer patients who underwent soft tissue reconstruction with pedicled flaps or free flaps. Methods A total of 171 patients were included in the study. Ninety-eight underwent reconstruction with a pectoralis major, submental, temporalis, or supraclavicular pedicled flap, and in 73 patients, a radial forearm or anterolateral thigh free flap had been used. The cases were retrospectively reviewed, and a comparative analysis was carried out between the two groups. Results Recipient site and flap complications, speech, and swallowing functions did not differ between groups, but donor site complications, operative time, hospital stay, and costs were significantly reduced in the pedicled flap group compared with the free flap group. However, the pectoralis major flap reconstruction resulted in a more inferior swallowing function than the free flap reconstruction. Conclusions With comparable complications and functional outcomes, while decreasing in costs, pedicled flaps are a useful alternative to free flaps in oral cavity cancer reconstruction. However, in an extensive defect (> 70 cm 2 ), free flaps are the reconstruction of choice for the preservation of swallowing function.
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Affiliation(s)
- Pichit Sittitrai
- Department of Otolaryngology, Chiang Mai University hospital, Chiang Mai, Thailand
| | | | - Hanpon Klibngern
- Department of Otolaryngology, Chiang Mai University hospital, Chiang Mai, Thailand
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Beydoun AS, Koss K, Nielsen T, Holcomb AJ, Pichardo P, Purdy N, Zebolsky AL, Heaton CM, McMullen CP, Yesensky JA, Moore MG, Goyal N, Kohan J, Sajisevi M, Tan K, Petrisor D, Wax MK, Kejner AE, Hassan Z, Trott S, Larson A, Richmon JD, Graboyes EM, Wood CB, Jackson RS, Pipkorn P, Bruening J, Massey B, Puram SV, Zenga J. Perioperative Topical Antisepsis and Surgical Site Infection in Patients Undergoing Upper Aerodigestive Tract Reconstruction. JAMA Otolaryngol Head Neck Surg 2022; 148:547-554. [PMID: 35476816 PMCID: PMC9047735 DOI: 10.1001/jamaoto.2022.0684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Surgical site infections (SSIs) after vascularized reconstruction of the upper aerodigestive tract (UADT) are associated with considerable morbidity. The association between perioperative prophylaxis practices, particularly topical antisepsis, and SSIs remains uncertain. Objective To assess the association between perioperative topical antisepsis and SSIs in patients undergoing vascularized reconstruction of the UADT. Design, Setting, and Participants This cohort study included patients from 12 academic tertiary care centers over an 11-month period, from July 1, 2020, to June 1, 2021. Patients undergoing open surgical procedures requiring a communication between the UADT and cervical skin with a planned regional pedicled flap, free flap, or both were included. Patients with an active infection at the time of surgical procedure were excluded. Main Outcomes and Measures The primary outcome measure was an SSI within 30 days of surgery. The association of demographic characteristics, perioperative antibiotic prophylaxis, surgical technique, and postoperative care with SSIs was assessed using univariable and multivariable analyses. The relative risk ratio and 95% CIs for developing SSI were calculated for each of the variables based on predetermined categories. Variables for which the relative risk 95% CI did not include the value of zero effect (relative risk = 1.00) were included in the multivariable model. Results A total of 554 patients (median age, 64 years; range, 21-95 years; 367 men [66.2%]) were included. Cancer ablation was the most frequent reason for surgery (n = 480 [86.6%]). Overall, the SSI rate was 20.9% (n = 116), with most infections involving the head and neck surgical site only (91 [78.4%]). The median time to SSI diagnosis was 11 days (range, 1-28 days). Topical antisepsis mucosal preparation was performed preoperatively in 35.2% (195) and postoperatively in 52.2% (289) of cases. Ampicillin and sulbactam was the most common systemic antibiotic prophylaxis agent used (n = 367 [66.2%]), with 24 hours being the most common duration (n = 363 [65.5%]). On multivariable analysis, preoperative topical antisepsis mucosal preparation (odds ratio [OR], 0.49; 95% CI, 0.30-0.77) and systemic prophylaxis with piperacillin and tazobactam (OR, 0.42; 95% CI, 0.21-0.84) were associated with a decreased risk of a postoperative SSI. The use of an osseous vascularized flap was associated with an increased risk of postoperative SSI (OR, 1.76; 95% CI, 1.13-2.75). Conclusions and Relevance Findings of this study suggest that preoperative topical antisepsis mucosal preparation was independently associated with a decreased risk of SSIs in a 12-center multi-institutional cohort. Further investigation of the association between individual perioperative practices and the incidence of postoperative SSIs is necessary to develop evidence-based protocols to reduce SSIs after UADT reconstruction.
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Affiliation(s)
- Ahmed Sam Beydoun
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
| | - Kevin Koss
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
| | - Tyson Nielsen
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Omaha, Nebraska
| | - Andrew James Holcomb
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Omaha, Nebraska
| | - Priscilla Pichardo
- Department of Otolaryngology-Head & Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Nicholas Purdy
- Department of Otolaryngology-Head & Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Aaron L Zebolsky
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Chase M Heaton
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Caitlin P McMullen
- Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Jessica A Yesensky
- Department of Surgery, Indiana University School of Medicine, Indianapolis
| | - Michael G Moore
- Department of Surgery, Indiana University School of Medicine, Indianapolis
| | - Neerav Goyal
- Department of Otolaryngology-Head and Neck Surgery, Penn State College of Medicine, Hershey, Pennsylvania
| | - Joshua Kohan
- Division of Otolaryngology, Department of Surgery, University of Vermont Medical Center, Burlington
| | - Mirabelle Sajisevi
- Division of Otolaryngology, Department of Surgery, University of Vermont Medical Center, Burlington
| | - Kenneth Tan
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland
| | - Daniel Petrisor
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland
| | - Mark K Wax
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland
| | - Alexandra E Kejner
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington
| | - Zain Hassan
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington
| | - Skylar Trott
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington
| | - Andrew Larson
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Jeremy D Richmon
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - C Burton Wood
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis
| | - Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Jennifer Bruening
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
| | - Becky Massey
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Joseph Zenga
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
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Bernstein JD, Bracken DJ, Abeles SR, Orosco RK, Weissbrod PA. Surgical wound classification in otolaryngology: A state‐of‐the‐art review. World J Otorhinolaryngol Head Neck Surg 2022; 8:139-144. [PMID: 35782398 PMCID: PMC9242420 DOI: 10.1002/wjo2.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 12/05/2021] [Indexed: 12/04/2022] Open
Abstract
Objective To describe the issues related to the assignment of surgical wound classification as it pertains to Otolaryngology—Head & Neck surgery, and to present a simple framework by which providers can assign wound classification. Data Sources Literature review. Conclusion Surgical wound classification in its current state is limited in its utility. It has recently been disregarded by major risk assessment models, likely due to inaccurate and inconsistent reporting by providers and operative staff. However, if data accuracy is improved, this metric may be useful to inform the risk of surgical site infection. In an era of quality‐driven care and reimbursement, surgical wound classification may become an equally important indicator of quality. In its current state, surgical wound classification has been disregarded as a key metric, likely due to habitual inaccuracies in procedure categorization. A new paradigm for surgical wound classification specific to Otolaryngology—Head & Neck Surgery is presented. The possibility of surgical wound classification serving as an important indicator of quality of care is discussed and contextualized in current health care trends.
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Affiliation(s)
- Jeffrey D. Bernstein
- Department of Otolaryngology University of California San Diego La Jolla California USA
| | - David J. Bracken
- Department of Otolaryngology University of California San Diego La Jolla California USA
| | - Shira R. Abeles
- Department of Medicine, Division of Infectious Disease and Global Public Health University of California San Diego San Diego California USA
| | - Ryan K. Orosco
- Department of Otolaryngology University of California San Diego La Jolla California USA
- Moores Cancer Center University of California San Diego La Jolla California USA
| | - Philip A. Weissbrod
- Department of Otolaryngology University of California San Diego La Jolla California USA
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Tamagawa S, Iyo T, Kono M, Sugita G, Takeda S, Kumashiro N, Murakami D, Enomoto K, Ohtani M, Hotomi M. Impact of the practical guideline on appropriate usage of antimicrobial treatments for surgical site infections in reconstructive surgery of head and neck cancer. J Infect Chemother 2021; 28:401-405. [PMID: 34887177 DOI: 10.1016/j.jiac.2021.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 10/23/2021] [Accepted: 11/21/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVES In 2016, Japanese Society of Chemotherapy and Japan Society for Surgical Infection presented the practical guideline for appropriate usage of antimicrobial agents to prevent postoperative infections. This study aims to exhibit the validity of the guideline as a series of effective strategies for prevention of surgical site infections (SSIs) during reconstructive surgery of the head and neck cancer. METHODS We retrospectively evaluated patients who underwent head and neck reconstructive surgery with free or pedicle flaps in a single institute in Japan between July 2010 and July 2020. We evaluated the incidence of SSIs, patient backgrounds, and microbiological characteristics on the basis of antimicrobial prophylaxis recommended by the guideline. RESULTS Enrolled in this study were 102 patients in our institution who underwent head and neck reconstructive surgery with free or pedicle flaps between July 2010 and July 2020. In the period between January 2018 to July 2020 after the SSI guideline was advocated (SSI guideline period), the ratio of administration of sulbactam/ampicillin (SBT/ABPC) was significantly higher (P < 0.001) and the duration of prophylactic antimicrobial treatment was significantly shorter than in the period between July 2010 to December 2017 before the SSI guideline was advocated (Pre-SSI guideline period) (P < 0.001). Incidence of SSIs were similar, even when antibiotic use was changed to be short-term single-agent administration in accordance with the practical guideline. CONCLUSIONS Adherence to the current Japanese practical guideline on appropriate antimicrobial prophylaxis for SSIs can shorten the duration of usage of antimicrobial treatment without increasing the risk for occurrence of SSIs.
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Affiliation(s)
- Shunji Tamagawa
- Department of Otorhinolaryngology Head and Neck Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8510, Japan
| | - Takuro Iyo
- Department of Otorhinolaryngology Head and Neck Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8510, Japan
| | - Masamitsu Kono
- Department of Otorhinolaryngology Head and Neck Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8510, Japan
| | - Gen Sugita
- Department of Otorhinolaryngology Head and Neck Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8510, Japan
| | - Saori Takeda
- Department of Otorhinolaryngology Head and Neck Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8510, Japan
| | - Naoko Kumashiro
- Department of Otorhinolaryngology Head and Neck Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8510, Japan
| | - Daichi Murakami
- Department of Otorhinolaryngology Head and Neck Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8510, Japan
| | - Keisuke Enomoto
- Department of Otorhinolaryngology Head and Neck Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8510, Japan
| | - Makiko Ohtani
- Department of Otorhinolaryngology Head and Neck Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8510, Japan
| | - Muneki Hotomi
- Department of Otorhinolaryngology Head and Neck Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8510, Japan.
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9
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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: 1] [Impact Index Per Article: 0.3] [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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10
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Surgical and remote site infections after reconstructive surgery of the head and neck: A risk factor analysis. J Craniomaxillofac Surg 2021; 50:178-187. [PMID: 34802884 DOI: 10.1016/j.jcms.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 09/27/2021] [Accepted: 11/10/2021] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to identify risk factors for surgical (SSI) and remote site (RSI) infections, pathogens and antibiotic resistances in patients after pedicled and free flap reconstruction in the head and neck area. SSI criteria implicated infections affecting superficial or deep tissue in the flap area with purulent discharge, fistula, abscess formation and local infections signs. RSI criteria were defined as infections remote from the surgical site presenting with systemic symptoms like fever, leucocytosis, increase in C-reactive protein, purulent tracheobronchial secretion or deterioration of blood gases. Focus adequate specimen sampling and aerobic and anaerobic incubation and cultivation was performed. Epidemiological data, factors directly related to surgery or reconstruction, perioperative antibiotic regimen, length of stay, autologous blood transfusion and microbiological aspects were retrospectively analysed in 157 patients. 10.8% of patients presented SSI, 12.7% RSI. Cultivated bacteria were sampled from flap sites, blood cultures, central catheters and sputum including mainly gram-negative bacteria (70.3%) being frequently resistant against penicillin (85%) and third generation cephalosporine derivates (48%). Autologous blood transfusion (p = 0.018) and perioperative clindamycin use (p = 0.002) were independent risk factors for overall (SSI and RSI combined) infections. Prior radiation (p = 0.05), autologous blood transfusion (p = 0.034) and perioperative clindamycin use (p = 0.004) were predictors for SSIs. ASA >2 (p = 0.05) was a risk factor for remote site infections and prolonged ICU stay (p = 0.002) was associated with overall infections, especially in irradiated patients. Efforts need to be made in improving patient blood management, antibiotic stewardship and accurate postoperative care to avoid postoperative infections after head and neck reconstructive surgery.
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11
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Tjoa T, Rathi VK, Goyal N, Yarlagadda BB, Barshak MB, Rich DL, Emerick KS, Lin DT, Deschler DG, Durand ML. Pneumonia, urinary tract infection, bacteremia, and Clostridioides difficile infection following major head and neck free and pedicled flap surgeries. Oral Oncol 2021; 122:105541. [PMID: 34564017 DOI: 10.1016/j.oraloncology.2021.105541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 08/21/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Medical postoperative infections (MPIs) are important causes of morbidity following major head and neck free and pedicled flap reconstruction, but the incidence, time of onset, and microbiology are not well characterized. MATERIALS AND METHODS Medical records were reviewed of all head and neck flap surgeries performed 2009-2014 at an academic medical center. Postoperative pneumonia, urinary tract infection (UTI), bloodstream infection (BSI), Clostridioides difficile (CDI), and surgical site infections (SSI) were noted. Catheter-associated UTI (CAUTI), central line-associated BSI (CLABSI), and methicillin-resistant Staphylococcus aureus (MRSA) BSI were also evaluated. RESULTS Following 715 free (540) or pedicled (175) flap surgeries, 14.1% of patients developed ≥one MPI including pneumonia (10.6%), UTI (2.1%), BSI (0.7%), and CDI (2.4%). Onset was ≤7 days in 77%. The MPI incidence in free vs pedicled flaps was similar. By multivariate analysis, age ≥65 and clindamycin perioperative prophylaxis were associated with increased MPI risk, clean class surgery with decreased risk. The incidence of CAUTI (<1.0%), CLABSI (0.1%), and hospital-onset MRSA BSI (0.1%) was low. SSI rate (7.8% overall) was higher in patients who developed pneumonia (18.4 vs 6.6, p = 0.004). MPI cultures grew gram-negative bacilli or S. aureus in 75%. The length of stay was longer in patients who developed a MPI than those who did not (17.4 vs 10.4 days, p < 0.0001). CONCLUSIONS One-seventh of major head and neck flap surgeries were complicated by MPIs, three-quarters of infections developed within 1 week postoperatively. Gram-negative bacilli and S. aureus were the predominant pathogens.
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Affiliation(s)
- Tjoson Tjoa
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, United States.
| | - Vinay K Rathi
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, United States.
| | - Neerav Goyal
- Department of Otolaryngology, Penn State Milton S. Hershey Medical Center, 200 Campus Drive, Hershey, PA 17033, United States.
| | - Bharat B Yarlagadda
- Department of Otolaryngology, Lahey Hospital & Medical Center, 41 Mall Road, Burlington, MA 01805, United States.
| | - Miriam B Barshak
- Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States.
| | - Debbie L Rich
- Department of Nursing, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, United States
| | - Kevin S Emerick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, United States.
| | - Derrick T Lin
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, United States.
| | - Daniel G Deschler
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, United States.
| | - Marlene L Durand
- Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States.
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12
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Alonso-García M, Toledano-Muñoz A, Aparicio-Fernández JM, De-la-Rosa-Astacio FM, Rodríguez-Villar D, Gil-de-Miguel A, Durán-Poveda M, Rodríguez-Caravaca G. Adequacy of antibiotic prophylaxis and incidence of surgical site infections in neck surgery. Sci Rep 2021; 11:16413. [PMID: 34385521 PMCID: PMC8361086 DOI: 10.1038/s41598-021-95831-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/28/2021] [Indexed: 01/21/2023] Open
Abstract
Health care-related infections are frequent and among them surgical site infection (SSI) are the most frequent in hospitals. The objective was to evaluate the adequacy of antibiotic prophylaxis in patients undergoing neck surgery and its relationship with the incidence of surgical site infection (SSI). Prospective cohort study. The adequacy of antibiotic prophylaxis in patients undergoing neck surgery was evaluated. Antibiotic prophylaxis was considered adequate when it conformed to all items of the protocol (antibiotic used, time of administration, administration route, dose and duration). The cumulative incidence of SSI was calculated, and the relationship between SSI and antibiotic prophylaxis adequacy was determined using adjusted relative risk (RR). Antibiotic prophylaxis was administered in 63 patients and was adequate in 85.7% (95% CI 75.0–92.3) of them. The cumulative incidence of SSI was 6.4% (95% CI 3.4–11.8). There was no significant relationship between antibiotic prophylaxis inadequacy and the incidence of SSI (RR = 2.4, 95% CI 0.6–10.6). Adequacy of antibiotic prophylaxis was high and it did not affect the incidence of SSIs.
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Affiliation(s)
- M Alonso-García
- Department of Preventive Medicine, Alcorcón Foundation University Hospital, C/ Budapest 1, 28922, Alcorcón, Madrid, Spain.,Department of Medical Specialities and Public Health, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - A Toledano-Muñoz
- Department of Medical Specialities and Public Health, Rey Juan Carlos University, Alcorcón, Madrid, Spain.,Department of Otorhinolaryngology, Alcorcón Foundation University Hospital, Alcorcón, Madrid, Spain
| | - J M Aparicio-Fernández
- Department of Otorhinolaryngology, Alcorcón Foundation University Hospital, Alcorcón, Madrid, Spain
| | - F M De-la-Rosa-Astacio
- Department of Otorhinolaryngology, Alcorcón Foundation University Hospital, Alcorcón, Madrid, Spain
| | - D Rodríguez-Villar
- Department of Medical Specialities and Public Health, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - A Gil-de-Miguel
- Department of Medical Specialities and Public Health, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - M Durán-Poveda
- Department of Medical Specialities and Public Health, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - G Rodríguez-Caravaca
- Department of Preventive Medicine, Alcorcón Foundation University Hospital, C/ Budapest 1, 28922, Alcorcón, Madrid, Spain. .,Department of Medical Specialities and Public Health, Rey Juan Carlos University, Alcorcón, Madrid, Spain.
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13
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Mays AC, Yarlagadda B, Achim V, Jackson R, Pipkorn P, Huang AT, Rajasekaran K, Sridharan S, Rosko AJ, Orosco RK, Coughlin AM, Wax MK, Shnayder Y, Spanos WC, Farwell DG, McDaniel LS, Hanasono MM. Examining the relationship of immunotherapy and wound complications following flap reconstruction in patients with head and neck cancer. Head Neck 2021; 43:1509-1520. [PMID: 33417293 DOI: 10.1002/hed.26601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/12/2020] [Accepted: 12/30/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Immunotherapy agents are used to treat advanced head and neck lesions. We aim to elucidate relationship between immunotherapy and surgical wound complications. METHODS Retrospective multi-institutional case series evaluating patients undergoing ablative and flap reconstructive surgery and immunotherapy treatment. MAIN OUTCOME wound complications. RESULTS Eight-two (62%) patients received preoperative therapy, 89 (67%) postoperative, and 33 (25%) in both settings. Forty-one (31%) patients had recipient site complications, 12 (9%) had donor site. Nineteen (14%) had major recipient site complications, 22 (17%) had minor. There was no statistically significant difference in complications based on patient or tumor-specific variables. Preoperative therapy alone demonstrated increased major complications (odds ratio [OR] 3.7, p = 0.04), and trend to more donor site complications (OR 7.4, p = 0.06), however treatment in both preoperative and postoperative therapy was not. CONCLUSIONS Preoperative immunotherapy may be associated with increased wound complications. Controlled studies are necessary to delineate this association and potential risks of therapy.
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Affiliation(s)
- Ashley C Mays
- Department of Otolaryngology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Bharat Yarlagadda
- Department of Otolaryngology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Virginie Achim
- Department of Otolaryngology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ryan Jackson
- Department of Otolaryngology, Washington University - St Louis, St Louis, Missouri, USA
| | - Patrik Pipkorn
- Department of Otolaryngology, Washington University - St Louis, St Louis, Missouri, USA
| | - Andrew T Huang
- Department of Otolaryngology, Baylor College of Medicine, Houston, Texas, USA
| | - Karthik Rajasekaran
- Department of Otolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shaum Sridharan
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrew J Rosko
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ryan K Orosco
- Department of Otolaryngology, University of California San Diego, San Diego, California, USA
| | - Andrew M Coughlin
- Department of Otolaryngology, Nebraska Methodist Health System, Omaha, Nebraska, USA
| | - Mark K Wax
- Department of Otolaryngology, Oregon Health Sciences University, Portland, Oregon, USA
| | | | - William C Spanos
- Department of Otolaryngology, Sanford Health, Sioux Falls, South Dakota, USA
| | - Donald Gregory Farwell
- Department of Otolaryngology, University of California Davis, Sacramento, California, USA
| | - Lee S McDaniel
- Louisiana State University Health Sciences Center School of Public Health, New Orleans, Louisiana, USA
| | - Matthew M Hanasono
- Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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14
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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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15
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Lindeborg MM, Sethi RKV, Puram SV, Parikh A, Yarlagadda B, Varvares M, Emerick K, Lin D, Durand ML, Deschler DG. Predicting length of stay in head and neck patients who undergo free flap reconstruction. Laryngoscope Investig Otolaryngol 2020; 5:461-467. [PMID: 32596488 PMCID: PMC7314462 DOI: 10.1002/lio2.410] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/09/2020] [Accepted: 05/15/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Understanding factors that affect postoperative length of stay (LOS) may improve patient recovery, hasten postoperative discharge, and minimize institutional costs. This study sought to (a) describe LOS among head and neck patients undergoing free flap reconstruction and (b) identify factors that predict increased LOS. METHODS A retrospective cohort was performed of 282 head and neck patients with free flap reconstruction for oncologic resection between 2011 and 2013 at a tertiary academic medical center. Patient demographics, tumor characteristics, and surgical and infectious complications were characterized. Multivariable regression identified predictors of increased LOS. RESULTS A total of 282 patients were included. Mean age was 64.7 years (SD = 12.2) and 40% were female. Most tumors were located in the oral cavity (53.9% of patients), and most patients underwent radial forearm free flap (RFFF) reconstruction (RFFF-73.8%, anterolateral thigh flap-11.3%, and fibula free flap-14.9%). Intraoperative complications were rare. The most common postoperative complications included nonwound infection (pneumonia [PNA] or urinary tract infection [UTI]) (15.6%) and wound breakdown/fistula (15.2%). Mean and median LOS were 13 days (SD = 7.7) and 10 days (interquartile range = 7), respectively. Statistically significant predictors of increased LOS included flap take back (Beta coefficient [C] = +4.26, P < .0001), in-hospital PNA or UTI (C = +2.52, P = .037), wound breakdown or fistula (C = +5.0, P < .0001), surgical site infection (C = +3.54, P = .017), and prior radiation therapy (C = +2.59, P = .004). CONCLUSION Several perioperative factors are associated with increased LOS. These findings may help with perioperative planning, including the need for vigilant wound care, optimization of antibiotics prophylaxis, and institution-level protocols for postoperative care and disposition of free flap patients. LEVEL OF EVIDENCE 2b; retrospective cohort.
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Affiliation(s)
- Michael M. Lindeborg
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Rosh K. V. Sethi
- Department of OtolaryngologyUniversity of MichiganAnn ArborMichiganUSA
| | - Sidharth V. Puram
- Department of OtolaryngologyWashington University School of Medicine in Saint LouisSaint LouisMissouriUSA
| | - Anuraag Parikh
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Bharat Yarlagadda
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Mark Varvares
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Kevin Emerick
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Derrick Lin
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Marlene L. Durand
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
- Department of MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Daniel G. Deschler
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Department of OtolaryngologyHarvard Medical SchoolBostonMassachusettsUSA
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16
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Vander Poorten V, Uyttebroek S, Robbins KT, Rodrigo JP, de Bree R, Laenen A, F Saba N, Suarez C, Mäkitie A, Rinaldo A, Ferlito A. Perioperative Antibiotics in Clean-Contaminated Head and Neck Surgery: A Systematic Review and Meta-Analysis. Adv Ther 2020; 37:1360-1380. [PMID: 32141017 PMCID: PMC7140756 DOI: 10.1007/s12325-020-01269-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Indexed: 12/31/2022]
Abstract
Background The optimal evidence-based prophylactic antibiotic regimen for surgical site infections following major head and neck surgery remains a matter of debate. Methods Medline, Cochrane, and Embase were searched for the current best evidence. Retrieved manuscripts were screened according to the PRISMA guidelines. Included studies dealt with patients over 18 years of age that underwent clean-contaminated head and neck surgery (P) and compared the effect of an intervention, perioperative administration of different antibiotic regimens for a variable duration (I), with control groups receiving placebo, another antibiotic regimen, or the same antibiotic for a different postoperative duration (C), on surgical site infection rate as primary outcome (O) (PICO model). A systematic review was performed, and a selected group of trials investigating a similar research question was subjected to a random-effects model meta-analysis. Results Thirty-nine studies were included in the systematic review. Compared with placebo, cefazolin, ampicillin–sulbactam, and amoxicillin–clavulanate were the most efficient agents. Benzylpenicillin and clindamycin were clearly less effective. Fifteen studies compared short- to long-term prophylaxis; treatment for more than 48 h did not further reduce wound infections. Meta-analysis of five clinical trials including 4336 patients, where clindamycin was compared with ampicillin–sulbactam, implied an increased infection rate for clindamycin-treated patients (OR = 2.73, 95% CI 1.50–4.97, p = 0.001). Conclusion In clean-contaminated head and neck surgery, cefazolin, amoxicillin–clavulanate, and ampicillin–sulbactam for 24–48 h after surgery were associated with the highest prevention rate of surgical site infection.
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Affiliation(s)
- Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven and Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium.
| | - Saartje Uyttebroek
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven and Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - K Thomas Robbins
- Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annouschka Laenen
- Leuven Biostatistics and Statistical Bioinformatics Centre, KU Leuven, Leuven, Belgium
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Carlos Suarez
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain
- Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain
| | - Antti Mäkitie
- Department of Otorhinolaryngology Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
| | | | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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17
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Vander Poorten V, Uyttebroek S, Robbins KT, Rodrigo JP, de Bree R, Laenen A, F Saba N, Suarez C, Mäkitie A, Rinaldo A, Ferlito A. Perioperative Antibiotics in Clean-Contaminated Head and Neck Surgery: A Systematic Review and Meta-Analysis. Adv Ther 2020. [PMID: 32141017 DOI: 10.1007/s12325‐020‐01269‐2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The optimal evidence-based prophylactic antibiotic regimen for surgical site infections following major head and neck surgery remains a matter of debate. METHODS Medline, Cochrane, and Embase were searched for the current best evidence. Retrieved manuscripts were screened according to the PRISMA guidelines. Included studies dealt with patients over 18 years of age that underwent clean-contaminated head and neck surgery (P) and compared the effect of an intervention, perioperative administration of different antibiotic regimens for a variable duration (I), with control groups receiving placebo, another antibiotic regimen, or the same antibiotic for a different postoperative duration (C), on surgical site infection rate as primary outcome (O) (PICO model). A systematic review was performed, and a selected group of trials investigating a similar research question was subjected to a random-effects model meta-analysis. RESULTS Thirty-nine studies were included in the systematic review. Compared with placebo, cefazolin, ampicillin-sulbactam, and amoxicillin-clavulanate were the most efficient agents. Benzylpenicillin and clindamycin were clearly less effective. Fifteen studies compared short- to long-term prophylaxis; treatment for more than 48 h did not further reduce wound infections. Meta-analysis of five clinical trials including 4336 patients, where clindamycin was compared with ampicillin-sulbactam, implied an increased infection rate for clindamycin-treated patients (OR = 2.73, 95% CI 1.50-4.97, p = 0.001). CONCLUSION In clean-contaminated head and neck surgery, cefazolin, amoxicillin-clavulanate, and ampicillin-sulbactam for 24-48 h after surgery were associated with the highest prevention rate of surgical site infection.
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Affiliation(s)
- Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven and Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium.
| | - Saartje Uyttebroek
- Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven and Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - K Thomas Robbins
- Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annouschka Laenen
- Leuven Biostatistics and Statistical Bioinformatics Centre, KU Leuven, Leuven, Belgium
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Carlos Suarez
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain
| | - Antti Mäkitie
- Department of Otorhinolaryngology Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
| | | | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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18
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Torabi SJ, Chouairi F, Dinis J, Alperovich M. Head and Neck Reconstructive Surgery: Characterization of the One-Team and Two-Team Approaches. J Oral Maxillofac Surg 2019; 78:295-304. [PMID: 31622570 DOI: 10.1016/j.joms.2019.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 09/09/2019] [Accepted: 09/10/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE To the best of our knowledge, no studies have compared the patient profiles for 1- versus 2-team surgery within head and neck oncosurgery. PATIENTS AND METHODS A retrospective study of the data from 2968 patients who had undergone concurrent head and neck extirpative and reconstructive surgery in the National Surgical Quality Improvement Program (2010 to 2017) was conducted. Patients were stratified into 1- and 2-team surgery groups, and the demographic data were compared. Univariate analyses of the outcomes before and after propensity score matching were conducted. RESULTS Most ablative and reconstructive head and neck procedures (68.5%) were performed using a 1-team approach. The patients who had undergone 2-team surgery were more likely to have a higher American Society of Anesthesiologists classification (P < .001), to require mandibulectomy (P < .001) or glossectomy (P < .001), and to receive a microvascular free flap (P < .001) but were less likely to require parotidectomy (P < .001) or to receive a rotational flap (P < .001). Before propensity score matching, the patients undergoing 2-team surgery had longer operative times (P < .001), longer postoperative stays (P < .001), greater rates of a return to the operating room (P = .001), and an increased rate of complications (P < .001). After propensity score matching, the 2-team approach continued to have longer operative times (P < .001) and an increased incidence of complications (P < .001) but no significant differences in the length of stay or rate of return to the operating room after Bonferroni's correction. CONCLUSIONS Nationally, most head and neck ablative and reconstructive surgeries were completed by 1 team. More complicated reconstructive procedures involving microvascular free flaps have been more commonly performed by 2 teams, resulting in slightly longer operative times and greater associated complication rates.
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Affiliation(s)
- Sina J Torabi
- Medical Student, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Fouad Chouairi
- Medical Student, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Jacob Dinis
- Medical Student, Department of Surgery, Yale University School of Medicine, New Haven, CT; and Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, CT
| | - Michael Alperovich
- Assistant Professor, Section of Plastic and Reconstructive Surgery Department of Surgery, Yale University School of Medicine, New Haven, CT.
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Impact of sarcopenia on postoperative surgical site infections in patients undergoing flap reconstruction for oral cancer. Int J Oral Maxillofac Surg 2019; 49:576-581. [PMID: 31601472 DOI: 10.1016/j.ijom.2019.09.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 07/11/2019] [Accepted: 09/13/2019] [Indexed: 01/06/2023]
Abstract
Sarcopenia is characterized by progressive and generalized loss of skeletal muscle mass and strength. The aim of the study was to investigate the impact of skeletal muscle mass on surgical site infection (SSI) in flap reconstruction for defects after oral cancer resection. The subjects were a non-randomized, retrospective cohort of 106 patients who underwent this procedure after preoperative abdominal-lumbar computed tomography (CT). Cross-sectional areas (cm2) of skeletal muscles in the L3 region were measured by manual outlining on CT images. These areas were then normalized for height (cm2/m2) and defined as the skeletal muscle index (SMI). Recipient site SSI occurred in 28 patients (26.4%). Lower body mass index, haemoglobin and SMI were significantly related to recipient site SSI in univariate analysis (P<0. 05). In a multiple logistic regression model, lower SMI was a significant risk factor for recipient site SSI (odds ratio = 3.95 per 10 cm2/m2 decrease, P=0. 005). This result suggests that increasing skeletal muscle mass by exercise or nutrition before surgery may prevent recipient site SSI after resection of oral cancer and subsequent reconstruction.
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Risk Factors for Surgical Site Infection in Patients Undergoing Free and Pedicled Myocutaneous Flap Reconstruction After Oral Cancer Resection. J Oral Maxillofac Surg 2019; 77:1075-1081. [DOI: 10.1016/j.joms.2018.12.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 12/25/2018] [Accepted: 12/25/2018] [Indexed: 01/16/2023]
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Gabrysz-Forget F, Tabet P, Rahal A, Bissada E, Christopoulos A, Ayad T. Free versus pedicled flaps for reconstruction of head and neck cancer defects: a systematic review. J Otolaryngol Head Neck Surg 2019; 48:13. [PMID: 30871637 PMCID: PMC6417188 DOI: 10.1186/s40463-019-0334-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 03/04/2019] [Indexed: 11/13/2022] Open
Abstract
Objective The present review focuses on comparative studies of reconstruction with free flaps (FF) versus pedicled flaps (PF) after oncologic resection. Method A systematic review was developed in compliance with PRISMA guidelines and performed using the Pubmed, Medline, EMBASE, Amed and Biosis databases. Results A total of 30 articles were included. FF are associated with a longer operative time, a higher cost and a higher incidence of postoperative revisions compared to PF. FF are associated with a longer stay at the intensive care unit than the supraclavicular artery island flap (SCAIF) and with a more extended hospital stay compared to the submental island flap (SMIF). FF are associated with fewer infections and necrosis compared to the pectoralis major myocutaneous flap (PMMF). Conclusion The comparison of both type of flaps is limited by the inherent design of the studies included. In sum, FF seem superior to the PMMF for several outcomes. SMIF and SCAIF compare favorably to FF for some specific indications achieving similar outcomes at a lower cost.
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Affiliation(s)
| | - Paul Tabet
- Faculty of Medicine, Université de Montreal, Montreal, QC, Canada
| | - Akram Rahal
- Division of Otolaryngology - Head & Neck Surgery service, Université de Montréal, Montreal, QC, Canada
| | - Eric Bissada
- Division of Otolaryngology - Head & Neck Surgery service, Université de Montréal, Montreal, QC, Canada
| | - Apostolos Christopoulos
- Division of Otolaryngology - Head & Neck Surgery service, Université de Montréal, Montreal, QC, Canada
| | - Tareck Ayad
- Division of Otolaryngology - Head & Neck Surgery service, Université de Montréal, Montreal, QC, Canada. .,Department of Surgery, Centre Hospitalier de l'Université de Montréal, 900, Saint-Denis St. pavillon R, H2X 0A9, Montreal, Canada.
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