Analysis of risk factors for surgical-site infections in 276 oral cancer surgeries with microvascular free-flap reconstructions at a single university hospital

Karakida, Kazunari; Aoki, Takayuki; Ota, Yoshihide; Yamazaki, Hiroshi; Otsuru, Mitsunobu; Takahashi, Miho; Sakamoto, Haruo; Miyasaka, Muneo

doi:10.1007/s10156-010-0108-y

Cited by 98 publications

(147 citation statements)

References 11 publications

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“…However, the validity of these risk factors is controversial in the current literature [7,[25][26][27]. Our study also demonstrated a significantly lower rate of SSI in patients treated with penicillins and a significantly higher rate of SSI in patients treated with clindamycin.…”

Section: Discussionsupporting

confidence: 62%

Antibiotic Use after Free Tissue Reconstruction of Head and Neck Defects: Short Course vs. Long Course

Khariwala

Pierce

et al. 2016

Surgical Infections

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Background: Free tissue reconstruction has become the standard of care for most major defects in the head and neck. Surgical site infection (SSI) can lead to vessel thrombosis and eventual flap loss. The use of antibiotics after free tissue reconstruction has not been studied in the current environment of heightened bacterial antibiotic resistance. We compared the use of short-term and longer-term antibiotics in a series of patients receiving free tissue reconstructions. Methods: A retrospective review was performed of 147 patients receiving 149 free flaps who were treated with either short-course (£2 d; n = 149 [43%]) or long-course (>2 d; n = 85 [57%])) post-operative antibiotics from 2009 to 2014. The outcomes examined were infection, return to the operating room, length of hospital stay, and patient death up to six weeks post-surgery. In addition, risk factors associated with SSI were explored. Results: Surgical site infection, flap dehiscence, flap loss, and length of stay were not different in the two groups. However, those receiving long-course antibiotics had a significantly higher rate of pneumonia (24.7% vs. 10.9%; p = 0.03), although they had a lower rate of urinary tract infection (0.0% vs 9.4%, respectively; p = 0.01). Body mass index remained a statistically significant risk factor in the multivariable analysis (p = 0.005). Conclusion: Prolonged antibiotic use after free flap reconstruction of head and neck defects does not appear to prevent SSI better than short-course treatment in this population. Moreover, long-course antibiotic use was associated with a higher risk of pneumonia.

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Section: Discussionsupporting

confidence: 62%

Antibiotic Use after Free Tissue Reconstruction of Head and Neck Defects: Short Course vs. Long Course

Khariwala

Pierce

et al. 2016

Surgical Infections

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“…The risk of SSI has been reported to be 10.9% to 45.0% in patients who undergo head and neck cancer surgery, despite parenteral antibiotic prophylaxis. [1][2][3][4][5][6][7][8] SSI not only causes a prolonged hospital stay and decreased quality of life in patients who undergo oral cancer surgery, but also adversely impacts the outcome because of the need to delay postoperative treatment in patients with adverse prognostic features. The CDC guidelines [13] state that the risk of SSI can be conceptualized as a level of bacterial contamination Â virulence/resistance of the host patient, and that if a surgical site is contaminated with >10 5 microorganisms per gram of tissue, the risk of SSI is markedly increased.…”

Section: Discussionmentioning

confidence: 99%

“…The sample size was calculated from a previous report and our pilot study. [1][2][3][4][5][6][7][8][9] We assumed a 30% incidence of SSI in the control group and that intervention could reduce this figure to 15%. A 2-tailed significance level of a = 0.05 and a power of 0.90 required enrollment of 132 patients.…”

Section: Methodsmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8] The reasons for the high incidence of SSI are thought to include not only surgical technique and poor preoperative nutrition but also the presence of pathogenic microorganisms in the oral cavity. Furthermore, patients with oral cancer who undergo tumor resection combined with reconstructive surgery and tracheotomy have higher than normal levels of bacteria in the oropharyngeal fluid because of swallowing disturbance and reduced selfcleaning in the oral cavity.…”

Section: Introductionmentioning

confidence: 99%

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Prevention of surgical site infection after oral cancer surgery by topical tetracycline: Results of a multicenter randomized control trial.

Funahara

Yanamoto

Suzuki

et al. 2018

JCO

Self Cite

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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.Abbreviations: CDC = Centers for Disease Control and Prevention, RCT = randomized control trial, SSI = surgical site infection.

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“…In an analyis of 276 patients submitted to free flap reconstruction, one hundred and twelve patients (40.6 %) had post-operative surgical-site infection. Duration of surgery and ASA (American Society of Anesthesiologists) score were significant factors for local and neck infection (Karakida et al, 2010). In our experience, surgical site infections were the most frequent postoperative complication, occurring in 94 patients (15.54 %).…”

Section: Risk Factors and Complications Of Free Flap Oral Reconstructionmentioning

confidence: 57%

Microsurgical Reconstruction of the Oral Cavity and Oropharynx After Cancer Ablation

Rodrigues¹,

Köhler²,

Kowalski³

2012

Oral Cancer

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Analysis of risk factors for surgical-site infections in 276 oral cancer surgeries with microvascular free-flap reconstructions at a single university hospital

Cited by 98 publications

References 11 publications

Antibiotic Use after Free Tissue Reconstruction of Head and Neck Defects: Short Course vs. Long Course

Antibiotic Use after Free Tissue Reconstruction of Head and Neck Defects: Short Course vs. Long Course

Prevention of surgical site infection after oral cancer surgery by topical tetracycline: Results of a multicenter randomized control trial.

Microsurgical Reconstruction of the Oral Cavity and Oropharynx After Cancer Ablation

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