Risk factors for surgical‐site infections in head and neck cancer surgery

Lotfi, Carlos Jorge; Cavalcanti, Rita de Cássia; Silva, Adriana Maria Costa e; Latorre, Maria do Rosário Dias de Oliveira; Ribeiro, Karina de Cássia Braga; Carvalho, André Lopes; Kowalski, Luiz Paulo

doi:10.1016/j.otohns.2007.09.018

Cited by 118 publications

(136 citation statements)

References 23 publications

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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

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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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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

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“…However, there is still a high degree of variability in the implementation of peri-operative antibiotic prophylaxis. Given the greater risk of SSI in free flap reconstructions [9][10][11] and the potential highly morbid consequences of infection, many clinicians use antibiotics in an effort to prevent complications. Still, data attesting to the value of this practice are lacking.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical site infection (SSI), one of the most common complications, may lead to vessel thrombosis and, eventually, to flap loss [6]. Moreover, reconstruction with free flaps is a significant risk factor for SSI in clean-contaminated head and neck operations [9][10][11]. Therefore, there has been great interest in determining the optimal regimen for antibiotic prophylaxis in the peri-operative period.…”

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confidence: 99%

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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Wound Healing and Infection in Surgery

Sørensen¹

2012

Arch Surg

478

126

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To clarify the evidence on smoking and postoperative healing complications across surgical specialties and to determine the impact of perioperative smoking cessation intervention. Data Sources: Cohort studies and randomized controlled trials. Study Selection: Selected studies were identified through electronic databases (CENTRAL, MEDLINE, and EMBASE) and by hand searching. Data Extraction: Multiple data on study characteristics were extracted. Risk of bias was assessed by means of the Newcastle-Ottawa Scale and Jadad score. Healing outcome was classified as necrosis, healing delay and dehiscence, surgical site infection, wound complications, hernia, and lack of fistula or bone healing. Mantel-Haenszel and inverse variance methods for metaanalysis (fixed-and random-effects models) were used.

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Risk factors for surgical‐site infections in head and neck cancer surgery

Cited by 118 publications

References 23 publications

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

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

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

Wound Healing and Infection in Surgery

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