Surgical Site Infection Affects Length of Stay After Complex Head and Neck Procedures

Abstract

Objectives/Hypothesis: Quality improvement (QI) initiatives emphasize a need for reduction in hospital length of stay (LOS). We sought to determine the impact of surgical site infections (SSIs) on LOS after complex head and neck surgery (HNS). Study Design: Retrospective cohort analysis. Methods: An analysis of the American College of Surgeons National Surgical Quality Improvement Program was undertaken. All adult patients undergoing complex HNS from 2005 to 2016 were included in the analysis. Our main outcomes were SSI incidence and increase in hospital LOS attributable to SSI. Results: Of 4,014 patients identified, 16.5% developed SSI. History of smoking, diabetes, preoperative wound infection, contaminated or dirty wound classes, and prolonged operative time were found to significantly predict postoperative SSI. Adjusting for significant pre-and postoperative factors, SSI was associated with significantly increased LOS (hazard ratio = 0.486, 95% confidence interval: 0.419-0.522). Conclusions: SSI following complex HNS is associated with significantly increased hospital LOS. This result supports the need for institutional QI strategies that target SSIs after head and neck procedures in an effort to provide the highest quality care at the lowest possible cost. Our analysis identifies risk factors that can allow identification of patients at high risk of SSI and prolonged hospitalization.

Predictors of surgical site infection following reconstructive flap surgery: A multi-institutional analysis of 37,177 patients

“…We aim to provide surgeons with conclusions that can help guide patient selection, counseling, and surgical planning to help minimize the risk of SSI postoperatively. The overall 30-day incidence rate of SSI in our patient cohort was 7.5%, which falls within the range reported in the literature (8,9,13). However, due to different techniques and sites of reconstruction, surgeon expertise, patient demographics and comorbidities, and duration of patient follow-up, accurate complication rates may be difficult to compare among studies (14).…”

“…For our H&N population consisting of 2,381 patient who underwent RFS, 4.2% of them (100 patients) developed SSI, which is in discordance with the range reported in existing literature (7,8,30,31). In a study by Lebo et (32).…”

“…Moreover, predictors of SSI following these procedures have been described in the literature. Active smoking and hypertension were found to be significant predictors of SSI following breast reconstruction, while increased length of hospital stay was a significant predictor of SSI following head and neck reconstruction (8,9). Nonetheless, the incidence and predictors of SSI following trunk and extremity reconstruction have not been investigated.…”

Machine learning models to predict length of stay and discharge destination in complex head and neck surgery

“…To address this, we have published our algorithms via an encrypted online interface and encourage clinicians to test hypothetical situations. Fourth, patients undergoing laryngectomy or composite tissue excision followed by free tissue transfer were combined similar to a previous study regarding complex head and neck surgery patients 16 . Following this proof‐of‐concept investigation, future studies using multi‐institutional cohorts or other national databases will allow utilization of more homogenous surgical cohorts with adequate reliability and number of subjects and variables.…”

“…Given the de‐identified and publicly available nature of this database, this study was exempted from Institutional Review Board approval. Complex head and neck surgeries were defined as laryngectomy or composite tissue excision followed by free tissue transfer, modeled after a recent NSQIP study by Lebo and colleagues 16 . The following current procedural terminology (CPT) codes were used to collect patients undergoing laryngectomy: 31360, 31 365, 31 368, 31 390, and 31 395.…”