The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Risk factors and etiology of surgical site infection after radical neck dissection in patients with head and neck cancer

  • Park, So Yeon (Division of Infectious Diseases, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital) ;
  • Kim, Mi Suk (Department of Nursing, Kyungbuk College) ;
  • Eom, Joong Sik (Division of Infectious Diseases, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital) ;
  • Lee, Jin Seo (Division of Infectious Diseases, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital) ;
  • Rho, Young Soo (Department of Otorhinolaryngology-Head and Neck Surgery, Ilsong Memorial Institute of Head and Neck Cancer, Hallym University Kangdong Sacred Heart Hospital)
  • Received : 2015.04.30
  • Accepted : 2015.05.26
  • Published : 2016.01.01
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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.

Keywords

References

  1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 2011;61:69-90. https://doi.org/10.3322/caac.20107
  2. Marur S, Forastiere AA. Head and neck cancer: changing epidemiology, diagnosis, and treatment. Mayo Clin Proc 2008;83:489-501. https://doi.org/10.4065/83.4.489
  3. Andry G, Hamoir M, Leemans CR. The evolving role of surgery in the management of head and neck tumors. Curr Opin Oncol 2005;17:241-248. https://doi.org/10.1097/01.cco.0000160277.86386.dc
  4. Cunha TF, Soares Melancia TA, Zagalo Fernandes Ribeiro CM, et al. Risk factors for surgical site infection in cervico-facial oncological surgery. J Craniomaxillofac Surg 2012;40:443-448.
  5. Hirakawa H, Hasegawa Y, Hanai N, Ozawa T, Hyodo I, Suzuki M. Surgical site infection in clean-contaminated head and neck cancer surgery: risk factors and prognosis. Eur Arch Otorhinolaryngol 2013;270:1115-1123. https://doi.org/10.1007/s00405-012-2128-y
  6. Park SH, Choi SM, Lee DG, et al. Emergence of extended-spectrum $\beta$-lactamase-producing escherichia coli as a cause of community-onset bacteremia in South Korea: risk factors and clinical outcomes. Microb Drug Resist 2011;17:537-544. https://doi.org/10.1089/mdr.2011.0072
  7. Penel N, Lefebvre D, Fournier C, Sarini J, Kara A, Lefebvre JL. Risk factors for wound infection in head and neck cancer surgery: a prospective study. Head Neck 2001;23:447-455. https://doi.org/10.1002/hed.1058
  8. Penel N, Fournier C, Lefebvre D, Lefebvre JL. Multivariate analysis of risk factors for wound infection in head and neck squamous cell carcinoma surgery with opening of mucosa. Study of 260 surgical procedures. Oral Oncol 2005;41:294-303. https://doi.org/10.1016/j.oraloncology.2004.08.011
  9. Lotfi CJ, Cavalcanti Rde C, Costa e Silva AM, et al. Risk factors for surgical-site infections in head and neck cancer surgery. Otolaryngol Head Neck Surg 2008;138:74-80. https://doi.org/10.1016/j.otohns.2007.09.018
  10. Belusic-Gobic M, Car M, Juretic M, Cerovic R, Gobic D, Golubovic V. Risk factors for wound infection after oral cancer surgery. Oral Oncol 2007;43:77-81. https://doi.org/10.1016/j.oraloncology.2006.01.006
  11. Delgado-Rodriguez M, Mariscal-Ortiz M, Gomez-Ortega A, et al. Alcohol consumption and the risk of nosocomial infection in general surgery. Br J Surg 2003;90:1287-1293. https://doi.org/10.1002/bjs.4186
  12. Girod DA, McCulloch TM, Tsue TT, Weymuller EA Jr. Risk factors for complications in clean-contaminated head and neck surgical procedures. Head Neck 1995;17:7-13. https://doi.org/10.1002/hed.2880170103
  13. Kumar A, Carson JL. Perioperative anemia in the elderly. Clin Geriatr Med 2008;24:641-648. https://doi.org/10.1016/j.cger.2008.07.003
  14. Malone DL, Genuit T, Tracy JK, Gannon C, Napolitano LM. Surgical site infections: reanalysis of risk factors. J Surg Res 2002;103:89-95. https://doi.org/10.1006/jsre.2001.6343
  15. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999: Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999;20:250-278.
  16. Ogihara H, Takeuchi K, Majima Y. Risk factors of postoperative infection in head and neck surgery. Auris Nasus Larynx 2009;36:457-460. https://doi.org/10.1016/j.anl.2008.10.005
  17. Swift AC. Wound sepsis, chemoprophylaxis and major head and neck surgery. Clin Otolaryngol Allied Sci 1988;13:81-83. https://doi.org/10.1111/j.1365-2273.1988.tb00746.x
  18. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373-383. https://doi.org/10.1016/0021-9681(87)90171-8
  19. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:606-608. https://doi.org/10.1017/S0195941700015241
  20. Johnson JT, Myers EN, Thearle PB, Sigler BA, Schramm VL Jr. Antimicrobial prophylaxis for contaminated head and neck surgery. Laryngoscope 1984;94:46-51. https://doi.org/10.1002/lary.5540940111
  21. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999: Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 1999;27:97-132. https://doi.org/10.1016/S0196-6553(99)70088-X
  22. Roy MC, Perl TM. Basics of surgical-site infection surveillance. Infect Control Hosp Epidemiol 1997;18:659-668. https://doi.org/10.1086/647694
  23. Lee DH, Kim SY, Nam SY, Choi SH, Choi JW, Roh JL. Risk factors of surgical site infection in patients undergoing major oncological surgery for head and neck cancer. Oral Oncol 2011;47:528-531. https://doi.org/10.1016/j.oraloncology.2011.04.002
  24. Schwartz SR, Yueh B, Maynard C, Daley J, Henderson W, Khuri SF. Predictors of wound complications after laryngectomy: a study of over 2000 patients. Otolaryngol Head Neck Surg 2004;131:61-68. https://doi.org/10.1016/j.otohns.2003.08.028
  25. Shah JP, Haribhakti V, Loree TR, Sutaria P. Complications of the pectoralis major myocutaneous flap in head and neck reconstruction. Am J Surg 1990;160:352-355. https://doi.org/10.1016/S0002-9610(05)80541-0
  26. Lee JI, Kwon M, Roh JL, et al. Postoperative hypoalbuminemia as a risk factor for surgical site infection after oral cancer surgery. Oral Dis 2015;21:178-184. https://doi.org/10.1111/odi.12232
  27. Konishi T, Watanabe T, Kishimoto J, Nagawa H. Elective colon and rectal surgery differ in risk factors for wound infection: results of prospective surveillance. Ann Surg 2006;244:758-763. https://doi.org/10.1097/01.sla.0000219017.78611.49
  28. Elfenbein DM, Schneider DF, Chen H, Sippel RS. Surgical site infection after thyroidectomy: a rare but significant complication. J Surg Res 2014;190:170-176. https://doi.org/10.1016/j.jss.2014.03.033

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