Surgical and remote site infections after reconstructive surgery of the head and neck: A risk factor analysis
Introduction
Flap reconstruction after extensive ablative surgery in the head an neck area has been successfully established and extended over the last decades (Meier et al., 2019; Kainulainen et al., 2020). Despite further improvement there is, however, a wide field of factors that can create serious post-operative complications. Alongside pneumonia, surgical site infections (SSI) have up to 40% prevalence among the most common health-care associated infections and have a significant impact on the patient's morbidity and the health system (de Lissovoy et al., 2009; Magill et al., 2014; Abt et al., 2018; Ramos-Zayas et al., 2021). As head and neck surgery and patient clientele become more complex, it is important to identify and stratify variables that contribute to surgical and remote site infections and to develop strategies that support patients' convalescence in maxillofacial surgery (Cannonet al., 2017). Among others, extended operation times, high ASA scores and certain antibiotic regimens have been investigated for their influence on the development of surgical site infections in literature (Karakida et al., 2010; Kamizono et al., 2014; Goyal et al., 2017; Qiu et al., 2019). Nevertheless, exact mechanisms remain unclear. In this study the authors elaborate risk factors that may contribute to the development of postoperative infections. For this purpose, patient related data, as well as therapeutic procedures in patients who had undergone reconstructive flap surgery in the head and neck area were analysed. Pathogens were isolated from site of infection and antibiotic resistance patterns were identified.
Section snippets
Patients and treatment
The records of patients who received flap reconstruction in the department of Oral and Maxillofacial Surgery at the University Hospital of Regensburg, Germany, between January 14ths 2016 and December 13th, 2018 were evaluated.
In routine ablative and/or reconstructive flap surgery amoxicillin/clavulanic acid 2/0.2g or ampicillin/sulbactam acid 2/1g were used as first choice (89.2%) for calculated intravenous antibiotic prophylaxis. First dose was given at the beginning of surgery and repeated
Results
The study included 157 patients, 99 male and 58 female who received flap reconstruction in the head and neck area. The observed period extends from January 2016 to December 2018. Average age was 63.27 years (range 26–89 years). See Table 1.
Discussion
As soon as oropharyngeal or digestive tract mucosa is breached, surgery is classified as clean-contaminated by the Centers for Disease Control and Prevention (CDC) (Horan et al., 1992). After oral cancer surgery, surgical sites are subjected to saliva and secretion (Al-Qurayshi et al., 2019; Centers for Disease Control and Prevention and National Healthcare Safety Network, 2021). However, the incidence of surgical site infections (SSI) after reconstructive surgery ranges between 20% and 40% in
Conclusion
Multivariate analysis in this study revealed autologous blood transfusion and length of stay on intensive care unit to be associated with surgical and overall infection risk. Prior radiation and clindamycin application are risk factors for surgical site infections after clean-contaminated surgery while poor ASA score is a predictor for remote site infections. Bacterial spectrum found in SSI differs from normal oral flora, emphasizing Enterobacteriaceae and gram-negative strains with high
Ethics
The study was conducted under approval of the local Ethical Committee (Nr: 18-1131-104) and conducted in accordance with the ethical standards of the declaration of Helsinki.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Declaration of competing interest
None.
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