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Supportive Care in Cancer

Erschienen in:

26.11.2021 | Original Article

Risk factors for surgical site infection in head and neck cancer

verfasst von: Chengwen Gan, Yannan Wang, Yan Tang, Kai Wang, Bincan Sun, Mengxue Wang, Feiya Zhu

Erschienen in: Supportive Care in Cancer | Ausgabe 3/2022

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Abstract

Purpose

Surgical site infection (SSI) frequently occurs in patients with head and neck cancer (HNC) after tumor resection and can lead to death in severe cases. Moreover, there is no definitive conclusion about the risk factors of SSI. Therefore, it is of great clinical significance to study the factors affecting the SSI.

Methods

The HNC patients included in this study were all from the Department of Oral and Maxillofacial Surgery of the Second Xiangya Hospital of Central South University (CSU), and these patients received surgical treatment in the department from January 2018 to December 2019. The cross tabulation with chi-squared testing and multivariate regression analysis were applied to determine the risk factors of SSI. To identify the key risk factors of SSI, the caret package was used to construct three different machine learning models to investigate important features involving 26 SSI-related risk factors.

Results

Participants were 632 HNC patients who underwent surgery in our department from January 2018 to December 2019. During the postoperative period, 82 patients suffered from SSI, and surgical site infection rate (SSIR) was about 12.97%. Multivariate logistic regression analysis shows that diabetes mellitus, primary tumor site (floor of mouth), preoperative radiotherapy, flap failure, and neck dissection (bilateral) are risk factors for SSI of HNC. Machine learning indicated that diabetes mellitus, primary tumor site (floor of mouth), and flap failure were consistently ranked the top three in the 26 SSI-related risk factors.

Conclusion

Diabetes mellitus, primary tumor site (floor of mouth), flap failure, preoperative radiotherapy, and neck dissection (bilateral) are risk factors for SSI of HNC.

Son HJ, Roh JL, Choi SH, Nam SY, Kim SY (2018) Nutritional and hematologic markers as predictors of risk of surgical site infection in patients with head and neck cancer undergoing major oncologic surgery. Head Neck 40(3):596–604PubMedCrossRef

Akashi M, Furudoi S, Hashikawa K, Sakakibara A, Hasegawa T, Shigeta T, Minamikawa T, Komori T (2015) Postoperative abnormal response of C-reactive protein as an indicator for infectious complications after oral oncologic surgery with primary reconstruction. J Otolaryngol Head Neck Surg 44(1):1–5CrossRef

Cloke D, Green J, Khan A, Hodgkinson P, McLean N (2004) Factors influencing the development of wound infection following free-flap reconstruction for intra-oral cancer. Br J Plast Surg 57(6):556–560PubMedCrossRef

Lee JI, Kwon M, Roh JL, Choi J, Choi SH, Nam S, Kim S (2015) Postoperative hypoalbuminemia as a risk factor for surgical site infection after oral cancer surgery. Oral Dis 21(2):178–184PubMedCrossRef

Liu SA, Wong YK, Poon CK, Wang CC, Wang CP, Tung KC (2007) Risk factors for wound infection after surgery in primary oral cavity cancer patients. Laryngoscope 117(1):166–171PubMedCrossRef

Simons JP, Johnson JT, Yu VL, Vickers RM, Gooding WE, Myers EN, Pou AM, Wagner RL, Grandis JR (2001) The role of topical antibiotic prophylaxis in patients undergoing contaminated head and neck surgery with flap reconstruction. Laryngoscope 111(2):329–335PubMedCrossRef

Lotfi CJ, Cavalcanti RDC, Silva AMCE, Latorre MdRDdO, Kowalski LP (2008) Risk factors for surgical-site infections in head and neck cancer surgery. Otolaryngol Head Neck Surg 138(1):74–80PubMedCrossRef

Sato J, Goto J, Harahashi A, Murata T, Hata H, Yamazaki Y, Satoh A, Notani K-I, Kitagawa Y (2011) Oral health care reduces the risk of postoperative surgical site infection in inpatients with oral squamous cell carcinoma. Support Care Cancer 19(3):409–416PubMedCrossRef

Cunha TFS, Melancia TAS, Ribeiro CMZF, Brito JAAD, Miguel SSA, CasalDAAEBod (2012) Risk factors for surgical site infection in cervico-facial oncological surgery. J Cranio-Maxillofac Surg 40(5):443–448CrossRef

10.

Dong HL, Sang YK, Nam SY, Choi SH, Choi JW, Roh JL (2011) Risk factors of surgical site infection in patients undergoing major oncological surgery for head and neck cancer. Oral Oncol 47(6):528–531CrossRef

11.

Liu SA, Wong YK, Poon CK, Wang CC, Wang CP, Tung KC (2010) Risk factors for wound infection after surgery in primary oral cavity cancer patients. Laryngoscope 117(1):166–171CrossRef

12.

Ogihara H, Takeuchi K, Majima Y (2009) Risk factors of postoperative infection in head and neck surgery. Auris Nasus Larynx 36(4):457–460PubMedCrossRef

13.

Shi M, Han Z, Qin L, Su M, Liu Y, Li M, Cheng L, Huang X, Sun Z (2020) Risk factors for surgical site infection after major oral oncological surgery: the experience of a tertiary referral hospital in China. J Int Med Res 48(8):300060520944072PubMedCrossRef

14.

Busch C-J, Knecht R, Münscher A, Matern J, Dalchow C (2016) Postoperative antibiotic prophylaxis in clean-contaminated head and neck oncologic surgery: a retrospective cohort study. Eur Arch Oto-Rhino-Laryngol 273(9):2805–2811CrossRef

15.

Fusconi M, Gallo A, Vitiello C, Pagliuca G, Pulice G, de Vincentiis M (2006) Clean-contaminated neck surgery: risk of infection by intrinsic and extrinsic factors. Arch Otolaryngol Head Neck Surg 132(9):953PubMedCrossRef

16.

Coskun H, Erisen L, Basut O (2000) Factors affecting wound infection rates in head and neck surgery. Otolaryngol Head Neck Surg 123(3):328–333PubMedCrossRef

17.

Sepehr A, Santos BJG, Chou C, Karimi K, Devcic Z, Oels S, Armstrong WB (2009) Antibiotics in head and neck surgery in the setting of malnutrition, tracheotomy, and diabetes. Laryngoscope 119(3):549–553PubMedCrossRef

18.

Raikundalia MD, Fang CH, Spinazzi EF, Vazquez A, Park RC, Baredes S, Eloy JA (2016) Impact of diabetes mellitus on head and neck cancer patients undergoing surgery. Otolaryngol Head Neck Surg 154(2):294–299PubMedCrossRef

19.

Belusic-Gobic M, Zubovic A, Cerovic R, Dekanic A, Marzic D, Zamolo G (2018) Multivariate analysis of risk factors for postoperative wound infection following oral and oropharyngeal cancer surgery. J Cranio-Maxillofac Surg 46(1):135–141CrossRef

20.

Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, Reinke CE, Morgan S, Solomkin JS, Mazuski JE (2017) Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. Jama Surg

21.

Lotfi CJ, CavalcantiRde C, Costa e Silva AM, LatorreMdo R, Ribeiro Kde C, Carvalho AL, Kowalski LP (2008) Risk factors for surgical-site infections in head and neck cancer surgery. Otolaryngol Head Neck Surg 138(1):74–80PubMedCrossRef

22.

Mangram AJ, Horan TC, Pearson ML, Silver C, Jarvis WR (1999) Guideline for prevention of surgical site infection, 1999. Am J Infect Control 27(2)

23.

Yang L, Zhou M, Sherliker P, Cai Y, Peto R, Wang L, Millwood I, Smith M, Hu Y, Yang G (2012) Alcohol drinking and overall and cause-specific mortality in China: nationally representative prospective study of 220 000 men with 15 years of follow-up. Int J Epidemiol 41(4):1101–1113PubMedCrossRef

24.

Chen JH, Asch SM (2017) Machine learning and prediction in medicine - beyond the peak of inflated expectations. N Engl J Med 376(26):2507–2509PubMedPubMedCentralCrossRef

25.

Khitan Z, Jacob AD, Balentine C, Jacob AN, Sanabria JR, Shapiro JI (2018) Predicting adverse outcomes in end stage renal disease: machine learning applied to the United States Renal Data System. Marshall J Med 4(4):75CrossRef

26.

Zhou X, Han J, Zhen X, Liu Y, Cui Z, Yue Z, Ding L, Xu S (2020) Analysis of genetic alteration signatures and prognostic values of m6A regulatory genes in head and neck squamous cell carcinoma. Front Oncol 10:718PubMedPubMedCentralCrossRef

27.

Deist TM, Dankers F, Valdes G, Wijsman R, Hsu IC, Oberije C, Lustberg T, van Soest J, Hoebers F, Jochems A et al (2018) Machine learning algorithms for outcome prediction in (chemo)radiotherapy: an empirical comparison of classifiers. Med Phys 45(7):3449–3459PubMedCrossRef

28.

Tsai M-H, Chuang H-C, Lin Y-T, Lu H, Chen W-C, Fang F-M, Chien C-Y (2018) Clinical impact of albumin in advanced head and neck cancer patients with free flap reconstruction—a retrospective study. PeerJ 6:e4490PubMedPubMedCentralCrossRef

29.

Dort JC, Farwell DG, Findlay M, Huber GF, Kerr P, Shea-Budgell MA, Simon C, Uppington J, Zygun D, Ljungqvist O (2017) Optimal perioperative care in major head and neck cancer surgery with free flap reconstruction: a consensus review and recommendations from the enhanced recovery after surgery society. JAMA Otolaryngol Head Neck Surg 143(3):292–303PubMedCrossRef

30.

Wang Y, Wang M, Tang Y, Sun B, Wang K, Zhu F (2021) Perioperative mortality of head and neck cancers. BMC Cancer 21(1):1–9

31.

Girod DA, Mcculloch TM, Tsue TT, Weymuller EA (1995) Risk factors for complications in clean-contaminated head and neck surgical procedures. Head Neck 17(1)

32.

Jeffcoate WJ, Price P, Harding KG (2004) Wound healing and treatments for people with diabetic foot ulcers. Diabetes Metab Res Rev 20(S1):S78–S89PubMedCrossRef

33.

Knapp S (2013) Diabetes and infection: is there a link?-A mini-review. Gerontology 59(2):99–104PubMedCrossRef

34.

Cooley BC, Hanel DP, Anderson RB, Foster MD, Gould JS (1992) The influence of diabetes on free flap transfer: I. Flap survival and microvascular healing. Ann Plast Surg 29(1):58–64PubMedCrossRef

35.

Rosado P, Cheng HT, Wu CM, Wei FC, Eisele DW (2015) Influence of diabetes mellitus on postoperative complications and failure in head and neck free flap reconstruction: a systematic review and meta-analysis. Head Neck 37(4):615–618PubMedCrossRef

36.

(2004) Previous chemotherapy as a predictor of wound infections in nonmajor head and neck surgery: results of a prospective study. Head Neck 26(6):513

37.

Robbins KT, Favrot S, Hanna D, Cole R (1990) Risk of wound infection in patients with head and neck cancer. Head Neck 12(2):143–148PubMedCrossRef

38.

Dormand EL, Banwell PE, Goodacre TE (2010) Radiotherapy and wound healing. Int Wound J 2(2):112–127CrossRef

39.

Lee M, Chin RY, Eslick GD, Sritharan N, Paramaesvaran S (2015) Outcomes of microvascular free flap reconstruction for mandibular osteoradionecrosis: a systematic review. J Craniomaxillofac Surg 43(10):2026–2033PubMedCrossRef

40.

Sugita S, Hozumi T, Yamakawa K, Goto T, Kondo T (2016) Risk factors for surgical site infection after posterior fixation surgery and intraoperative radiotherapy for spinal metastases. Eur Spine J 25(4):1034–1038PubMedCrossRef

41.

Mijiti A, Kuerbantayi N, Zhang ZQ, Su MY, Zhang XH, Huojia M (2020) Influence of preoperative radiotherapy on head and neck free-flap reconstruction: systematic review and meta-analysis. Head Neck 42(8):2165–2180PubMedCrossRef

42.

Sokoya M, Bahrami A, Vincent A, Kadakia S, Inman J, Saman M, Ducic Y (2018) Preoperative radiation and complication rates after double free flap reconstruction of head and neck cancer. Am J Otolaryngol 39(5):558–560PubMedCrossRef

43.

Hideo S, Kouji O, Masaaki T (2015) Risk factors for postoperative complications following oral surgery. J Appl Oral Sci Rev Fob 23(4):419–423CrossRef

44.

Karakida K, Aoki T, Ota Y, Yamazaki H, Otsuru M, Takahashi M, Sakamoto H, Miyasaka M (2010) Analysis of risk factors for surgical-site infections in 276 oral cancer surgeries with microvascular free-flap reconstructions at a single university hospital. J Infect Chemother 16(5):334–339PubMedCrossRef

45.

Goyal N, Yarlagadda BB, Deschler DG, Emerick KS, Lin DT, Rich DL, Rocco JW, Durand ML (2017) Surgical site infections in major head and neck surgeries involving pedicled flap reconstruction. Ann Otol Rhinol Laryngol 126(1):20–28PubMedCrossRef

46.

Cannon RB, Houlton JJ, Mendez E, Futran ND (2017) Methods to reduce postoperative surgical site infections after head and neck oncology surgery. Lancet Oncol 18(7):e405–e413PubMedCrossRef

47.

Yang CH, Chew KY, Solomkin JS, Lin PY, Chiang YC, Kuo YR (2013) Surgical site infections among high-risk patients in clean-contaminated head and neck reconstructive surgery: concordance with preoperative oral flora. Ann Plast Surg 71(Suppl 1):S55-60PubMedCrossRef

48.

Durand ML, Yarlagadda BB, Rich DL, Lin DT, Emerick KS, Rocco JW, Deschler DG (2015) The time course and microbiology of surgical site infections after head and neck free flap surgery. Laryngoscope 125(5):1084–1089PubMedCrossRef

49.

Orabona GD, Corvino R, Maglitto F, Abbate V, Bonavolontà P, Romano A, Salzano G, Califano L (2018) Infective complications after free flaps reconstruction in patients affected by head and neck cancer Our experience on 77 cases. Ann Ital Chir 89:62–65PubMed

50.

Veve MP, Davis SL, Williams AM, McKinnon JE, Ghanem TA (2017) Considerations for antibiotic prophylaxis in head and neck cancer surgery. Oral Oncol 74:181–187PubMedCrossRef

Titel: Risk factors for surgical site infection in head and neck cancer
verfasst von: Chengwen Gan
Yannan Wang
Yan Tang
Kai Wang
Bincan Sun
Mengxue Wang
Feiya Zhu
Publikationsdatum: 26.11.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: Supportive Care in Cancer / Ausgabe 3/2022
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-021-06687-8

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Risk factors for surgical site infection in head and neck cancer