Korean J Intern Med.  2016 Jan;31(1):162-169. 10.3904/kjim.2016.31.1.162.

Risk factors and etiology of surgical site infection after radical neck dissection in patients with head and neck cancer

• Park SY
• Kim MS
• Eom JS
• Lee JS
• Rho YS

• KMID: 2373785
• DOI: http://doi.org/10.3904/kjim.2016.31.1.162

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.

Keyword

Surgical site infection; Head and neck neoplasms; Microbiology

MeSH Terms

Aged
Bacteriological Techniques
Blood Loss, Surgical
Cardiovascular Diseases/complications
Chi-Square Distribution
Female
Head and Neck Neoplasms/*surgery
Humans
Incidence
Logistic Models
Male
Medical Records
Middle Aged
Multivariate Analysis
Neck Dissection/*adverse effects
Odds Ratio
Operative Time
Republic of Korea
Retrospective Studies
Risk Factors
Sex Factors
Surgical Wound Infection/diagnosis/epidemiology/*microbiology
Treatment Outcome