Ana Ramos-Zayas1, Francisco López-Medrano2, Irene Urquiza-Fornovi1, Ignacio Zubillaga1, Ramón Gutiérrez1, Gregorio Sánchez-Aniceto1, Julio Acero3, Fernando Almeida3, Ana Galdona3, María José Morán4, Marta Pampin4, José Luis Cebrián4. 1. Oral and Maxillofacial Surgery Department, "12 de Octubre" University Hospital, Institute for Biomedical Research (i+12), Universidad Complutense, 28041 Madrid, Spain. 2. Unit of Infectious Diseases, "12 de Octubre" University Hospital, Institute for Biomedical Research (i+12), Department of Medicine, School of Medicine, Universidad Complutense, 28041 Madrid, Spain. 3. Oral and Maxillofacial Surgery Department, "Ramón y Cajal" University Hospital, Institute for Biomedical Research IRYCIS, Universidad de Alcalá, 28034 Madrid, Spain. 4. Oral and Maxillofacial Surgery Department, "La Paz" University Hospital, Institute for Biomedical Research IdiPAZ, Universidad Autónoma, 28046 Madrid, Spain.
Abstract
(1) Background: Healthcare-associated infections (HAIs) after head and neck free-flap reconstruction are a common postoperative complication. Risk factors for HAIs in this context and their consequences have not been adequately described. (2) Methods: Ongoing prospective multicentre study between 02/2019 and 12/2020. Demographic characteristics and outcomes were analysed, focusing on infections. (3) Results: Forty out of 65 patients (61.54%) suffered HAIs (surgical site infection: 52.18%, nosocomial pneumonia: 23.20%, bloodstream infection: 13% and urinary tract infection: 5.80%). Methicillin-resistant Staphylococcus aureus (MRSA) and resistant Pseudomonas aeruginosa, Klebsiella pneumoniae and Enterobacter cloacae were the most frequently implicated. The significant risk factors for infection were: previous radiotherapy (Odds ratio (OR): 5.42; 95% confidence interval (CI), 1.39-21.10), anaemia (OR: 8.00; 95% CI, 0.96-66.95), salvage surgery (eight out of eight patients), tracheostomy (OR: 2.86; 95% CI, 1.01-8.14), surgery duration (OR: 1.01; 95% CI, 1.00-1.02), microvascular reoperation <72 h (eight/eight) and flap loss (eight/eight). The major surgical complications were: a need to reoperate (OR: 6.89; 95% CI, 1.42-33.51), prolonged hospital admission (OR: 1.16; 95% CI, 1.06-1.27) and delay in the initiation of postoperative radiotherapy (OR: 9.07; 95% CI, 1.72-47.67). The sixth month mortality rate in patients with HAIs was 7.69% vs. 0% in patients without HAIs (p = 0.50). (4) Conclusions: HAIs were common after this type of surgery, many of them caused by resistant microorganisms. Some modifiable risk factors were identified. Infections played a role in cancer prognosis by delaying adjuvant therapy.
(1) Background: Healthcare-associated infections (HAIs) after head and neck free-flap reconstruction are a common postoperative complication. Risk factors for HAIs in this context and their consequences have not been adequately described. (2) Methods: Ongoing prospective multicentre study between 02/2019 and 12/2020. Demographic characteristics and outcomes were analysed, focusing on infections. (3) Results: Forty out of 65 patients (61.54%) suffered HAIs (surgical site infection: 52.18%, nosocomial pneumonia: 23.20%, bloodstream infection: 13% and urinary tract infection: 5.80%). Methicillin-resistant Staphylococcus aureus (MRSA) and resistant Pseudomonas aeruginosa, Klebsiella pneumoniae and Enterobacter cloacae were the most frequently implicated. The significant risk factors for infection were: previous radiotherapy (Odds ratio (OR): 5.42; 95% confidence interval (CI), 1.39-21.10), anaemia (OR: 8.00; 95% CI, 0.96-66.95), salvage surgery (eight out of eight patients), tracheostomy (OR: 2.86; 95% CI, 1.01-8.14), surgery duration (OR: 1.01; 95% CI, 1.00-1.02), microvascular reoperation <72 h (eight/eight) and flap loss (eight/eight). The major surgical complications were: a need to reoperate (OR: 6.89; 95% CI, 1.42-33.51), prolonged hospital admission (OR: 1.16; 95% CI, 1.06-1.27) and delay in the initiation of postoperative radiotherapy (OR: 9.07; 95% CI, 1.72-47.67). The sixth month mortality rate in patients with HAIs was 7.69% vs. 0% in patients without HAIs (p = 0.50). (4) Conclusions: HAIs were common after this type of surgery, many of them caused by resistant microorganisms. Some modifiable risk factors were identified. Infections played a role in cancer prognosis by delaying adjuvant therapy.
Entities:
Keywords:
antibiotic prophylaxis; free flaps; head and neck surgery; healthcare-associated infections; osteoradionecrosis; reconstructive surgery; resistant microorganisms; surgical site infection
Authors: A Weyh; R Nocella; M Abdelmalik; R Pucci; A Quimby; A Bunnell; R Fernandes Journal: Int J Oral Maxillofac Surg Date: 2020-05-29 Impact factor: 2.789