Ahmed Sam Beydoun1, Kevin Koss1, Tyson Nielsen2, Andrew James Holcomb2, Priscilla Pichardo3, Nicholas Purdy3, Aaron L Zebolsky4, Chase M Heaton4, Caitlin P McMullen5, Jessica A Yesensky6, Michael G Moore6, Neerav Goyal7, Joshua Kohan8, Mirabelle Sajisevi8, Kenneth Tan9, Daniel Petrisor9, Mark K Wax9, Alexandra E Kejner10, Zain Hassan10, Skylar Trott10, Andrew Larson11, Jeremy D Richmon11, Evan M Graboyes12, C Burton Wood13, Ryan S Jackson14, Patrik Pipkorn14, Jennifer Bruening1, Becky Massey1, Sidharth V Puram14, Joseph Zenga1. 1. Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee. 2. Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, Omaha, Nebraska. 3. Department of Otolaryngology-Head & Neck Surgery, Geisinger Medical Center, Danville, Pennsylvania. 4. Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco. 5. Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida. 6. Department of Surgery, Indiana University School of Medicine, Indianapolis. 7. Department of Otolaryngology-Head and Neck Surgery, Penn State College of Medicine, Hershey, Pennsylvania. 8. Division of Otolaryngology, Department of Surgery, University of Vermont Medical Center, Burlington. 9. Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland. 10. Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington. 11. Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston. 12. Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston. 13. Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis. 14. Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri.
Abstract
Importance: Surgical site infections (SSIs) after vascularized reconstruction of the upper aerodigestive tract (UADT) are associated with considerable morbidity. The association between perioperative prophylaxis practices, particularly topical antisepsis, and SSIs remains uncertain. Objective: To assess the association between perioperative topical antisepsis and SSIs in patients undergoing vascularized reconstruction of the UADT. Design, Setting, and Participants: This cohort study included patients from 12 academic tertiary care centers over an 11-month period, from July 1, 2020, to June 1, 2021. Patients undergoing open surgical procedures requiring a communication between the UADT and cervical skin with a planned regional pedicled flap, free flap, or both were included. Patients with an active infection at the time of surgical procedure were excluded. Main Outcomes and Measures: The primary outcome measure was an SSI within 30 days of surgery. The association of demographic characteristics, perioperative antibiotic prophylaxis, surgical technique, and postoperative care with SSIs was assessed using univariable and multivariable analyses. The relative risk ratio and 95% CIs for developing SSI were calculated for each of the variables based on predetermined categories. Variables for which the relative risk 95% CI did not include the value of zero effect (relative risk = 1.00) were included in the multivariable model. Results: A total of 554 patients (median age, 64 years; range, 21-95 years; 367 men [66.2%]) were included. Cancer ablation was the most frequent reason for surgery (n = 480 [86.6%]). Overall, the SSI rate was 20.9% (n = 116), with most infections involving the head and neck surgical site only (91 [78.4%]). The median time to SSI diagnosis was 11 days (range, 1-28 days). Topical antisepsis mucosal preparation was performed preoperatively in 35.2% (195) and postoperatively in 52.2% (289) of cases. Ampicillin and sulbactam was the most common systemic antibiotic prophylaxis agent used (n = 367 [66.2%]), with 24 hours being the most common duration (n = 363 [65.5%]). On multivariable analysis, preoperative topical antisepsis mucosal preparation (odds ratio [OR], 0.49; 95% CI, 0.30-0.77) and systemic prophylaxis with piperacillin and tazobactam (OR, 0.42; 95% CI, 0.21-0.84) were associated with a decreased risk of a postoperative SSI. The use of an osseous vascularized flap was associated with an increased risk of postoperative SSI (OR, 1.76; 95% CI, 1.13-2.75). Conclusions and Relevance: Findings of this study suggest that preoperative topical antisepsis mucosal preparation was independently associated with a decreased risk of SSIs in a 12-center multi-institutional cohort. Further investigation of the association between individual perioperative practices and the incidence of postoperative SSIs is necessary to develop evidence-based protocols to reduce SSIs after UADT reconstruction.
Importance: Surgical site infections (SSIs) after vascularized reconstruction of the upper aerodigestive tract (UADT) are associated with considerable morbidity. The association between perioperative prophylaxis practices, particularly topical antisepsis, and SSIs remains uncertain. Objective: To assess the association between perioperative topical antisepsis and SSIs in patients undergoing vascularized reconstruction of the UADT. Design, Setting, and Participants: This cohort study included patients from 12 academic tertiary care centers over an 11-month period, from July 1, 2020, to June 1, 2021. Patients undergoing open surgical procedures requiring a communication between the UADT and cervical skin with a planned regional pedicled flap, free flap, or both were included. Patients with an active infection at the time of surgical procedure were excluded. Main Outcomes and Measures: The primary outcome measure was an SSI within 30 days of surgery. The association of demographic characteristics, perioperative antibiotic prophylaxis, surgical technique, and postoperative care with SSIs was assessed using univariable and multivariable analyses. The relative risk ratio and 95% CIs for developing SSI were calculated for each of the variables based on predetermined categories. Variables for which the relative risk 95% CI did not include the value of zero effect (relative risk = 1.00) were included in the multivariable model. Results: A total of 554 patients (median age, 64 years; range, 21-95 years; 367 men [66.2%]) were included. Cancer ablation was the most frequent reason for surgery (n = 480 [86.6%]). Overall, the SSI rate was 20.9% (n = 116), with most infections involving the head and neck surgical site only (91 [78.4%]). The median time to SSI diagnosis was 11 days (range, 1-28 days). Topical antisepsis mucosal preparation was performed preoperatively in 35.2% (195) and postoperatively in 52.2% (289) of cases. Ampicillin and sulbactam was the most common systemic antibiotic prophylaxis agent used (n = 367 [66.2%]), with 24 hours being the most common duration (n = 363 [65.5%]). On multivariable analysis, preoperative topical antisepsis mucosal preparation (odds ratio [OR], 0.49; 95% CI, 0.30-0.77) and systemic prophylaxis with piperacillin and tazobactam (OR, 0.42; 95% CI, 0.21-0.84) were associated with a decreased risk of a postoperative SSI. The use of an osseous vascularized flap was associated with an increased risk of postoperative SSI (OR, 1.76; 95% CI, 1.13-2.75). Conclusions and Relevance: Findings of this study suggest that preoperative topical antisepsis mucosal preparation was independently associated with a decreased risk of SSIs in a 12-center multi-institutional cohort. Further investigation of the association between individual perioperative practices and the incidence of postoperative SSIs is necessary to develop evidence-based protocols to reduce SSIs after UADT reconstruction.
Authors: Dale W Bratzler; E Patchen Dellinger; Keith M Olsen; Trish M Perl; Paul G Auwaerter; Maureen K Bolon; Douglas N Fish; Lena M Napolitano; Robert G Sawyer; Douglas Slain; James P Steinberg; Robert A Weinstein Journal: Surg Infect (Larchmt) Date: 2013-03-05 Impact factor: 2.150
Authors: Corinna Wicke; Andreas Bachinger; Stephan Coerper; Stefan Beckert; Maria B Witte; Alfred Königsrainer Journal: Wound Repair Regen Date: 2009 Jan-Feb Impact factor: 3.617
Authors: Vincent Vander Poorten; Saartje Uyttebroek; K Thomas Robbins; Juan P Rodrigo; Remco de Bree; Annouschka Laenen; Nabil F Saba; Carlos Suarez; Antti Mäkitie; Alessandra Rinaldo; Alfio Ferlito Journal: Adv Ther Date: 2020-03-05 Impact factor: 3.845