Surgical Site Infection After Primary Open Surgery for Laryngeal Cancer in a Tertiary Hospital in Belgrade, Serbia: A 10-Year Prospective Cohort Study

Overview

Journal Antibiotics (Basel)

Specialty Pharmacology

Date 2024 Oct 25

PMID 39452185

Authors

Jelena Sotirovic

Nemanja Rancic

Ljubomir Pavicevic

Nenad Baletic

Aleksandar Dimic

Ognjen cukic

Aleksandar Peric

Milanko Milojevic

Nenad Ljubenovic

Darko Milosevic

Vesna Suljagic

Affiliations

Soon will be listed here.

Abstract

Background: Surgical site infection (SSI) in laryngeal cancer (LC) patients significantly increases morbidity and may postpone adjuvant therapy. Additionally, SSI can prolong hospitalization, thus representing a burden for the healthcare system. Most of the published studies refer to SSI after salvage laryngectomy.

Methods: The present prospective cohort study aimed to clarify the incidence and factors associated with SSI in patients after primary open surgery for LC. Through regular hospital surveillance of patients who underwent primary partial or total laryngectomy, we gathered 24 putative factors and identified SSI from 2013 to 2022. Patients with SSI were compared with patients without SSI.

Results: SSI was observed in 21 (6.6%) of 319 patients. ULRA showed that the occurrence of SSI was significantly associated with the American Society of Anesthesiologists (ASA) score, other postoperative healthcare-associated (HAI) infection, T classification, N classification, advanced clinical stage (III-IV), length of stay (LOS), duration of drainage, and the National Healthcare Safety Network (NHSN) risk index. Multivariate logistic regression analysis identified two independent factors associated with SSI occurring in these patients: duration of drainage (RR (relative risk) 1.593; 95% CI 1.159-2.189; = 0.004) and LOS (RR: 1.074; 95% CI: 1.037-1.112; < 0.001).

Conclusions: Our study provided insight into the burden of SSI in LC patients, highlighting several priority areas and targets for quality improvement.

References

Cirkovic I, Markovic-Denic L, Bajcetic M, Dragovac G, dordevic Z, Mioljevic V . Microbiology of Healthcare-Associated Infections: Results of a Fourth National Point Prevalence Survey in Serbia. Antibiotics (Basel). 2022; 11(9). PMC: 9495255. DOI: 10.3390/antibiotics11091161. View

Vander Poorten V, Uyttebroek S, Robbins K, Rodrigo J, de Bree R, Laenen A . Perioperative Antibiotics in Clean-Contaminated Head and Neck Surgery: A Systematic Review and Meta-Analysis. Adv Ther. 2020; 37(4):1360-1380. PMC: 7140756. DOI: 10.1007/s12325-020-01269-2. View

Seneviratne S, Hoffman G, Varadhan H, Kitcher J, Cope D . Does microbial colonisation of a neck drain predispose to surgical site infection: clean vs clean-contaminated procedures. Eur Arch Otorhinolaryngol. 2018; 275(5):1249-1255. DOI: 10.1007/s00405-018-4921-8. View

Langerman A, Ham S, Pisano J, Pariser J, Hohmann S, Meltzer D . Laryngectomy Complications Are Associated with Perioperative Antibiotic Choice. Otolaryngol Head Neck Surg. 2015; 153(1):60-8. DOI: 10.1177/0194599815583641. View

Weber R, Berkey B, Forastiere A, Cooper J, Maor M, Goepfert H . Outcome of salvage total laryngectomy following organ preservation therapy: the Radiation Therapy Oncology Group trial 91-11. Arch Otolaryngol Head Neck Surg. 2003; 129(1):44-9. DOI: 10.1001/archotol.129.1.44. View

Horan T, Gaynes R, Martone W, Jarvis W, Emori T . CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992; 13(10):606-8. View

Nassar A . Mapping the Risk Factors of Pharyngocutaneous Fistula After Salvage Laryngectomies. Indian J Otolaryngol Head Neck Surg. 2023; 74(Suppl 3):5954-5958. PMC: 9895164. DOI: 10.1007/s12070-021-02603-y. View

Veve M, Davis S, Williams A, McKinnon J, Ghanem T . Considerations for antibiotic prophylaxis in head and neck cancer surgery. Oral Oncol. 2017; 74:181-187. DOI: 10.1016/j.oraloncology.2017.09.011. View

Ogihara H, Takeuchi K, Majima Y . Risk factors of postoperative infection in head and neck surgery. Auris Nasus Larynx. 2008; 36(4):457-60. DOI: 10.1016/j.anl.2008.10.005. View

10.

Lee J, Baek M, Choi S, Kwon S, Kim K, Park S . Retrospective analysis of culture-negative versus culture-positive postoperative spinal infections. Medicine (Baltimore). 2018; 97(20):e10643. PMC: 5976297. DOI: 10.1097/MD.0000000000010643. View

11.

Park S, Kim M, Eom J, Lee J, Rho Y . Risk factors and etiology of surgical site infection after radical neck dissection in patients with head and neck cancer. Korean J Intern Med. 2016; 31(1):162-9. PMC: 4712421. DOI: 10.3904/kjim.2016.31.1.162. View

12.

Dormand E, Banwell P, Goodacre T . Radiotherapy and wound healing. Int Wound J. 2006; 2(2):112-27. PMC: 7951225. DOI: 10.1111/j.1742-4801.2005.00079.x. View

13.

Sotirovic J, Suljagic V, Baletic N, Pavicevic L, Bijelic D, Erdoglija M . Risk factors for surgical site infection in laryngeal cancer surgery. Acta Clin Croat. 2015; 54(1):57-64. View

14.

Skitarelic N, Morovic M, Manestar D . Antibiotic prophylaxis in clean-contaminated head and neck oncological surgery. J Craniomaxillofac Surg. 2007; 35(1):15-20. DOI: 10.1016/j.jcms.2006.10.006. View

15.

Wang Y, Wang M, Tang Y, Sun B, Wang K, Zhu F . Perioperative mortality of head and neck cancers. BMC Cancer. 2021; 21(1):256. PMC: 7941918. DOI: 10.1186/s12885-021-07998-z. View

16.

Rock C, Thom K, Masnick M, Johnson J, Harris A, Morgan D . Frequency of Klebsiella pneumoniae carbapenemase (KPC)-producing and non-KPC-producing Klebsiella species contamination of healthcare workers and the environment. Infect Control Hosp Epidemiol. 2014; 35(4):426-9. PMC: 4030386. DOI: 10.1086/675598. View

17.

Al-Qurayshi Z, Walsh J, Owen S, Kandil E . Surgical Site Infection in Head and Neck Surgery: A National Perspective. Otolaryngol Head Neck Surg. 2019; 161(1):52-62. DOI: 10.1177/0194599819832858. View

18.

Fitzmaurice C, Allen C, Barber R, Barregard L, Bhutta Z, Brenner H . Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-years for 32 Cancer Groups, 1990 to 2015: A Systematic Analysis for the Global Burden of Disease Study. JAMA Oncol. 2016; 3(4):524-548. PMC: 6103527. DOI: 10.1001/jamaoncol.2016.5688. View

19.

Gan C, Wang Y, Tang Y, Wang K, Sun B, Wang M . Risk factors for surgical site infection in head and neck cancer. Support Care Cancer. 2021; 30(3):2735-2743. DOI: 10.1007/s00520-021-06687-8. View

20.

Ramos-Zayas A, Lopez-Medrano F, Urquiza-Fornovi I, Zubillaga I, Gutierrez R, Sanchez-Aniceto G . The Impact of Healthcare-Associated Infections in Patients Undergoing Oncological Microvascular Head and Neck Reconstruction: A Prospective Multicentre Study. Cancers (Basel). 2021; 13(9). PMC: 8123773. DOI: 10.3390/cancers13092109. View