Sage Journals: Discover world-class research

Abstract

Objectives

To examine trend, prevalence, and outcomes of surgical site infection (SSI) in head and neck surgery.

Study Design

Retrospective cross-sectional analysis.

Setting

The Nationwide Readmissions Database (2010-2014), which represents 56.6% of all US hospitalization.

Subjects

Adult patients (≥18 years) who underwent head and neck surgery. Patients with SSI were compared with controls.

Methods

Analysis included chi-square test and multivariate logistic and linear regression models.

Results

A total of 427 cases and 116,921 controls were identified. SSI prevalence among patients who underwent head and neck surgery was 0.37%, of which 41.0% was reported within the initial admission while the remaining 59.0% was reported on readmission within 30 days of first surgery. SSI was associated with a higher mortality risk (odds ratio, 3.95; 95% CI, 1.25-12.50; P = .019). Multivariate analysis demonstrated that a higher risk of SSI was associated with major surgery of the ear, nose and paranasal sinuses, mouth and tonsil, salivary glands and ducts, maxillofacial bones and mandible, and pharynx and larynx (P < .05 each). However, a lower risk of SSI was reported in thyroid and parathyroid and nonmajor procedures (P < .05 each). Other factors associated with a higher risk of SSI included multiple comorbidities, smoking, cancer diagnosis, concomitant neck dissection, and tracheostomy (P < .05 each). SSI was associated with a mean ± SE additional hospital stay of 8.1 ± 0.8 days per case (P < .001) and an additional cost on the health system of $20,953.00 ± $186.3 per case (P < .001).

Conclusions

SSI is associated with a significant mortality risk and burden on the health system. More than half of SSI cases were identified on readmission.

Keywords

surgical site infection otolaryngology head and neck surgery prevalence outcome mortality risk length of stay health services cost

Get full access to this article

View all access options for this article.

References

Horan

Gaynes

Martone

Jarvis

Emori

TG.

CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13:606-608.

de Lissovoy

Fraeman

Hutchins

Murphy

Song

Vaughn

. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control. 2009;37:387-397.

Magill

Edwards

Bamberg

et al . Multistate point-prevalence survey of health care–associated infections. N Engl J Med. 2014;370:1198-1208.

Berrios-Torres

Umscheid

Bratzler

et al . Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152:784-791.

National Healthcare Safety Network, Centers for Disease Control and Prevention. Surgical site infection (SSI) event. https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. Updated 2018. Accessed July 26, 2018.

Abt

Sethi

Puram

Varvares

MA.

Preoperative laboratory data are associated with complications and surgical site infection in composite head and neck surgical resections. Am J Otolaryngol. 2018;39:261-265.

Ifeacho

Bajaj

Jephson

Albert

DM.

Surgical site infections in paediatric otolaryngology operative procedures. Int J Pediatr Otorhinolaryngol. 2012;76:1020-1022.

Lotfi

Cavalcanti Rde

Costa

Silva

et al . Risk factors for surgical-site infections in head and neck cancer surgery. Otolaryngol Head Neck Surg. 2008;138:74-80.

Lee

Kim

Nam

Choi

Roh

JL.

Risk factors of surgical site infection in patients undergoing major oncological surgery for head and neck cancer. Oral Oncol. 2011;47:528-531.

10.

O’Hara

Thom

Preas

MA.

Update to the Centers for Disease Control and Prevention and the Healthcare Infection Control Practices Advisory Committee guideline for the prevention of surgical site infection (2017): a summary, review, and strategies for implementation. Am J Infect Control. 2018;46:602-609.

11.

National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control. 2004;32:470-485.

12.

Edwards

Peterson

et al . National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control. 2009;37:783-805.

13.

Healthcare Cost and Utilization Project. Overview of the nationwide readmissions database (NRD). https://www.hcup-us.ahrq.gov/nrdoverview.jsp. Updated 2017.

14.

Bureau of Labor Statistics, US Department of Labor. Databases, tables and calculators by subject: consumer price index. http://www.bls.gov/data/. Updated 2016. Accessed September 18, 2016.

15.

Quan

Sundararajan

Halfon

et al . Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43:1130-1139.

16.

Emori

Culver

Horan

et al . National Nosocomial Infections Surveillance System (NNIS): description of surveillance methods. Am J Infect Control. 1991;19:19-35.

17.

Cloke

Green

Khan

Hodgkinson

McLean

NR.

Factors influencing the development of wound infection following free-flap reconstruction for intra-oral cancer. Br J Plast Surg. 2004;57:556-560.

18.

Cunha

Soares Melancia

Zagalo Fernandes Ribeiro

Almeida de Brito

Abreu Miguel

Andre Abreu Esteves Bogalhao do Casal

Risk factors for surgical site infection in cervico-facial oncological surgery. J Craniomaxillofac Surg. 2012;40:443-448.

19.

de Melo

Ribeiro

Kowalski

Deheinzelin

Risk factors for postoperative complications in oral cancer and their prognostic implications. Arch Otolaryngol Head Neck Surg. 2001;127:828-833.

20.

Girod

McCulloch

Tsue

Weymuller

Jr.

Risk factors for complications in clean-contaminated head and neck surgical procedures. Head Neck. 1995;17:7-13.

21.

Grandis

Snyderman

Johnson

D’Amico

Postoperative wound infection: a poor prognostic sign for patients with head and neck cancer. Cancer. 1992;70:2166-2170.

22.

Karakida

Aoki

Ota

et al . 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. 2010;16:334-339.

23.

Ogihara

Takeuchi

Majima

Risk factors of postoperative infection in head and neck surgery. Auris Nasus Larynx. 2009;36:457-460.

24.

Penel

Fournier

Lefebvre

JL.

Multivariate analysis of risk factors for wound infection in head and neck squamous cell carcinoma surgery with opening of mucosa: study of 260 surgical procedures. Oral Oncol. 2005;41:294-303.

25.

Robbins

Favrot

Hanna

Cole

Risk of wound infection in patients with head and neck cancer. Head Neck. 1990;12:143-148.

26.

Lepelletier

Ravaud

Baron

Lucet

JC.

Agreement among health care professionals in diagnosing case vignette–based surgical site infections. PLoS One. 2012;7:e35131.

27.

Park

Kim

Eom

Lee

Rho

YS.

Risk factors and etiology of surgical site infection after radical neck dissection in patients with head and neck cancer. Korean J Intern Med. 2016;31:162-169.

28.

Govaerts

Raemaekers

Verlinden

Kalai

Somers

Offeciers

FE.

Use of antibiotic prophylaxis in ear surgery. Laryngoscope. 1998;108:107-110.

29.

Patel

Jayawardena

ADL

Walden

Penn

Francis

DO.

Evidence-based use of perioperative antibiotics in otolaryngology. Otolaryngol Head Neck Surg. 2018;158:783-800.

30.

Funahara

Yanamoto

Ueda

et al . Prevention of surgical site infection after oral cancer surgery by topical tetracycline: results of a multicenter randomized control trial. Medicine (Baltimore). 2017;96(48):e8891.

31.

Coskun

Erisen

Basut

Factors affecting wound infection rates in head and neck surgery. Otolaryngol Head Neck Surg. 2000;123:328-333.

32.

Edwards

Horan

Berrios-Torres

Fridkin

SK.

Improving risk-adjusted measures of surgical site infection for the National Healthcare Safety Network. Infect Control Hosp Epidemiol. 2011;32:970-986.

33.

Bastier

Leroyer

Lasheras

Rogues

Darrouzet

Franco-Vidal

Early and late surgical site infections in ear surgery. Acta Otorhinolaryngol Ital. 2016;36:127-134.

34.

Lee

Kwon

Roh

et al . Postoperative hypoalbuminemia as a risk factor for surgical site infection after oral cancer surgery. Oral Dis. 2015;21:178-184.

35.

Umscheid

Mitchell

Doshi

Agarwal

Williams

Brennan

PJ.

Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol. 2011;32:101-114.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.02 MB

Surgical Site Infection in Head and Neck Surgery: A National Perspective

Abstract

Objectives

Study Design

Setting

Subjects

Methods

Results

Conclusions

Keywords

Get full access to this article

References

Supplementary Material