A Predictive Model for Wound Sepsis in Oncologic Surgery of the Head and Neck

Abstract

A prospective analysis of patients undergoing surgical resection of squamous cell carcinoma of the upper aerodigestive tract was performed in order to identify the patients at risk of postoperative wound infection and to develop a model predictive of wound infection. Fifty-nine patients who underwent extirpative clean-contaminated procedures--all of whom received cefazolin as the sole chemoprophylactic agent, were studied over a 1-year period. Twenty-three variables were recorded for each patient in the study. The overall rate of wound infection was 25.4%. Univariate analysis indicated that three variables were significantly related to the likelihood of postoperative wound infection. These included tumor stage (P = 0.0180), nodal stage (P = 0.0062), and duration of surgery (P = 0.0151). The Biomedical Computer Program (BMDP), a logistic regression program specifically designed for a binary dependent variable (infection vs. no infection) based on independent variables that may be continuous or categorical, was used in development of a model predictive of wound infection. T-stage, N-stage, and the presence of concomitant disease made up the combination of factors found to be most predictive of infection in our study population. Considering "success" to be the development of infection if the probability was 75% or higher, and the absence of infection if the probability was less than 25%, the multiple regression analysis model demonstrated a predictive success rate of 74.6%. Our results indicate that the risk of infection in patients undergoing clean-contaminated oncologic surgery of the head and neck is greatest for patients who have advanced disease that requires prolonged surgery in the presence of concomitant diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

Risk factors for wound infection in head and neck cancer surgery: A prospective study

“…In our study we could not correctly assess the nutritional status of our patients. Unlike our study, Cole et al 20 noted a tendency toward infection in patients with tobacco history. Like Clayman et al 21 and Doerr et al, 22 we did not find increased WI rates after preoperative edentulation.…”

“…In previous stud- ies, duration of the operation was a risk factor. 6,20,37 On the contrary, we found no correlation between WI risk and the length of the procedure. In several studies, 6,15,16 flap reconstruction, especially with major pectoralis myocutaneous flap, was linked to WI.…”

“…We found, like Cole et al, 20 that the presence of laryngectomy stoma increased the risk for WI. The presence of a permanent tracheostomy may have led to colonization of the wound and favored infection persistence (infection on foreign body).…”

Prognostic significance of wound infections following major head and neck cancer surgery: an open non-comparative prospective study

“…The management and prevention of WI are real issues in perioperative care in head and neck cancer surgery. Because WI have been found to occur in up to 15% of patients despite antibiotic prophylaxis in all recent prospective studies [1,2,4,5,6,8,9,10,11,12,17,18,19,22,23,25,27,28,31,33,34], we must consider that major head and neck cancer surgery with opening of the upper aerodigestive tract is contaminated or dirty surgery [7]. Postoperative WI tend to be polymicrobial with mixed aerobic and anaerobic flora [3,9,13].…”

“…However, in our experience nutritional parameters (weight loss, body mass index, prealbumin and albumin levels) were not associated with risk for WI. Cole et al [5] found that the presence of laryngectomy stoma is also significant. It has been stated that the existence of a stoma preoperatively may lead to colonization of secretions and infection [30].…”