Surgical prophylaxis with gram-negative activity for reduction of surgical site infections after microvascular reconstruction for head and neck cancer

Objective To characterize and identify risk factors for 30-day surgical site infections (SSIs) in patients with head and neck cancer who underwent microvascular reconstruction. Study Design Cross-sectional study with nested case-control design. Setting Nine American tertiary care centers. Subjects and Methods Hospitalized patients were included if they underwent head and neck cancer microvascular reconstruction from January 2003 to March 2016. Cases were defined as patients who developed 30-day SSI; controls were patients without SSI at 30 days. Postoperative antibiotic prophylaxis (POABP) regimens were categorized by Gram-negative (GN) spectrum: no GN coverage, enteric GN coverage, and enteric with antipseudomonal GN coverage. All POABP regimens retained activity against anaerobes and Gram-positive bacteria. Thirty-day prevalence of and risk factors for SSI were evaluated. Results A total of 1307 patients were included. Thirty-day SSI occurred in 189 (15%) patients; median time to SSI was 11.5 days (interquartile range, 7-17). Organisms were isolated in 59% of SSI; methicillin-resistant Staphylococcus aureus (6%) and Pseudomonas aeruginosa (9%) were uncommon. A total of 1003 (77%) patients had POABP data: no GN (17%), enteric GN (52%), and antipseudomonal GN (31%). Variables independently associated with 30-day SSI were as follows: female sex (adjusted odds ratio [aOR], 1.6; 95% CI, 1.1-2.2), no GN POABP (aOR, 2.2; 95% CI, 1.5-3.3), and surgical duration ≥11.8 hours (aOR, 1.9; 95% CI, 1.3-2.7). Longer POABP durations (≥6 days) or antipseudomonal POABP had no association with SSI. Conclusions POABP without GN coverage was significantly associated with SSI and should be avoided. Antipseudomonal POABP or longer prophylaxis durations (≥6 days) were not protective against SSI. Antimicrobial stewardship interventions should be made to limit unnecessary antibiotic exposures, prevent the emergence of resistant organisms, and improve patient outcomes.

Download Full-text

Faculty Opinions recommendation of Patient-Reported Aesthetic and Psychosocial Outcomes After Microvascular Reconstruction for Head and Neck Cancer.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.740517857.793587958 ◽

2021 ◽

Author(s):

Giulio Cantu

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Psychosocial Outcomes ◽

Microvascular Reconstruction ◽

Patient Reported

Download Full-text

Third Repeat Microvascular Reconstruction in Head and Neck Cancer Patients Aged 65 Years and Older: A Longitudinal and Sequential Analysis

Scientific Reports ◽

10.1038/s41598-017-15948-8 ◽

2017 ◽

Vol 7 (1) ◽

Cited By ~ 1

Author(s):

Jonas Löfstrand ◽

Kai-Ping Chang ◽

Jennifer An-Jou Lin ◽

Charles Yuen Yung Loh ◽

Hsuan-Yu Chou ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Sequential Analysis ◽

Microvascular Reconstruction

Download Full-text

Reirradiation After Surgery and Microvascular Reconstruction

Otolaryngology ◽

10.1016/j.otohns.2008.05.501 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P93-P93

Author(s):

Jeffrey D. Suh ◽

Brian Paul Kim ◽

Elliot Abemayor ◽

Joel A Sercarz ◽

Vishad Nabili ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Free Flap ◽

Salvage Surgery ◽

Late Complications ◽

Microvascular Reconstruction ◽

Increased Risk ◽

Cord Injury ◽

Recurrent Head

Problem To evaluate the outcome and complications of reirradiation of recurrent head and neck cancer after salvage surgery and microvascular reconstruction. Methods Retrospective Study. Twelve patients underwent salvage surgery with microvascular reconstruction for recurrent or new primary head and neck cancer in a previously irradiated field. Median prior RT dose was 63.0 Gy (range 30.0–72.8). Patients then underwent postoperative reirradiation, receiving a median total cumulative radiation dose of 115.0 Gy. Results Three patients (25%) experienced acute complications (<3 months) during reirradiation that resolved with conservative care. Four patients (33%) developed grade 3 or 4 late reirradiation complications (>3 months). There were no incidences of free flap failure. No patients suffered brain necrosis, spinal cord injury, or carotid rupture. The incidence of soft tissue necrosis and osteoradionecrosis was 8%. There were no treatment-related mortalities. Six patients (50%) are alive without evidence of recurrent disease a median of 40 months after reirradiation (range 4–64 months). Conclusion Free flap reconstruction followed by reirradiation is not associated with an increased risk of perioperative, acute, or late complications. Microvascular free flaps allow for maximal resection and reliable reconstruction of previously irradiated cancers before high dose reirradiation, and may reduce the incidence of severe late complications and treatment related mortality. Significance Reirradiation for recurrent head and neck squamous cell carcinoma remains controversial. However, increasing evidence has demonstrated improved survival and locoregional control with reirradiation at the cost of potentially severe or sometimes fatal radiation toxicity. We hypothesize that using well-vascularized tissue and bone at the time of salvage surgery can reduce the incidence of reirradiation complications. This would allow patients at high risk for recurrence to more safely receive a second course of radiation therapy. To our knowledge this is the first report of the effects of microvascular reconstruction on complications and outcomes of patients undergoing salvage surgery and external beam reirradiation.

Download Full-text