Faculty Collaboration Database

Perioperative Topical Antisepsis and Surgical Site Infection in Patients Undergoing Upper Aerodigestive Tract Reconstruction. JAMA Otolaryngol Head Neck Surg 2022 Jun 01;148(6):547-554

Date

04/28/2022

Pubmed ID

35476816

Pubmed Central ID

PMC9047735

DOI

10.1001/jamaoto.2022.0684

Scopus ID

2-s2.0-85129444547 (requires institutional sign-in at Scopus site)   1 Citation

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.

Author List

Beydoun AS, Koss K, Nielsen T, Holcomb AJ, Pichardo P, Purdy N, Zebolsky AL, Heaton CM, McMullen CP, Yesensky JA, Moore MG, Goyal N, Kohan J, Sajisevi M, Tan K, Petrisor D, Wax MK, Kejner AE, Hassan Z, Trott S, Larson A, Richmon JD, Graboyes EM, Wood CB, Jackson RS, Pipkorn P, Bruening J, Massey B, Puram SV, Zenga J

Authors

Jennifer D. Bruening MD Assistant Professor in the Otolaryngology department at Medical College of Wisconsin
Becky Massey MD Associate Professor in the Otolaryngology department at Medical College of Wisconsin
Joseph Zenga MD Assistant Professor in the Otolaryngology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Antibiotic Prophylaxis
Antisepsis
Cohort Studies
Free Tissue Flaps
Humans
Male
Middle Aged
Risk Factors
Surgical Wound Infection