title: Risk factors and etiology of surgical site infection after radical neck dissection in patients with head and neck cancer.
abstract: OBJECTIVE
  Surgical site infection (SSI) is a major complication after radical neck dissection (RND) in patients with head and neck cancer (HNC). We investigated the incidence, risk factors, and etiology of SSI among patients who underwent RND.
  
  
  METHODS
  A retrospective cohort study was performed on HNC patients, excluding those with thyroid cancer, who underwent first RND at a teaching hospital between January 2006 and June 2010. Medical records were collected and analyzed to evaluate the risk factors and microbiological etiologies.
  
  
  RESULTS
  A total of 370 patients underwent first RND. The overall incidence of SSI was 19.7% (73/370). Multivariate analysis showed that male sex (odds ratio [OR], 4.281; p = 0.004), cardiovascular diseases (OR, 1.941; p = 0.020), large amount of blood loss during surgery (OR, 4.213; p = 0.001), and surgery lasting longer than 6 hours (OR, 4.213; p = 0.002) were significantly associated with SSI. The most common causative pathogen was Staphylococcus aureus (32.6%), and 93.2% of S. aureus isolates were methicillin-resistant. Klebsiella pneumoniae (13/92, 14.1%), Pseudomonas aeruginosa (11/92, 12.0%), and Enterococcus species (11/92, 12.0%) were also frequently detected.
  
  
  CONCLUSIONS
  Based on our results, we predict that certain groups of patients are at high risk for SSIs after major HNC surgery. Preventive measures or close monitoring in these patients may be required to reduce the likelihood of postoperative SSIs. Furthermore, even though additional research is required, we would consider changing the prophylactic antibiotic regimens according to the causative organisms.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea.
authors.forename: So Yeon
authors.initials: SY
authors.lastname: Park
authors.affiliation: Department of Nursing, Kyungbuk College, Youngju, Korea.
authors.forename: Mi Suk
authors.initials: MS
authors.lastname: Kim
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea.
authors.forename: Joong Sik
authors.initials: JS
authors.lastname: Eom
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea.
authors.forename: Jin Seo
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Ilsong Memorial Institute of Head and Neck Cancer, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea.
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Rho
mesh_terms: D000368:Aged; D001431:Bacteriological Techniques; D016063:Blood Loss, Surgical; D002318:Cardiovascular Diseases / Q000150:complications; D016009:Chi-Square Distribution; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D015999:Multivariate Analysis; D037981:Neck Dissection / Q000009:adverse effects*; D016017:Odds Ratio; D061646:Operative Time; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D016896:Treatment Outcome
keywords: Head and neck neoplasms; Microbiology; Surgical site infection