头颈部癌症游离皮瓣重建术后手术部位感染的危险因素：回顾性澳大利亚队列研究。
Risk factors for surgical site infection in free-flap reconstructive surgery for head and neck cancer: Retrospective Australian cohort study.
机构信息
The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.
Department of Plastic & Reconstructive Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
出版信息
Head Neck. 2021 Nov;43(11):3417-3428. doi: 10.1002/hed.26837. Epub 2021 Aug 18.
BACKGROUND
Surgical site infections (SSI) are common complications of free-flap reconstruction for head and neck cancer defects. This study aimed to identify risk factors for SSI following a significant change in local antibiotic prophylaxis practice.
METHODS
A retrospective cohort study was conducted of 325 patients receiving free-flap reconstruction for head and neck cancer defects at a tertiary hospital in Melbourne, Australia between 2013 and 2019. Charts were queried for recipient SSI (primary outcome), donor SSI, other infections, antibiotic use, hospital length of stay, and mortality.
RESULTS
Risk factors for SSI included female sex, T-classification, hardware insertion, clindamycin prophylaxis, and operative duration. There was a trend toward increased SSI with shorter ≤24 h prophylaxis (OR: 0.43).
CONCLUSION
Antibiotic duration and type were associated with SSI. Complexity of surgery, T-classification, hardware use, and operative duration were also independently associated with SSI. A prospective trial is indicated to elicit optimal prophylactic antibiotic duration.
背景
手术部位感染（SSI）是头颈部癌症缺损游离皮瓣重建的常见并发症。本研究旨在确定局部抗生素预防措施发生重大变化后 SSI 的风险因素。
方法
对 2013 年至 2019 年间在澳大利亚墨尔本的一家三级医院接受头颈部癌症缺损游离皮瓣重建的 325 名患者进行了回顾性队列研究。查询了接受者 SSI（主要结局）、供体 SSI、其他感染、抗生素使用、住院时间和死亡率的图表。
结果
SSI 的危险因素包括女性、T 分类、内置物、克林霉素预防和手术时间。预防时间≤24 小时的 SSI 有增加的趋势（OR：0.43）。
结论
抗生素持续时间和类型与 SSI 有关。手术的复杂性、T 分类、内置物使用和手术时间也与 SSI 独立相关。需要进行前瞻性试验以确定最佳预防性抗生素持续时间。
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