Gan Chengwen, Wang Yannan, Tang Yan, Wang Kai, Sun Bincan, Wang Mengxue, Zhu Feiya
Department of Oral and Maxillofacial Surgery, Hainan Provincial People's Hospital, Haikou, Hainan, China.
Department of Plastic Surgery, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.
Support Care Cancer. 2022 Mar;30(3):2735-2743. doi: 10.1007/s00520-021-06687-8. Epub 2021 Nov 26.
Surgical site infection (SSI) frequently occurs in patients with head and neck cancer (HNC) after tumor resection and can lead to death in severe cases. Moreover, there is no definitive conclusion about the risk factors of SSI. Therefore, it is of great clinical significance to study the factors affecting the SSI.
The HNC patients included in this study were all from the Department of Oral and Maxillofacial Surgery of the Second Xiangya Hospital of Central South University (CSU), and these patients received surgical treatment in the department from January 2018 to December 2019. The cross tabulation with chi-squared testing and multivariate regression analysis were applied to determine the risk factors of SSI. To identify the key risk factors of SSI, the caret package was used to construct three different machine learning models to investigate important features involving 26 SSI-related risk factors.
Participants were 632 HNC patients who underwent surgery in our department from January 2018 to December 2019. During the postoperative period, 82 patients suffered from SSI, and surgical site infection rate (SSIR) was about 12.97%. Multivariate logistic regression analysis shows that diabetes mellitus, primary tumor site (floor of mouth), preoperative radiotherapy, flap failure, and neck dissection (bilateral) are risk factors for SSI of HNC. Machine learning indicated that diabetes mellitus, primary tumor site (floor of mouth), and flap failure were consistently ranked the top three in the 26 SSI-related risk factors.
Diabetes mellitus, primary tumor site (floor of mouth), flap failure, preoperative radiotherapy, and neck dissection (bilateral) are risk factors for SSI of HNC.
头颈部癌（HNC）患者肿瘤切除术后手术部位感染（SSI）频繁发生，严重时可导致死亡。此外，关于SSI的危险因素尚无定论。因此，研究影响SSI的因素具有重要的临床意义。
本研究纳入的HNC患者均来自中南大学湘雅二医院口腔颌面外科，这些患者于2018年1月至2019年12月在该科室接受手术治疗。采用交叉表卡方检验和多因素回归分析来确定SSI的危险因素。为了确定SSI的关键危险因素，使用caret软件包构建三种不同的机器学习模型，以研究涉及26个与SSI相关的危险因素的重要特征。
研究对象为2018年1月至2019年12月在我科接受手术的632例HNC患者。术后期间，82例患者发生SSI，手术部位感染率（SSIR）约为12.97%。多因素logistic回归分析显示，糖尿病、原发肿瘤部位（口底）、术前放疗、皮瓣坏死和双侧颈淋巴结清扫是HNC患者发生SSI的危险因素。机器学习表明，糖尿病、原发肿瘤部位（口底）和皮瓣坏死在26个与SSI相关的危险因素中始终位列前三。
糖尿病、原发肿瘤部位（口底）、皮瓣坏死、术前放疗和双侧颈淋巴结清扫是HNC患者发生SSI的危险因素。
