Postoperative antibiotic prophylaxis in clean-contaminated head and neck oncologic surgery: a retrospective cohort study
|
|
- Maria Melton
- 5 years ago
- Views:
Transcription
1 DOI /s HEAD AND NECK Postoperative antibiotic prophylaxis in clean-contaminated head and neck oncologic surgery: a retrospective cohort study C.-J. Busch 1 R. Knecht 1 A. Münscher 1 J. Matern 1 C. Dalchow 1 B. B. Lörincz 1 Received: 30 June 2015 / Accepted: 7 December 2015 Springer-Verlag Berlin Heidelberg 2015 Abstract Antibiotic prophylaxis is commonly used in head and neck oncologic surgery, due to the clean-contaminated nature of these procedures. There is a wide variety in the use of prophylactic antibiotics regarding the duration of application and the choice of agent. The purpose of this study was to determine whether short-term or long-term antibiotic prophylaxis has an impact on the development of head and neck surgical wound infection (SWI). Retrospective chart review was carried out in 418 clean-contaminated head and neck surgical oncology cases at our department. More than 50 variables including tumour type and stage, type of surgical treatment, comorbidities, duration and choice of antibiotic prophylaxis, and the incidence of SWI were analysed. Following descriptive data analysis, Chi square test by Pearson and Fisher s exact test were used for statistical evaluation. Fifty-eight of the 418 patients (13.9 %) developed SWI. Patients with advanced disease and tracheotomy showed a & C.-J. Busch cjbusch@uke.de R. Knecht r.knecht@uke.de A. Münscher a.muenscher@uke.de J. Matern julia.matern@gmail.com C. Dalchow c.dalchow@uke.de B. B. Lörincz b.loerincz@uke.de 1 Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Center Hamburg- Eppendorf, Martinistr. 52, Hamburg, Germany significantly higher rate of SWI than those with early stage disease and without tracheotomy (p = and p = , respectively). However, there was no significant difference between the SWI rates in the short term and long term treatment groups (14.6 and 13.2 %, respectively; p = 0.689). Diabetes and body weight were not found to be risk factors for SWI. Long-term antibiotic prophylaxis was not associated with a decrease in SWI in the entire cohort of patients undergoing clean-contaminated major head and neck oncologic surgery. Our data confirmed the extent of surgery and tracheotomy as being risk factors for postoperative SWI. Keywords Postoperative antibiotic prophylaxis Head and neck squamous cell carcinoma (HNSCC) Head and neck oncologic surgery Clean-contaminated surgery Surgical wound infection (SWI) Introduction Surgical wound infection (SWI) is one of the most common postoperative complications. It may affect hospitalisation time and possibly results in additional interventions. Despite the advances in surgical and anaesthesia procedures and improvements in perioperative care, such adverse events, compromising the outcomes of patients undergoing head and neck surgery, are well known. After urinary tract infection (23 40 %) and respiratory complication (17 23 %), surgical wound infection is the third most common type of nosocomial infections [1, 2]. Patients undergoing major head and neck oncologic surgery are at great risk of developing complications since they often have significant co-morbidities, resulting in increased anaesthetic and surgical risks [3]. Additionally,
2 there is little doubt that most head and neck procedures include clean-contaminated surgical sites, exposed to bacterial contamination through the communicating mucosal barriers and increasing the risk of wound infection [4]. Prophylactic antibiotics are commonly used in patients undergoing head and neck surgery [5]. However, the choice of the specific antimicrobial agents and the duration of the treatment are controversial and the incidence of the reported wound infections (40 63 %) is still high [6, 7]. Currently, there is no scientific evidence for the use of prophylactic antibiotics in clean or clean-contaminated head and neck surgery [8]. The development of a SWI often results in prolonged hospital stay, additional surgical interventions, delayed adjuvant treatment and, altogether, in a higher cumulative burden for the patient as well as for the health care system. A number of patient-related and treatment-related risk factors have been identified, possibly leading to SWI (Table 1). Performing a neck dissection in head and neck cancer patients can also increase the risk of SWI [9, 10]. The reasons for this may be the more significant tissue trauma, blood loss, number of surgical drains and longer operation time [3]. SWIs in head and neck cancer patients typically show multi-microbial colonisation [11]. Usually mainly Grampositive, but also Gram-negative aerobic bacteria cultures can be isolated in % of the cases [4, 11, 12]. To reduce the rate of SWI, pre-, peri- and postoperative measures are to be combined [13]. Besides reduction of patient-related risk factors, keeping bacterial contamination of the surgical site to a minimum is the most important prophylaxis. It is assumed that with an optimised preoperative surgical setting and preparation of the patient, SWI rates can be reduced significantly [14, 15]. The aim of this study was to assess the value of the current use of postoperative prophylactic antibiotics in our Table 1 Risk factors of surgical wound infections, according to Mangram et al. [33] Patient-related factors Advanced age Malnutrition Obesity Smoking Diabetes Colonization with S. aureus Coexistent infections at a remote body site Long preoperative hospital stay Altered immune response Previous radiotherapy Procedure-related factors Prolonged operation time Inadequate skin antisepsis Surgical drains Surgical technique Tissue trauma Operating room ventilation Insufficient antimicrobial prophylaxis Foreign material in surgical site Re-operation Duration of surgical scrub department. On this large cohort of surgically treated head and neck cancer patients, we compared the short-term versus long-term administration of antibiotic substances as well as assessed the role of risk factors leading to wound infections. Results of this study may lead to further prospective studies investigating the outcomes and the cost effectiveness of different prophylactic antibiotic treatment regimens. The role of antibiotic prophylaxis Antibiotic prophylaxis is usually recommended in two scenarios: either in case of increased risk for SWI, e.g. clean-contaminated or contaminated surgical site, or if the potential development of SWI would lead to an disproportionately significant loss for the patient, e.g. to removal of the implanted foreign material or to free flap failure [16, 17]. Starting time and duration of the antibiotic treatment are to be considered carefully, along with the right choice of the antimicrobial agent [18]. The standard procedure is to administer prophylactic antibiotics within 2 h prior to surgery [19]. The frequency of the antimicrobial prophylaxis should correspond to the time interval that ensures adequate concentrations at the incision site during the period of potential infection, keeping the risk of adverse effects, development of resistance and the associated costs at the minimum in the same time [20]. Inappropriate use of postoperative antibiotics still occurs in the daily routine. Personal decisions of the surgeons are not always based on established guidelines to meet safety criteria. A common problem in this setting is the use of prophylactic antibiotics for a longer period of time than recommended [21]. Patients and methods A retrospective chart review of all patients having undergone clean-contaminated major head and neck oncologic surgery of the upper aerodigestive tract in the past 4 years at our tertiary academic center was carried out. A total of 418 patients were included in this study. Most cases were primary surgeries. In 41 of the 418 patients (9.8 %), locoregional recurrences were treated. Patients with salvage surgery were also included: 35 of the 418 patients (8.4 %) received radiotherapy and 32 of the 418 patients (7.7 %) received chemotherapy prior to their surgery. More than 50 variables such as tumour type and stage, type of surgical treatment (i.e. partial or total laryngectomy, partial or total pharyngectomy, tracheotomy, oral cavity resection, etc.), comorbidities, preoperative radiotherapy and/or chemotherapy, body weight/bmi, duration
3 and type of antibiotic prophylaxis, and the incidence of surgical wound infection (SWI) were collected and analysed. SWI was defined according to the North American Centers for Disease Control (CDC) classification upon presenting with wound dehiscence, purulent drainage, abscess formation, or cellulitis [22]. Features such as erythema, skin induration in the wound and/or contact sensitivity alone were not accepted as SWI. Fistula formation was recorded in case of obvious clinical observation or radiological detection. Pneumonia was registered after a positive chest X-ray and/or microbiology culture. As for the cut-off point in the duration of the antibiotic treatment, we have chosen B7 or[7 days of antibiotic prophylaxis. Patients who received 7 or fewer days of prophylactic treatment were allocated to the short-term group, while patients with at least 8 days of treatment or more, were allocated to the long-term group. Subgroup analysis regarding diabetes, body mass index (BMI, classification according to the WHO, 2004), and further postoperative complications were also performed. Due to the retrospective character of this study, a potential selection bias should be taken into account concerning the antibiotic treatment time. Data collection and statistical analysis were performed using Microsoft Office Excel and SPSS (version 22) for Windows. Our analysis was restricted to individuals with a complete set of data on all variables required for a particular analysis. Following descriptive data analysis, we used the chi square test by Pearson as well as Fisher s exact test to statistically evaluate our data and to compare the two groups. Only p values below 0.05 were considered as statistically significant (values written bold in the tables). Multivariate analysis was performed with logistic regression. Patient characteristics A total of 418 patients were included in this study, with a mean age of 62 years and a 95 % standard deviation (±SD) of 12 years. There were 318 (76.1 %) male and 100 (23.9 %) female patients. Mean body mass index (BMI) ± SD was ± 4.4 kg/m 2 with approximately half of the patients presenting with normal weight (n = 208, 49.8 %), 40 patients (9.6 %) were underweight, and 132 patients (31.6 %) as well as 38 patients (9.1 %) showing preobesity and obesity, respectively. In this setting, the main indications for clean-contaminated major head and neck oncologic surgery was laryngeal cancer (n = 137, 32.8 %) and oropharyngeal cancer (n = 100, 23.9 %), followed by oral cavity cancer (n = 67, 16 %). Procedures for the treatment of laryngeal cancer included total laryngectomy (n = 40, 9.6 %), partial laryngectomy (n = 40, 9.6 %), and endolaryngeal chordectomy (n = 39, 9.3 %). In cases of the latter, only those patients undergoing neck dissection and/or tracheotomy were included in this study. More than half of the patients (n = 192, 53 %) had advanced disease with UICC Stage IV. Only eight patients (2.2 %) presented with distant metastasis. Thirty-five (8.4 %) patients received radiotherapy and 32 patients (7.7 %) received chemotherapy prior to their surgery. Altogether, 197 patients (47.1 %) received temporary tracheotomy either before (59 of the 197 patients, with no communication between the tracheotomy site and the main operative site) or during (138 of the 197 patients, with possible communication between the two sites) the oncologic resection or reconstruction. Antibiotics Since the given antibiotic prophylaxis was subject to individual decision of the surgeon in charge, the choice of antibiotic substances, their dose, their daily distribution and the duration of their administration showed very heterogenic patterns. Most commonly cefazolin, clindamycin, cefuroxime, ampicillin/sulbactam, and metronidazole were applied postoperatively. A subgroup of 269 patients (64.4 %) received a single antibiotic agent during the entire treatment period. Another 118 (28.2 %) and 31 patients (7.4 %) were given a second and third antibiotic substance over time, respectively. Results Surgical wound infection Altogether, 58 of our 418 patients (13.9 %) developed SWI. Patients with advanced stage disease had significantly more frequently SWI than those with early stage disease (p = 0.012). In the former group, 19.8 % of patients had Stage IV disease. Further, patients with tracheotomy showed a higher SWI rate than those without (p = ), irrespective of the timing of their tracheotomy (i.e., prior to or concurrently with their oncologic surgery) and of the possible communication between the tracheotomy site and the oncologic site. The rate of SWI in patients with tracheotomy was threefold higher than that in those without tracheotomy (19.3 vs. 6.2 %). There was no significant difference between the short-term and long-term treated groups with regards to SWI, as their infection rate was 14.6 and 13.2 %, respectively (p = 0.689). Other patient-specific risk factors for SWI were positive nodal stage, the extent of surgical resection and the
4 Table 2 The effect of patient-specific risk factors on SWI Risk factor No. of patients (n) No. of infected wounds (n) Rate of SWI (%) p value Age B65 years Age [65 years Underweight Normal weight Preobesity/obesity No diabetes Diabetes No preop. irradiation Preop. irradiation No preop. chemotherapy Preop. chemotherapy Early stage disease (St. I, II) Advanced disease (St. III, IV) N0 nodal stadium N-positive nodal stadium Minor surgery Major surgery No neck dissection Concurrent neck dissection No recurrence Recurrent disease No tracheotomy Tracheotomy Non-smoker Nicotine abuse No alcohol Alcohol abuse No liver cirrhosis Liver cirrhosis present No COPD COPD Bold values indicate statistical significance (p B 0.05) COPD chronic obstructive pulmonary disease Table 3 Multivariate analysis of selected risk factors for surgical wound infection Risk factor OR (95 % CI) p value N-positive nodal stadium 1.84 ( ) Tracheotomy 3.40 ( ) Neck dissection 1.15 ( ) Advanced stage disease 0.61 ( ) Major surgery 2.54 ( ) Bold values indicate statistical significance (p B 0.05) OR odds ratio, CI confidence interval addition of a neck dissection (Table 2). With these five significant risk factors, a multivariate analysis was performed, which verified the significance of tracheotomy and that of the extent of surgical resection (Table 3). Patients who received major surgery (e.g. operating time [3 h, laryngectomy, pharyngectomy, reconstructive surgery, etc.) and a tracheotomy had a and 3.4-fold higher risk, respectively, for developing SWI. Out of the 54 patients with diabetes, 7 (13 %) developed SWI. This rate was 14 % in the non-diabetic subpopulation (n = 51) of the same cohort. Within the diabetic group, further subgroups with short-term versus long-term antibiotic prophylaxis were compared to each other, with regards to their SWI rates. Thirty diabetic patients (55.6 %) were in the short-term subgroup, and 24 patients were (44.4 %) in the long-term subgroup. The rate of SWI in the former subgroup was 16.7 % (n = 5) versus 8.3 % (n = 2) in the latter. There was no significant difference between the number of patients with and without tracheotomy in the diabetic and in the non-diabetic patient groups. With a
5 Table 4 Body mass index (BMI) subgroups breakdown p value at 0.443, the difference was not significant, thus there was no reduction in the SWI rates after a longer period of antibiotic treatment in diabetic patients, compared to the short term treated diabetic subgroup. According to their BMI, the patients were divided into three subgroups (Table 4). There was no correlation between the patients weight and the risk of wound infection (p = 0.834). Regarding the length of antibiotic prophylaxis, there was also no significant difference in the rates of SWI between short term and long term treated patients among these three subgroups (all p [ 0.05). Further, there was no significant difference between patients with and without preoperative radiotherapy in their SWI rates. Fistula formation A pharyngocutaneous fistula was developed in 28 of the 418 patients (6.7 %), diagnosed after 10 ± 4 days postoperatively. The risk of fistula formation was higher in patients with tracheotomy (p = 0.004) and in patients having undergone major surgical procedures (p = 0.007; e.g. pharyngectomy, laryngectomy, free flap reconstruction, etc.). In a multivariate analysis, they were exposed to a and 2.49-fold higher risk of developing a fistula, respectively (Table 5). The risk of fistula formation did not correlate with preoperative radiotherapy, diabetes and BMI, nor with the duration of antibiotic prophylaxis. Pneumonia Underweight Normal weight Preobesity/obesity BMI B C25.00 n (%) 40 (9.6) 208 (49.8) 170 (40.6) Ø ± SD 16.9 ± ± ± 3.2 Median SD standard deviation In the entire cohort, a total of ten patients (2.4 %) developed pneumonia. Patients with tracheotomy (p = 0.04) and liver cirrhosis (p = 0.021) were exposed to a higher risk of pneumonia. All of these ten patients received only shortterm prophylactic antibiotic treatment. None of the patients in the long-term group suffered from pneumonia (p = ). Only one patient without tracheotomy developed pneumonia, the other nine pneumonia patients underwent tracheotomy as part of their oncologic head and neck procedure. The incidence of pneumonia was significantly higher in patients undergoing tracheotomy simultaneously with their oncologic surgery (p = 0.04). Table 5 Multivariate analysis of selected risk factors for fistula formation Risk factor OR (95 % CI) p value N-positive nodal 1.94 ( ) stadium Tracheotomy 3.35 ( ) Neck dissection 1.08 ( ) Advanced stage disease 0.55 ( ) Major surgery 2.49 ( ) Preop. chemotherapy 0.71 ( ) COPD 1.37 ( ) Poor dental status 1.19 ( ) Bold values indicate statistical significance (p B 0.05) OR odds ratio, CI confidence interval, COPD chronic obstructive pulmonary disease Discussion SWI rates vary a lot among different surgical interventions. Our retrospective study investigated the incidence of SWI in clean-contaminated head and neck cancer surgery, which often leads to higher SWI rates than sterile procedures do [23]. Without antibiotic prophylaxis, the incidence of SWI in clean-contaminated wounds varies between 24 and 87 % in the literature [24]. In our patient cohort, the overall SWI rate was 13.9 %, irrespective of the duration of the antibiotic treatment. The infection was diagnosed after 8.2 days (mean value) postoperatively. Comparing our results to similar studies in the literature, our SWI rate of 13.9 % is rather low. SWI rates are commonly reported between 20.1 and 50.5 % in the literature [3, 7, 25], with some exceptions at the low end between 3.1 and 11 % [5, 26]. Since study designs are very diverse, it is difficult to compare all these results with each other. Tumour stage is reported to have an impact on the risk of SWI. Several studies showed a positive correlation between advanced tumour stage and SWI in univariate analysis [3, 23, 25]. However, we did not find tumour stage to have a significant impact on SWI in our multivariate analysis, similarly to Liu et al. [24]. Advanced tumour stage often requires larger resections and prolonged surgical procedures. More extensive tissue trauma and larger wound surface may contribute to increased contamination, and consequently to a higher risk of surgical wound infection. Major procedures with large resections and prolonged operating times, often associated with a temporary tracheotomy performed during the same surgery, represent a significant independent risk factor for developing SWI. Robbins et al. [27] also demonstrated tracheotomy and longer operation time as risk factors for SWI. The infection rate of 8 % associated with procedures not longer than 2 h
6 increases up to 32.9 % in those lasting more than 8 h. Similarly, inclusion of a tracheotomy also increases the SWI rate from 8 up to 27 %. Several other groups have published comparable data in this regard [7, 23, 25, 28]. Further, foreign bodies, e.g. tracheal cannulas may be colonised by bacteria forming biofilm with an antibiotic resistency profile well adapted to the hospital environment [7]. A prolonged surgery usually correlates with major resections and reflects the complexity of the procedure, where preoperatively given antibiotics and surgical lavage may no longer be effective by the end of the procedure [28]. However, in contrast to our results, there are other publications demonstrating that tracheotomy and operating time did not have an impact on their SWI rates [11, 29]. Our results showed no difference between the SWI rates of the short-term (1 7 days) and long-term (C8) antibiotictreated groups (p = 0.689), similar to several other studies. However, definition of short term and long term in this regard varies a lot in the literature [5, 30]. Considering the distribution of risk factors for SWI between the two groups, patients in the long term treated group had significantly more risk factors than those in the short term treated group. However, this difference did not lead to a higher SWI rate in the long-term group. This imbalance is obviously a bias that arises from the retrospective character of this study. A similar effect was described by Sepehr et al. [31]. Although their SWI rates did not differ between the two groups either, there may have been a benefit from the prolonged antibiotic treatment in the long-term group, compensating for the unequal distribution of risk factors between the two groups. To clarify this hypothesis, prospective studies should be performed with stratification of the mentioned risk factors. In the literature, reported data regarding diabetes and low BMI as potential risk factors for SWI are controversial [3, 25]. In our study, we did not observe reduced SWI rates due to prolonged antibiotic treatment in diabetic patients. There was no correlation among the patients weight, the risk of SWI, and the duration of antibiotic prophylaxis either. Fistula formation did not correlate either with diabetes or with low BMI. Additional surgical procedures (e.g. tracheotomy) and the extent of surgery (major procedures) seem to have more impact on the incidence of complications, such as fistula formation or developing pneumonia, than the duration of the prophylactic antibiotic treatment. This is concordant with the results of a meta-analysis of postlaryngectomy pharyngocutaneous fistula formation [32]. However, 90 % of our patients with pneumonia did have a tracheotomy and they all were in the short-term antibiotic-treated group. Thus, high-risk patients undergoing major procedures including a tracheotomy might benefit from long-term prophylactic antibiotic treatment in terms of minimising the risk of pneumonia. Conclusion To date, this study presents the largest series of its kind, reporting on the effects of antibiotic prophylaxis in surgically treated head and neck cancer patients undergoing clean-contaminated procedures. Our data showed that long-term antibiotic prophylaxis is not associated with a further decrease in SWI rates in the entire cohort of patients. Furthermore, diabetes and low BMI did not increase the SWI rates. In either of these subgroups, prolonged administration of prophylactic antibiotics was not associated with lower infection rates. However, our data did confirm the extent of surgical procedure and tracheotomy as being risk factors for postoperative SWI. Due to the retrospective nature of this study, we may only assume that patients with a high risk of SWI might benefit from prolonged prophylactic antibiotic treatment. To verify this, a prospective study is required to focus on these subgroups with matched controls or risk factor stratification, in order to determine whether short-term antibiotic prophylaxis is still a valid option for patients with higher risk for SWI. The present retrospective analysis may only conclude that long-term antibiotic prophylaxis was not associated with further decreased SWI rates in patients undergoing clean-contaminated head and neck oncologic surgery and, therefore, prophylactic antibiotic treatment should not exceed 7 days in such patients without increased risk for SWI. References 1. Steinbrecher E et al (2002) Surveillance of postoperative wound infections: reference data of the Hospital Infection Surveillance System (KISS). Chirurg 73: Emmerson AM et al (1996) The Second National Prevalence Survey of infection in hospitals overview of the results. J Hosp Infect 32: Fusconi M et al (2006) Clean-contaminated neck surgery: risk of infection by intrinsic and extrinsic factors. Arch Otolaryngol Head Neck Surg 132: Clayman GL et al (1993) Bacteriologic profile of surgical infection after antibiotic prophylaxis. Head Neck 15: Righi M et al (1996) Short-term versus long-term antimicrobial prophylaxis in oncologic head and neck surgery. Head Neck 18: Agra IM et al (2003) Postoperative complications after en bloc salvage surgery for head and neck cancer. Arch Otolaryngol Head Neck Surg 129: Penel N et al (2005) Multivariate analysis of risk factors for wound infection in head and neck squamous cell carcinoma surgery with opening of mucosa. Study of 260 surgical procedures. Oral Oncol 41: Kreutzer K et al (2014) Current evidence regarding prophylactic antibiotics in head and neck and maxillofacial surgery. BioMed Res Int 2014:879437
7 9. de Melo GM et al (2001) Risk factors for postoperative complications in oral cancer and their prognostic implications. Arch Otolaryngol Head Neck Surg 127: Galli J et al (2005) Postlaryngectomy pharyngocutaneous fistula: incidence, predisposing factors, and therapy. Otolaryngol Head Neck Surg 133: Lotfi CJ et al (2008) Risk factors for surgical-site infections in head and neck cancer surgery. Otolaryngol Head Neck Surg 138: Rodrigo JP et al (2004) Efficacy of piperacillin-tazobactam in the treatment of surgical wound infection after clean-contaminated head and neck oncologic surgery. Head Neck 26: Simo R, French G (2006) The use of prophylactic antibiotics in head and neck oncological surgery. Curr Opin Otolaryngol Head Neck Surg 14: McConkey SJ et al (1999) Results of a comprehensive infection control program for reducing surgical-site infections in coronary artery bypass surgery. Infect Control Hosp Epidemiol 20: Harbarth S et al (2003) The preventable proportion of nosocomial infections: an overview of published reports. J Hosp Infect 54: quiz Kirby JP, Mazuski JE (2009) Prevention of surgical site infection. Surg Clin N Am 89: Woods RK, Dellinger EP (1998) Current guidelines for antibiotic prophylaxis of surgical wounds. Am Fam Physician 57: Barie PS (2002) Surgical site infections: epidemiology and prevention. Surg Infect (Larchmt) 3(Suppl 1):S9 S Classen DC et al (1992) The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 326: Fennessy BG et al (2007) Antimicrobial prophylaxis in otorhinolaryngology/head and neck surgery. Clin Otolaryngol 32: Codina C et al (1999) Perioperative antibiotic prophylaxis in Spanish hospitals: results of a questionnaire survey. Hospital Pharmacy Antimicrobial Prophylaxis Study Group. Infect Control Hosp Epidemiol 20: Leaper DJ (2010) Surgical-site infection. Br J Surg 97: Coskun H et al (2000) Factors affecting wound infection rates in head and neck surgery. Otolaryngol Head Neck Surg : Weber RS, Callender DL (1992) Antibiotic prophylaxis in cleancontaminated head and neck oncologic surgery. Ann Otol Rhinol Laryngol Suppl 155: Liu SA et al (2007) Risk factors for wound infection after surgery in primary oral cavity cancer patients. Laryngoscope 117: Ganly I et al (2009) Analysis of postoperative complications of open partial laryngectomy. Head Neck 31: Robbins KT et al (1990) Risk of wound infection in patients with head and neck cancer. Head Neck 12: Schwartz SR et al (2004) Predictors of wound complications after laryngectomy: a study of over 2000 patients. Otolaryngol Head Neck Surg 131: Girod DA et al (1995) Risk factors for complications in cleancontaminated head and neck surgical procedures. Head Neck 17: Velanovich V (1991) A meta-analysis of prophylactic antibiotics in head and neck surgery. Plast Reconstr Surg 87: discussion Sepehr A et al (2009) Antibiotics in head and neck surgery in the setting of malnutrition, tracheotomy, and diabetes. Laryngoscope 119: Paydarfar JA, Birkmeyer NJ (2006) Complications in head and neck surgery: a meta-analysis of postlaryngectomy pharyngocutaneous fistula. Arch Otolaryngol Head Neck Surg 132: Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) Guideline for prevention of surgical site infection, Hospital infection control practices advisory committee. Infect Control Hosp Epidemiol 20(4): ; quiz
Wojciech K. Mydlarz, M.D. Pharyngocutaneous Fistulas after Salvage Laryngectomy: Need for Vascularized Tissue
Wojciech K. Mydlarz, M.D. Pharyngocutaneous Fistulas after Salvage Laryngectomy: Need for Vascularized Tissue Disclosures No Relevant Financial Relationships or Commercial Interests Educational Objectives
More informationAntibiotic Prophylaxis in Uncontaminated Neck Dissection
The Laryngoscope VC 2011 The American Laryngological, Rhinological and Otological Society, Inc. Antibiotic Prophylaxis in Uncontaminated Neck Dissection Li-Xing Man, MSc, MD, MPA; Daniel M. Beswick, BS;
More informationPostoperative Surgical Site Infection after Incisional Hernia Repair: Link to Previous Surgical Site Infection? Zulfiqar Ali, AG Rehan
Original Article Postoperative Surgical Site Infection after Incisional Hernia Repair: Link to Previous Surgical Site Infection? Zulfiqar Ali, AG Rehan ABSTRACT Objective: Aim of the study was to determine
More informationABSTRACT. KEY WORDS antibiotics; prophylaxis; hysterectomy
Infectious Diseases in Obstetrics and Gynecology 8:230-234 (2000) (C) 2000 Wiley-Liss, Inc. Wound Infection in Gynecologic Surgery Aparna A. Kamat,* Leo Brancazio, and Mark Gibson Department of Obstetrics
More informationDoes Using a Laparoscopic Approach to Cholecystectomy Decrease the Risk of Surgical Site Infection?
ANNALS OF SURGERY Vol. 237, No. 3, 358 362 2003 Lippincott Williams & Wilkins, Inc. Does Using a Laparoscopic Approach to Cholecystectomy Decrease the Risk of Surgical Site Infection? Chesley Richards,
More informationEvidence-Base Use of Perioperative Antibiotics and Head and Neck Cancer Surgery May 2014
TITLE: Evidence-Base Use of Perioperative Antibiotics and Head and Neck Cancer Surgery SOURCE: Grand Rounds Presentation, The University of Texas Medical Branch at Galveston, Department of Otolaryngology
More informationORIGINAL ARTICLE. Salvage Surgery After Failure of Nonsurgical Therapy for Carcinoma of the Larynx and Hypopharynx
ORIGINAL ARTICLE Salvage Surgery After Failure of Nonsurgical Therapy for Carcinoma of the Larynx and Hypopharynx Sandro J. Stoeckli, MD; Andreas B. Pawlik, MD; Margareta Lipp, MD; Alexander Huber, MD;
More informationFactors influencing the development of wound infection following free-flap reconstruction for intra-oral cancer q
The British Association of Plastic Surgeons (2004) 57, 556 560 Factors influencing the development of wound infection following free-flap reconstruction for intra-oral cancer q D.J. Cloke*, J.E. Green,
More informationClinical analysis of 29 cases of nasal mucosal malignant melanoma
1166 Clinical analysis of 29 cases of nasal mucosal malignant melanoma HUANXIN YU and GANG LIU Department of Otorhinolaryngology Head and Neck Surgery, Tianjin Huanhu Hospital, Tianjin 300060, P.R. China
More informationSURGICAL SITE INFECTION AFTER PREOPERATIVE NEOADJUVANT CHEMOTHERAPY IN PATIENTS WITH LOCALLY ADVANCED ORAL SQUAMOUS CELL CARCINOMA
ORIGINAL ARTICLE SURGICAL SITE INFECTION AFTER PREOPERATIVE NEOADJUVANT CHEMOTHERAPY IN PATIENTS WITH LOCALLY ADVANCED ORAL SQUAMOUS CELL CARCINOMA Shih-An Liu, MD, PhD, 1,2,3 Yong-Kie Wong, BDS, MSc,
More informationDave Laverty MD Orthopedic Trauma Surgeon
Austin Trauma & Critical Care Conference Open Fracture Update 2018 Dave Laverty MD Orthopedic Trauma Surgeon Take Home Points We are stuck in the 90 s Time to antibiotics matters most Gram negative bacteria
More informationProcess audit for SSI. CME on Infection Prevention & Control Breach Candy Hospital Trust
Process audit for SSI CME on Infection Prevention & Control Breach Candy Hospital Trust Introduction SSIs are the most common healthcare-associated infection, accounting for 31% of all HAIs among hospitalized
More informationSalvage Laryngectomy. after R T Failure Indications, Complications and Results. Aug
Salvage Laryngectomy after R T Failure Indications, Complications and Results Aug.3.2013 Acknowledgments I am grateful to the following individuals who have allowed me to use their slides during this presentation:
More informationHead and neck free flap surgical site infections in the era of the Surgical Care Improvement Project
ORIGINAL ARTICLE Head and neck free flap surgical site infections in the era of the Surgical Care Improvement Project Bharat B. Yarlagadda, MD, 1 Daniel G. Deschler, MD, 1 Debbie L. Rich, RN, 2 Derrick
More informationHead and Neck Cancer in FA: Risks, Prevention, Screening, & Treatment Options David I. Kutler, M.D., F.A.C.S.
Head and Neck Cancer in FA: Risks, Prevention, Screening, & Treatment Options David I. Kutler, M.D., F.A.C.S. Associate Professor Division of Head and Neck Surgery Department of Otolaryngology-Head and
More informationClinical Outcome of Reconstruction With Tissue Expanders for Patients With Breast Cancer and Mastectomy
Clinical Outcome of Reconstruction With Tissue Expanders for Patients With Breast Cancer and Mastectomy Mitsui Memorial Hospital Department of Breast and Endocine surgery Daisuke Ota No financial support
More informationRisk factors for the initiation and aggravation of lymphoedema after axillary lymph node dissection for breast cancer
HEALTH SERVICES RESEARCH FUND Risk factors for the initiation and aggravation of lymphoedema after axillary lymph node dissection for breast cancer Key Messages 1. Previous inflammation or infection of
More informationRisk Factors of Early Complications of Tracheostomy at Kenyatta National Hospital.
Risk Factors of Early Complications of Tracheostomy at Kenyatta National Hospital. G. Karuga 1, H. Oburra 2, C. Muriithi 3. 1 Resident Ear Nose & Throat (ENT) Head & Neck Department. University of Nairobi
More informationRisk Factors and Survival Outcomes for Patients With Anastomotic Leakage After. Surgery for Head and Neck Squamous Cell Carcinoma
1 Title page (Original Article) Risk Factors and Survival Outcomes for Patients With Anastomotic Leakage After Surgery for Head and Neck Squamous Cell Carcinoma Do-Youn Kim 1* Jong-Lyel Roh 1* Jong Woo
More informationPrevention of Surgical Site Infections Pola Brenner and Patricio Nercelles
Chapter 11 Prevention of Surgical Site Infections Pola Brenner and Patricio Nercelles Key points In many countries surgical site infections are the most common healthcare-associated infections accounting
More informationRisk Factors for Surgical Site Infection (SSI) after Urological Surgery: Incisional and Deep-organ/space Experience at Anjo Hospital
J Rural Med 2009; 4(2): 59 63 Original article Risk Factors for Surgical Site Infection (SSI) after Urological Surgery: Incisional and Deep-organ/space Experience at Anjo Hospital Jun Sawai 1, Takehiko
More informationPharyngocutaneous Fistula Following Laryngectomy
Pharyngocutaneous Fistula Following Laryngectomy Pages with reference to book, From 130 To 132 Iqbal H.U daipurwala, Khalid Iqbal ( Department of Otolaryngology and Cervico-facial Surgery, Dow Medical
More informationPoor Outcomes in Head and Neck Non-Melanoma Cutaneous Carcinomas
10 The Open Otorhinolaryngology Journal, 2011, 5, 10-14 Open Access Poor Outcomes in Head and Neck Non-Melanoma Cutaneous Carcinomas Kevin C. Huoh and Steven J. Wang * Head and Neck Surgery and Oncology,
More informationPredicting Short Term Morbidity following Revision Hip and Knee Arthroplasty
Predicting Short Term Morbidity following Revision Hip and Knee Arthroplasty A Review of ACS-NSQIP 2006-2012 Arjun Sebastian, M.D., Stephanie Polites, M.D., Kristine Thomsen, B.S., Elizabeth Habermann,
More informationAppendix A: Summary of evidence from surveillance
Appendix A: Summary of evidence from surveillance 8-year surveillance (2017) Surgical site infections: prevention and treatment (2008) NICE guideline CG74 Summary of evidence from surveillance... 1 Research
More informationComplex Thoracoscopic Resections for Locally Advanced Lung Cancer
Complex Thoracoscopic Resections for Locally Advanced Lung Cancer Duke Thoracoscopic Lobectomy Workshop March 21, 2018 Thomas A. D Amico MD Gary Hock Professor of Surgery Section Chief, Thoracic Surgery,
More informationORIGINAL ARTICLE. Predicting the Prognosis of Oral Squamous Cell Carcinoma After First Recurrence
ORIGINAL ARTICLE Predicting the Prognosis of Oral Squamous Cell Carcinoma After First Recurrence Michael D. Kernohan, FDSRCS, FRCS, MSc; Jonathan R. Clark, FRACS; Kan Gao, BEng; Ardalan Ebrahimi, FRACS;
More informationSupplementary Online Content
Supplementary Online Content Bhangu A, Singh P, Lundy J, Bowley DM. Systemic review and meta-analysis of randomized clinical trials comparing primary vs delayed primary skin closure in contaminated and
More informationIncidence and risk factors of surgical wound infection in children: a prospective study
Scandinavian Journal of Surgery 99: 162 166, 2010 Incidence and risk factors of surgical wound infection in children: a prospective study K. Varik, Ü. Kirsimägi, E.-A.Värimäe, M. Eller, R. Lõivukene, V.
More informationMore than 150 consecutive open umbilical hernia repairs in a major Veterans Administration Medical Center
The American Journal of Surgery (2008) 196, 647 651 The Association of VA Surgeons More than 150 consecutive open umbilical hernia repairs in a major Veterans Administration Medical Center Buckminster
More informationNICE guideline Published: 10 February 2016 nice.org.uk/guidance/ng36
Cancer of the upper aerodigestive e tract: assessment and management in people aged 16 and over NICE guideline Published: 10 February 2016 nice.org.uk/guidance/ng36 NICE 2018. All rights reserved. Subject
More information2017 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Outcome
Measure #165 (NQF 0130): Coronary Artery Bypass Graft (CABG): Deep Sternal Wound Infection Rate National Quality Strategy Domain: Effective Clinical Care 2017 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY
More informationOutcomes of Patients with Preoperative Weight Loss following Colorectal Surgery
Outcomes of Patients with Preoperative Weight Loss following Colorectal Surgery Zhobin Moghadamyeghaneh MD 1, Michael J. Stamos MD 1 1 Department of Surgery, University of California, Irvine Nothing to
More informationEffectiveness of Prophylactic Antibiotics in Outpatient Plastic Surgery
545984AESXXX10.1177/1090820X14545984Aesthetic Surgery JournalAnigian et al research-article2014 Research Effectiveness of Prophylactic Antibiotics in Outpatient Plastic Surgery Kendall T. Anigian, BS;
More informationSurgical Management of Pancreatic Cancer
I Congresso de Oncologia D Or July 5-6, 2013 Surgical Management of Pancreatic Cancer Michael A. Choti, MD, MBA, FACS Department of Surgery Johns Hopkins University School of Medicine, Baltimore, MD Estimated
More informationPeriprosthetic joint infection: are patients with multiple prosthetic joints at risk?
Thomas Jefferson University Jefferson Digital Commons Rothman Institute Rothman Institute 6-1-2012 Periprosthetic joint infection: are patients with multiple prosthetic joints at risk? S Mehdi Jafari The
More informationThe Efficacy of NPWT on Primary Closed Incisions
The Efficacy of NPWT on Primary Closed Incisions Pieter Zwanenburg Researcher / PhD Candidate Marja Boermeester Professor of Surgery, Academic Medical Center, Amsterdam Incisional Negative Pressure Wound
More informationModifiable Risk Factors in Orthopaedic Infections
Modifiable Risk Factors in Orthopaedic Infections AAOS Patient Safety Committee Burden US Surgical Site Infections (SSI) by the Numbers ~300,000 SSIs/yr (17% of all HAI; second to UTI) 2%-5% of patients
More informationAnalysis of the outcome of young age tongue squamous cell carcinoma
Jeon et al. Maxillofacial Plastic and Reconstructive Surgery (2017) 39:41 DOI 10.1186/s40902-017-0139-8 Maxillofacial Plastic and Reconstructive Surgery RESEARCH Open Access Analysis of the outcome of
More informationLong term survival study of de-novo metastatic breast cancers with or without primary tumor resection
Long term survival study of de-novo metastatic breast cancers with or without primary tumor resection Dr. Michael Co Division of Breast Surgery Queen Mary Hospital The University of Hong Kong Conflicts
More informationOral Cavity. 1. Introduction. 1.1 General Information and Aetiology. 1.2 Diagnosis and Treatment
Oral Cavity 1. Introduction 1.1 General Information and Aetiology The oral cavity extends from the lips to the palatoglossal folds and consists of the anterior two thirds of the tongue, floor of the mouth,
More informationEndoscopic Posterior Cricoid Split with Costal Cartilage Graft: A Fifteen Year Experience
1 Endoscopic Posterior Cricoid Split with Costal Cartilage Graft: A Fifteen Year Experience John P. Dahl, MD, PhD, MBA 1,2, *, Patricia L. Purcell, MD 1, MPH, Sanjay R. Parikh, MD, FACS 1, and Andrew F.
More informationEMERGING EVIDENCE AND BEST PRACTICES TO PREVENT SSI IN COLON PROCEDURES
EMERGING EVIDENCE AND BEST PRACTICES TO PREVENT SSI IN COLON PROCEDURES Clifford Ko, MD, MS, MSHS, FACS, FASCRS Professor of Surgery UCLA Director, ACS NSQIP, American College of Surgeons EVIDENCE Ban
More informationRisk factors for postoperative haemorrhage after total thyroidectomy: clinical results based on 2,678 patients
www.nature.com/scientificreports OPEN Received: 2 February 2017 Accepted: 28 June 2017 Published online: 1 August 2017 Risk factors for postoperative haemorrhage after total thyroidectomy: clinical results
More informationSurveillance of Surgical Site Infection in Surgical Hospital Wards in Bulgaria,
International Journal of Current Microbiology and Applied Sciences ISSN: 2319-7706 Volume 7 Number 01 (2018) Journal homepage: http://www.ijcmas.com Original Research Article https://doi.org/10.20546/ijcmas.2018.701.361
More informationTrial protocol - NIVAS Study
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 Trial protocol - NIVAS Study METHODS Study oversight The Non-Invasive Ventilation after Abdominal Surgery
More informationENT cancer surgery. Bourgain Jean Louis. May 15, 2016
ENT cancer surgery Bourgain Jean Louis May 15, 2016 Predictors of impossible mask ventilation Kheterpal, S Anesthesiology. 110(4):891-897, April 2009. 53041 patients All patients treated by neck radiation
More informationSurgical strategies in esophageal cancer
Gastro-Conference Berlin 2005 October 1-2, 2005 Surgical strategies in esophageal cancer J. Rüdiger Siewert Department of Surgery, Klinikum rechts der Isar Technische Universität München Esophageal Cancer
More informationThoracoscopic Lobectomy for Locally Advanced Lung Cancer. Masters of Minimally Invasive Thoracic Surgery Orlando September 19, 2014
for Locally Advanced Lung Cancer Masters of Minimally Invasive Thoracic Surgery Orlando September 19, 2014 Thomas A. D Amico MD Gary Hock Endowed Professor and Vice Chair of Surgery Chief Thoracic Surgery
More informationIDENTIFYING RISK FACTORS FOR POSTOPERATIVE CARDIOVASCULAR AND RESPIRATORY COMPLICATIONS AFTER MAJOR ORAL CANCER SURGERY
ORIGINAL ARTICLE IDENTIFYING RISK FACTORS FOR POSTOPERATIVE CARDIOVASCULAR AND RESPIRATORY COMPLICATIONS AFTER MAJOR ORAL CANCER SURGERY Jasjit K. Dillon, BDS, MBBS, DDS, Stanley Y. Liu, DDS, Chirag M.
More informationSurvey of Laryngeal Cancer at SBUH comparing 108 cases seen here from to the NCDB of 9,256 cases diagnosed nationwide in 2000
Survey of Laryngeal Cancer at comparing 108 cases seen here from 1998 2002 to the of 9,256 cases diagnosed nationwide in 2000 Stony Brook University Hospital Cancer Program Annual Report 2002-2003 Gender
More informationCase Discussion: Post-implant infections & explant decision making
Author Information Full Names: Sailesh Arulkumar, MD David Provenzano, MD Affiliation: Sailesh Arulkumar MD: Attending Pain Physician, The Orthopaedic Center, Tulsa OK David Provenzano, MD: Attending Pain
More informationORIGINAL ARTICLE. Comorbidity as a Major Risk Factor for Mortality and Complications in Head and Neck Surgery
ORIGINAL ARTICLE Comorbidity as a Major Risk Factor for Mortality and Complications in Head and Neck Surgery Marciano B. Ferrier, MD; Emiel B. Spuesens; Saskia Le Cessie, PhD; Robert J. Baatenburg de Jong,
More informationPreoperative Biliary Drainage Among Patients With Resectable Hepatobiliary Malignancy: Does Technique Matter?
Preoperative Biliary Drainage Among Patients With Resectable Hepatobiliary Malignancy: Does Technique Matter? Q. Lina Hu, MD; Jason B. Liu, MD, MS; Ryan J. Ellis, MD, MS; Jessica Y. Liu, MD, MS; Anthony
More informationTreatment and prognosis of patients with recurrent laryngeal carcinoma: a retrospective study
Page 1 of 7 Treatment and prognosis of patients with recurrent laryngeal carcinoma: a retrospective study T Jin 1, H Lin 2,3, HX Lin 2,3, XY Cai 2,3, HZ Wang 2,3, WH Hu 2,3, LB Guo 4, JZ Zhao 5 * Abstract
More informationOutcome of rectal cancer after radiotherapy with a long or short waiting period before surgery, a descriptive clinical study
Original Article Outcome of rectal cancer after radiotherapy with a long or short waiting period before surgery, a descriptive clinical study Elmer E. van Eeghen 1, Frank den Boer 2, Sandra D. Bakker 1,
More informationRisk Factors for Spinal Surgical Site Infection, Houston, Texas
infection control and hospital epidemiology september 2009, vol. 30, no. 9 original article Risk Factors for Spinal Surgical Site Infection, Houston, Texas Kelley M. Boston, MPH; Sarah Baraniuk, PhD; Shana
More informationPredictors of Averse Events After Total Laryngectomy: An Analysis of the NSQIP Datasets
Research Article J o u r n a l o f O t o l a r y n g o l o g y A d v a n c e s ISSN NO: 2379-8572 DOI : 10.14302/issn.2379-8572.joa-14-429 Predictors of Averse Events After Total Laryngectomy: An Analysis
More informationThe surgical management of subglottic stenosis (SGS)
Original Research Pediatric Otolaryngology Short- versus Long-term Stenting in Children with Subglottic Stenosis Undergoing Laryngotracheal Reconstruction Otolaryngology Head and Neck Surgery 2018, Vol.
More informationPlate Exposure after Reconstruction by Plate and Anterolateral Thigh Flap in Head and Neck Cancer Patients with composite mandibular Defects
Plate Exposure after Reconstruction by Plate and Anterolateral Thigh Flap in Head and Neck Cancer Patients with composite mandibular Defects Chia-Hsuan Tsai/ Huang-Kai Kao M. D. Introduction Malignant
More informationTobacco Exposure and Complications in Conservative Laryngeal Surgery
Cancers 2014, 6, 1727-1735; doi:10.3390/cancers6031727 Article OPEN ACCESS cancers ISSN 2072-6694 www.mdpi.com/journal/cancers Tobacco Exposure and Complications in Conservative Laryngeal Surgery Francesca
More informationSelf-Assessment Module 2016 Annual Refresher Course
LS16031305 The Management of s With r. Lin Learning Objectives: 1. To understand the changing demographics of oropharynx cancer, and the impact of human papillomavirus on overall survival and the patterns
More informationThree months study of orthopaedic surgical site infections in an Egyptian University hospital
International Journal of Infection Control www.ijic.info ISSN 1996-9783 original article Three months study of orthopaedic surgical site infections in an Egyptian University hospital Ibtesam K Afifi 1,
More informationClinical Study Mucosal Melanoma in the Head and Neck Region: Different Clinical Features and Same Outcome to Cutaneous Melanoma
ISRN Dermatology Volume 2013, Article ID 586915, 5 pages http://dx.doi.org/10.1155/2013/586915 Clinical Study Mucosal Melanoma in the Head and Neck Region: Different Clinical Features and Same Outcome
More informationLocoregional recurrences are the most frequent
ORIGINAL ARTICLE SECOND SALVAGE SURGERY FOR RE-RECURRENT ORAL CAVITY AND OROPHARYNX CARCINOMA Ivan Marcelo Gonçalves Agra, MD, PhD, 1 João Gonçalves Filho, MD, PhD, 2 Everton Pontes Martins, MD, PhD, 2
More informationTitle. CitationInternational Journal of Clinical Oncology, 20(6): 1. Issue Date Doc URL. Rights. Type. File Information
Title Clinical outcomes of weekly cisplatin chemoradiother Sakashita, Tomohiro; Homma, Akihiro; Hatakeyama, Hir Author(s) Takatsugu; Iizuka, Satoshi; Onimaru, Rikiya; Tsuchiy CitationInternational Journal
More informationThe influence of closure technique in total laryngectomy on the development of a pseudo-diverticulum and dysphagia
Eur Arch Otorhinolaryngol (2017) 274:1967 1973 DOI 10.1007/s00405-016-4424-4 HEAD AND NECK The influence of closure technique in total laryngectomy on the development of a pseudo-diverticulum and dysphagia
More informationPediatric partial cricotracheal resection: A new technique for the posterior cricoid anastomosis
Otolaryngology Head and Neck Surgery (2006) 135, 318-322 ORIGINAL RESEARCH Pediatric partial cricotracheal resection: A new technique for the posterior cricoid anastomosis Mark E. Boseley, MD, and Christopher
More informationESPEN Congress Leipzig 2013
ESPEN Congress Leipzig 2013 Nutrition and cancer: impact on outcome Survival, quality of life, reduced toxicity: what can be achieved in cancer patients? M.A.E. van Bokhorst - de van der Schueren (NL)
More informationOverview of the WHO global guidelines for the prevention of surgical site infection
Overview of the WHO global guidelines for the prevention of surgical site infection Dr. Mohamed Abbas, MD, MS Semmelweiss CEE Conference Budapest 08.03.2017 Outline of presentation General background Burden
More informationVered Richter. Abstract
Surgical site infection rates and Post-discharge surveillance in the department of general surgery at Hadassah Ein-Kerem and validation of telephone surveillance Vered Richter Abstract Background Rates
More informationCigdem Benlice, Ipek Sapci, T. Bora Cengiz, Luca Stocchi, Michael Valente, Tracy Hull, Scott R. Steele, Emre Gorgun 07/23/2018
Does preoperative oral antibiotic or mechanical bowel preparation increase Clostridium difficile colitis after colon surgery? An assessment from ACS-NSQIP procedure-targeted database Cigdem Benlice, Ipek
More informationTreatment for Supraglottic Ca History: : Total Laryngectomy y was routine until early 50 s, when XRT was developed Ogura and Som developed the one-sta
Role of Laser Therapy in Laryngeal Cancer Khalid Hussain AL-Qahtani MD,MSc,FRCS(c) MSc Assistant Professor Consultant of Otolaryngology Advance Head & Neck Oncology, Thyroid & Parathyroid,Microvascular
More informationSpine Postoperative Infections: Risk Factors
Spine Postoperative Infections: Risk Factors Tomás Funes 1, 2 MD, Donato Pacione1 MD, Stephen Kalhorn 1 MD, Pablo Jalón 2 MD, Anthony Frempong-Boadu1 MD, Juan José Mezzadri 2 MD, PhD 1 Department of Neurosurgery,
More informationOverview. Stanley J. Rogers, MD, FACS Associate Clinical Professor of Surgery University of California San Francisco
GASTROINTESTINAL COMPLICATIONS AFTER BARIATRIC SURGERY Stanley J. Rogers, MD, FACS Associate Clinical Professor of Surgery University of California San Francisco UCSF DEPARTMENT OF SURGERY Original Article
More informationTreatment and predictive factors in patients with recurrent laryngeal carcinoma: A retrospective study
ONCOLOGY LETTERS 10: 3145-3152, 2015 Treatment and predictive factors in patients with recurrent laryngeal carcinoma: A retrospective study PEIJING LI 1*, WEIHAN HU 1*, YUAN ZHU 2 and JIANJIANG LIU 3 1
More informationIn CONTROL Fact Sheet NUMBER 1 Updated April 2009
In CONTROL Fact Sheet NUMBER 1 Updated April 2009 HEALTH-CARE-ASSOCIATED INFECTIONS The goal of a dental infection control program is to provide a safe working environment that will reduce the risk of
More informationA multiple logistic regression analysis of complications following microsurgical breast reconstruction
Original Article A multiple logistic regression analysis of complications following microsurgical breast reconstruction Samir Rao 1, Ellen C. Stolle 1, Sarah Sher 1, Chun-Wang Lin 1, Bahram Momen 2, Maurice
More informationSurgical outcomes in cases of postoperative recurrence of primary oral cancer that required reconstruction
Acta Med. Nagasaki 60: 119 124 MS#AMN 07187 Surgical outcomes in cases of postoperative recurrence of primary oral cancer that required reconstruction Shinya Ji n n o u c h i, MD 1, Kenichi Ka n e ko,
More informationAssessing perioperative risk
Assessing perioperative risk Chronic Obstructive Pulmonary Disease Dr. Michelle Caldecott Respiratory & Sleep Physician Epworth Healthcare Austin Health Impact of COPD on Postoperative Outcomes: Results
More informationKatsuro Sato. Department of Speech, Language and Hearing Sciences, Niigata University of Health and Welfare, Niigata, Japan
Report Niigata Journal of Health and Welfare Vol. 12, No. 1 Retrospective analysis of head and neck cancer cases from the database of the Niigata Prefecture Head and Neck Malignant Tumor Registration Committee
More informationCompliance with SCIP core measures and the Impact on Surgical Site Infections
Compliance with SCIP core measures and the Impact on Surgical Site Infections Using NSQIP to Evaluate Patient Outcomes and Reimbursement Guidelines Rickesha L. Wilson, MD July 28, 2014 2014 ACS NSQIP National
More informationHead and Neck Reirradiation: Perils and Practice
Head and Neck Reirradiation: Perils and Practice David J. Sher, MD, MPH Department of Radiation Oncology Dana-Farber Cancer Institute/ Brigham and Women s Hospital Conflicts of Interest No conflicts of
More informationTemporal Trends in Demographics and Overall Survival of Non Small-Cell Lung Cancer Patients at Moffitt Cancer Center From 1986 to 2008
Special Report Temporal Trends in Demographics and Overall Survival of Non Small-Cell Lung Cancer Patients at Moffitt Cancer Center From 1986 to 2008 Matthew B. Schabath, PhD, Zachary J. Thompson, PhD,
More informationA Comparative Study for the Role of Preoperative Antibiotic Prophylaxis in Prevention of Surgical Site Infections
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 13, Issue 4 Ver. IV. (Apr. 2014), PP 27-31 A Comparative Study for the Role of Preoperative Antibiotic
More informationInfection Control: Surgical Site Infections
Infection Control: Surgical Site Infections Infectious Disease Epidemiology Section Office of Public Health Louisiana Dept of Health & Hospitals 800-256-2748 www.oph.dhh.louisiana.gov Your taxes at work
More informationAmerican Head and Neck Society - Journal Club Volume 9, December 2016
- Table of Contents click the page number to go to the summary and full article link. Does resident participation influence otolaryngology-head and neck surgery morbidity and mortality? page 1 Risk of
More informationSurgical Apgar Score Predicts Post- Laparatomy Complications
ORIGINAL ARTICLE Surgical Apgar Score Predicts Post- Laparatomy Complications Dullo M 1, Ogendo SWO 2, Nyaim EO 2 1 Kitui District Hospital 2 School of Medicine, University of Nairobi Correspondence to:
More informationNational Institute for Health and Care Excellence. NICE Quality Standards Consultation Surgical Site Infection. Closing date: 5pm 17 June 2013
National Institute for Health and Care Excellence NICE Quality Standards Consultation Surgical Site Infection Closing date: 5pm 17 June 2013 Organisation Title (e.g. Dr, Mr, Ms, Prof) Name Job title or
More informationClinical Study The Incidence and Management of Pleural Injuries Occurring during Open Nephrectomy
Advances in Urology Volume 2009, Article ID 948906, 4 pages doi:10.1155/2009/948906 Clinical Study The Incidence and Management of Pleural Injuries Occurring during Open Nephrectomy Ali Fuat Atmaca, Abdullah
More informationMethicillin-Resistant Staphylococcus aureus (MRSA) S urveillance Report 2008 Background Methods
Methicillin-Resistant Staphylococcus aureus (MRSA) Surveillance Report 2008 Oregon Active Bacterial Core Surveillance (ABCs) Office of Disease Prevention & Epidemiology Oregon Department of Human Services
More informationPosition Statement on Management of the Axilla in Patients with Invasive Breast Cancer
- Official Statement - Position Statement on Management of the Axilla in Patients with Invasive Breast Cancer Sentinel lymph node (SLN) biopsy has replaced axillary lymph node dissection (ALND) for the
More informationORIGINAL ARTICLE. Incidental Parathyroidectomy During Thyroid Surgery Does Not Cause Transient Symptomatic Hypocalcemia
ORIGINAL ARTICLE Incidental Parathyroidectomy During Thyroid Surgery Does Not Cause Transient Symptomatic Hypocalcemia Aaron R. Sasson, MD; James F. Pingpank, Jr, MD; R. Wesley Wetherington, MD; Alexandra
More informationNicolae Bacalbasa Carol Davila University Of Medicine and Pharmacy
Nicolae Bacalbasa Carol Davila University Of Medicine and Pharmacy Approximately 5% to 10% of breast cancers are metastatic at diagnosis (1) 50% of breast cancer patients will develop distant metastases
More informationSurgical Site Infection Prevention: International Consensus on Process
Surgical Site Infection Prevention: International Consensus on Process Joseph S. Solomkin, M.D. Professor of Surgery (Emeritus) University of Cincinnati College of Medicine and Executive Director, OASIS
More informationAmerican Head and Neck Society - Journal Club Volume 22, July 2018
- Table of Contents click the page number to go to the summary and full article link. Location and Causation of Residual Lymph Node Metastasis After Surgical Treatment of Regionally Advanced Differentiated
More informationPreoperative tests (update)
National Institute for Health and Care Excellence. Preoperative tests (update) Routine preoperative tests for elective surgery NICE guideline NG45 Appendix C: April 2016 Developed by the National Guideline
More informationManagement of Clostridium Difficile: Total Colectomy versus Colon Sparing Surgery
Management of Clostridium Difficile: Total Colectomy versus Colon Sparing Surgery Rahul Narang, MD Colon and Rectal Surgery Assistant Professor of Surgery No Disclosure Clostridium Difficile Colitis: Treatments,
More informationDose-dependent effects of tobramycin in an animal model of Pseudomonas sinusitis Am J Rhino Jul-Aug; 21(4):423-7
AMINOGLYCOSIDES Dose-dependent effects of tobramycin in an animal model of Pseudomonas sinusitis Am J Rhino. 2007 Jul-Aug; 21(4):423-7 http://www.ncbi.nlm.nih.gov/pubmed/17882910 Evaluation of the in-vivo
More information