Study Of Risk Factors Regarding To Antibiotic Prophylaxis Of Postoperative Site Infection In Patients With Oral Cancer

OBJECTIVE1.To investigate general characteristics of oral cancer patients,to provide reference for clinical diagnosis and treatment of oral cancer patients;2.To explore risk factors of postoperative surgical site infection（SSI）in patients who undergo surgical treatment of oral cancer,to provide reference for reducing the incidence of SSI;3.To explore the risk factors regarding to perioperative antimicrobial prophylaxis of surgical site infection,to provide reference for clinical antibiotic administration precisely,pragmatically,individually for oral cancer patients.METHODSA retrospective study was conducted on 214 patients with oral cancer surgery who were admitted from 2018.07.01 to 2020.06.30 in The First Affiliated Hospital of Anhui Medical University.Twenty-five clinical data were investigated,including three aspects: individual,surgery,antimicrobial prophylaxis and treatment,including:The clinical date of the patient such as Age,Gender,Basic diseases,Body mass index,Length of stay before operation,Smoking,Drinking,Tumor size,Tumor localization,Tumor stage,the Differentiation of oral squamous cell,ASA class,Preoperative chemotherapy,Type of wound closure,Dissection,Tracheostomy,Titanium plate implantation,Operative time,NNIS score,The type of antibiotics before general anesthesia,Additional antibiotics after three operative hours,Nesogastric feeding,Number of drainage days.Summarize the epidemiological characteristics of the general population,And the risk factors of the surgical site infection were analyzed by univariate and multivariate logistic regression analyses.RESULTS1.Among 214 cases,47 showed postoperative SSI,and the infection rate was21.96%.here were 106 patients（49.53%）with systemic diseases,including 57patients（26.64%）with hypertension and 24 patients（11.21%）with diabetes.91（42.52%）had abnormal BMI;59（27.57%）had smoking history,60（28.04%）had drinking history;The most commom pathologic type of oral cancer is squamous cell carcinoma,which has 188 cases（87.85%）,and 117 cases（54.67%）of highly differentiated.The top three sites of incidence rate were buccal in 63 cases（29.44%）,tongue in 60 cases（28.04%）and lower gingival in 30 cases（14.02%）.There were 128cases（59.82%）whose primary lesion diameter was more than 2cm at initial diagnosis.2.33 patients（15.4%）received antibiotics before surgery,with an average duration of（4.00±3.59）days;All patients received prophylactic antibiotics 30 minutes before surgery.The average duration of postoperative antibiotic prophylaxis using in patients without SSI was（8.41±3.27）days;The mean duration of postoperative antibiotic use in patients with SSI was（11.02±3.68）days.3.In univariate analysis,the size of the primary lesion,TNM stage,lymph node dissection,partial/total resection of the jaw,titanium plate reconstruction,tracheotomy,surgical duration,NNIS score,nasal feeding,and type of preoperative antibiotics before incision within 30 min were associated with the occurrence rate of SSI.In Logistic regression analysis,surgical duration and the type of antibiotics before incision within 30 min were independent risk factors for SSI occurrence rate in patients with oral cancer.4.The area under the receiver operating characteristic（ROC）curve（AUC）of overall samples is 0.687.CONCLUSION1.Most patients with oral cancer are middle-aged and elderly,and most of them have systemic diseases,so Multidisciplinary Team model should be adopted clinically.The awareness of oral cancer is not strong,so we should strengthen the publicity of oral cancer science knowledge and carry out precancer screening actively.2.Oral cancer surgery is complicated and sophisticated,and the incidence of SSI is high,which is closely related to a variety of factors.Currently,the NNIS risk index dividing the operation time by 3 hours has a low predictive ability for the SSI.High attention should be paid to the prevention of SSI in oral cancer patients.Various related factors of SSI in patients should be fully evaluated before surgery,and teamwork should be adopted to reduce the operation time as much as possible.3.Antibiotics are widely used in oral cancer patients,and the types of prophylactic antibiotics are closely related to the incidence of SSI in oral cancer.Even different antibiotics of the same type have different effects on SSI prevention.The duration of postoperative antibiotic prophylactic using is longer,which needs large sample case-control researches to explore in oral cancer patients.