Complications and differences of wound healing comparing patients undergoing primary neck dissections and patients undergoing salvage neck dissections after chemoradiation in head and neck cancer.

Rouwenhorst, L. (Linda) (2014) Complications and differences of wound healing comparing patients undergoing primary neck dissections and patients undergoing salvage neck dissections after chemoradiation in head and neck cancer. thesis, Medicine.

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Abstract

Objective: To evaluate wound healing after neck dissections: its complications, influence of chemoradiation and patient-related factors that have impact on wound healing in patients with head and neck carcinoma. Design: 15-year retrospective cohort analysis Patients and methods: 203 neck dissections were performed in 189 patients, of which 99 patients (107 neck dissections) underwent chemoradiation therapy prior to neck dissection. Medical records were meticulously reviewed. Wound complications and patient-related factors that could influence wound healing were scored. Furthermore, complications were divided into major wound complications (complications requiring further operative intervention) and minor wound complications (complications without need of operative intervention). Results: Wound complications occurred in 35% of all neck dissections. Of all complications, 37% was a surgical site infection (SSI). Univariate regression analysis revealed that both comorbidity measured by a score above 1 on the American Society of Anesthesiologists (ASA) scale  (OR= 3.000, 95% CI= 0.062-0.885, P= 0.088) and chemoradiation therapy (OR= 2.833; 95% CI= 1.068-7.515, P= 0.036) were associated with higher probability of major wound complications. In contrary, a pre-surgery serum albumin > 44 g/l was associated with a decrease in major wound complications (OR = 0.234; 95% CI = 0.062-0.885, P= 0.032). Multivariate regression analysis revealed that smoking, diabetes mellitus and pre-surgery serum albumin > 44g/l together have impact on development of major wound complications; smoking (OR= 3.875; 95% CI= 1.093-13.742, P= 0.036) and diabetes mellitus (OR= 5.293; 95% CI= 0.907-30.887, P= 0.064) increase the probability of major wound complications and pre-surgery serum albumin > 44 g/l decreases the probability of major wound complications (OR= 0.314; 95% CI= 0.079-1.239, P= 0.098). Conclusions: The risk of wound complications in the present study is higher than described in literature. Surgical site infections are accountable for 37% of all wound complications. Comorbidity scored as ASA-score above 1-, chemoradiation therapy, smoking and diabetes mellitus increase the probability of major wound complications. Furthermore, a state of well-nutrition (measured by a pre-surgery serum albumin above 44 g/l) seems to be a protective factor against major wound complications.

Item Type:	Thesis (Thesis)
Supervisor name:	Geurts, T.W.
Supervisor name:	Henneman, R. and Balm, prof. A.J.M. and Nederlands Kanker Instituut
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:40
Last Modified:	25 Jun 2020 10:40
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/211

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