Incidence and risk factors of surgical site infection in patients with head and neck cancer: A meta-analysis

Abstract

We systematically review the incidence and risk factors of surgical site infection (SSI) in patients with head and neck cancer. PubMed, Embase, Cochrane Library, and Web of Science databases were searched to obtain studies on the risk factors for SSI in patients with HNC. The retrieval time was from the establishment of the database to February 2023. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias in included studies. Meta-analysis was performed by using Stata 15.1 software. A total of 32 articles including 128 919 patients with head and neck cancer and 2949 cases of SSI were included in this meta-analysis. The incidence rate of SSI in head and neck cancer ranges from 19% to 29%, and the overall infection rate was 24%. Meta-analysis indicated that BMI < 20 kg/m² (OR, 2.64; 95% CI, 1.74-4.00; I² , 0%), diabetes (OR, 3.00; 95% CI, 2.12-4.16; I² , 60.6%), ASA score (OR, 1.51; 95% CI, 1.29-1.77; I² , 0%), radiotherapy (OR, 2.27; 95% CI, 1.87-2.77; I² , 44.8%), chemotherapy (OR, 2.36; 95% CI, 1.64-3.40; I² , 0%), clindamycin antibiotic (OR, 2.99; 95% CI, 1.82-2.93; I² , 36.5%), deficit repair (OR, 3.76; 95% CI, 1.22-11.59; I² , 91.4%), neck dissection (OR, 2.13; 95% CI, 1.63-2.79; I² , 16.4%), blood transfusion (OR, 2.29; 95% CI, 1.52-3.45; I² , 66.2%), mandibular (OR, 3.17; 95% CI, 1.85-5.42; I² , 73%), tracheostomy (OR, 2.51; 95% CI, 1.74-3.62; I² , 86.4%), operation time (OR, 1.42; 95% CI, 1.16-1.74; I² , 86.4%), ALB (OR, 2.48; 95% CI, 1.95-3.15; I² , 5.3%) were risk factors of surgical site infection in patients with head and neck cancer (p < 0.05). The results of the sensitivity analysis showed good agreement in all risk factors and the results had stability. The present meta-analysis suggests that BMI < 20 kg/m² , diabetes, ASA score, radiotherapy, chemotherapy, clindamycin antibiotic, deficit repair, neck dissection, blood transfusion, mandibular, tracheostomy, operation time, and ALB were significant risk factors for SSI.

Keywords: head and neck cancer; incidence; meta-analysis; risk factors; surgical site infection.