Establishing a role for the oral microbiome in infectious complications following major oral cavity cancer surgery.

Surgery forms the backbone of treatment for most locoregional or advanced oral cavity squamous cell carcinoma. Unfortunately, infectious complications (including orocutaneous fistulas) are common following such extensive surgery and can afflict over half of patients. These complications can lead to delays in adjuvant treatment, prolonged hospitalization, reconstructive failure, and decreased quality of life. The frequency and morbidity associated with infectious complications has led to the search for pre-disposing risk factors; and, several have been identified, including both patient (e.g. diabetes) and surgical (e.g. operative time) factors. However, these findings are inconsistently reproduced, and risk factor modification has had a limited impact on rates of infectious complications. This is striking given that the likely contaminant-the oral microbiome-is a well-studied microbial reservoir. Because many oral cavity cancer surgeries involve violation of oral mucosa and the spillage of the oral microbiome into normally sterile areas (e.g. the neck), variance in oral microbiome composition and function could underly differences in infectious complications. The goal of this perspective is to highlight 1) this knowledge gap and 2) opportunities for studies in this domain. The implication of this line of thought is that the identification of oral microbial dysbiosis in patients undergoing surgery for oral cavity cancer could lead to targeted pre-operative therapeutic interventions, decreased infectious complications, and improved patient outcomes.

Time-to-operation delays and in-hospital complications in operative facial trauma: A national analysis.

BACKGROUND: Management of facial fractures is variable. Understanding how time to operative management impacts outcomes can help standardize practice. METHODS: Retrospective analysis of the ACS Trauma Quality Improvement Program (TQIP) database between 2016 and 2019. Adult patients with operative facial fractures were isolated by ICD-10 procedure codes, and further stratified by fracture location, including the mandible, orbit, maxilla, zygoma, and frontal bone. Multivariable logistic regression was conducted to predict in-hospital complications (both surgical and systemic complications) adjusting for time-to-operation, comorbidities, fracture location, AIS, and demographics. RESULTS: 1678 patients with operative facial fractures were identified. The median time-to-operation was 2 days (IQR 1.0-2.0 days). Most patients only had one operative fracture (95 %) and orbital fracture was the most common (44 %). The overall complication rate was higher for those operated after 2 days compared to those operated between 1 and 2 days and within 24 h (2.8 % vs 0.6 % vs 0.7 %; p < 0.001). Patients who were operated on after 48 h exhibited an increased risk of any complication (OR 4.72, 95 % CI 1.49-16.6, p = 0.010) on multivariable models. CONCLUSION: Delays in the management of facial fractures are associated with more in-hospital complications. However, the incidence of short-term postoperative complications remains low. Injury characteristics are the primary predictor of delays in operation, however Hispanic patients independently experienced delays in care.

Analyzing the Correlation Between Surgeon Experience and Patient Length of Hospital Stay.

Introduction  Many clinical, social, and even economic factors have been extensively analyzed in the literature and shown to influence the length of stay (LOS) after spinal procedures. However, surgeon's experience was mostly examined relative to a learning curve and not regarding the time in practice. The primary objective of this study was to determine the effect of one surgeon's experience on the LOS in patients undergoing one- to two-level transforaminal lumbar interbody fusions (TLIFs). Materials and Methods  The study design was a retrospective cohort study of hospital discharge data. The cohort was comprised of 240 consecutive patients who had undergone open one- or two-level elective TLIF procedures for lumbar degenerative disc disease. The primary predictor was the surgeon's experience based upon the years of practice. The primary outcome was LOS, which was controlled by the discharge criteria that remained consistent throughout the study. Results  Based on the Poisson regression model, it can be inferred that the LOS is not significantly associated with a surgeon's experience (Pr(>|t|) = 0.8985, CI: -0.5825 to 0.5114) while controlling for all other variables. Other independent factors did seem to significantly influence patients' LOS, including the admission type (Pr(>|t|) = 9.637-08, CI: -0.8186 to -0.3786), the number of TLIF levels (Pr(>|t|) = 1.721-06, CI: 0.0606 to 0.1446), the Clavien-Dindo ( Pr(>|t|) = 0, CI: 0.1489 to 0.1494), the American Society of Anesthesiologists (ASA) physical status classification scores (Pr(>|t|) = 4.878-3, CI: 0.0336 to 0.1880), and being discharged to skilled nursing facility (Pr(>|t|) = 3.44-2, CI: 0.0127 to 0.3339). Conclusions Based upon the years in practice, surgeon experience was not associated with length of hospitalization and estimated blood loss during surgery in patients undergoing one- and two-level TLIF surgeries. However, while controlling for all other variables, the surgeon's experience and surgical time had a highly significant correlation. The study results clearly demonstrated efficiency, but we did not identify a clear correlation between LOS and surgeon experience overtime suggesting that other factors are likely contributing to such outcome. The average LOS is a complex measure of healthcare resource use and hospital discharge policy or other variables are likely having more effect on LOS than individual surgeons' preferences.

The impact of BMI on operating room time, blood loss, and hospital stay in patients undergoing spinal fusion.

OBJECTIVE: Obesity affects not only the health of an individual but society as a whole and especially the healthcare system. Healthcare providers are faced with challenges to deliver adequate care in this resource-limited environment, assure safety, and accommodate the increasing population of overweight patients. The effects of increased body mass index (BMI) on clinical outcomes, complications, health care resource utilization, effectiveness of minimally invasive approaches, and perioperative parameters in spine surgeries have all been previously studied, but the majority of these findings are conflicting rather than conclusive. The main objective of this study was to analyze the impact of BMI on perioperative outcomes in patients undergoing one- to two-level elective TLIF procedures for degenerative spine conditions and to identify the need to modify internal hospital operational planning, team organization, and patient flow processes to accommodate patients who are overweight. PATIENTS AND METHODS: A single-center retrospective case-review study was completed. The study included 172 consecutive patients who underwent elective one- or two-level transforaminal lumbar interbody fusions (TLIF). The patients were categorized as obese if they had BMI value that was equal to or greater than 30 kg/m2. Outcome measures included surgical and non-operative operating room (OR) time, length of stay (LOS), and estimated blood loss (EBL). Multiple regression analyses were performed to determine if BMI had an effect on perioperative parameters while controlling for independent variables. RESULTS: BMI did not have a statistically significant effect on surgical (p = 0.13) and non-operative OR time (p = 0.82). Obese patients remained hospitalized on average 0.45 ± 0.25 days longer (p = 0.037) and lost 71.8 ± 26.3 mL more blood (p = 0.007). CONCLUSIONS: Obesity is associated with longer hospitalization and more intraoperative blood loss, but may have no impact on surgical and non-operative OR times in patients undergoing one- and two-level TLIFs.