Risk factors for the occurrence of infection in patients with oral squamous cell carcinoma after restorative reconstruction and its impact on recurrence and quality of life: a retrospective cohort study

BACKGROUND: Worldwide, there are approximately 300,000 new cases of oral squamous cell carcinoma (OSCC) and 100,000 deaths each year. The complexity of oral and maxillofacial structures leads to a high risk of surgical infection such as radical tumor resection and free flap reconstruction. Previous studies have shown that diabetes mellitus, previous radiotherapy, oral-neck communication, etc. are risk factors for postoperative infection, but the influence of time on prognosis has not been clarified in detail. This study supplements this aspect and provided a reference for improving the quality of life of patients. METHODS: We retrospectively analyzed a total of 168 patients who developed OSCC from July 2014 to September 2019. According to the inclusion and exclusion criteria of this study, the general data questionnaire designed by ourselves was used to sort out the general characteristics and clinical data of the subjects. The t test, Chi-square test and binary logistic regression were used for statistical analysis. Surgical site infections (SSI) are defined as infections associated with surgical procedures. The quality of life was evaluated by the 36-Item Short Form Survey (SF-36) score. A 3-year follow-up was conducted by telephone, Email and outpatient review. RESULTS: Among the 168 patients, the total number of postoperative infections was 22 (13.1%). Binary logistic regression analysis showed that body mass index (BMI) (OR =0.029, P=0.039), American Society of Anesthesiologists (ASA) classification (OR =21.443, P=0.042), preoperative radiotherapy (OR =19.993, P=0.022), Jaw resection status (OR =29.665, P=0.021), Perioperative transfusion (OR =29.148, P=0.020), preoperative white blood cell count (OR =1.763, P=0.017), albumin level (OR =0.853, P=0.033) were independent influencing factors between the two groups (P<0.05). Except for the social functioning and role-emotional dimensions, all dimensions of SF-36 in patients with infection were significantly lower than those without infection. CONCLUSIONS: The incidence of postoperative infection after restorative and reconstructive surgery for OSCC deserves the attention of clinicians. For high-risk infected persons, relevant anti-infection measures should be taken early against the infectious source, and the possibility of nosocomial infection should be attached great importance in clinical work. After discharge, patients should also actively do follow-up, education and other related work to reduce the incidence of postoperative infection.