Predictive factors of lethality and complications of deep fascial space infections of the neck
Autor(a) principal: | |
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Data de Publicação: | 2020 |
Outros Autores: | , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Revista do Colégio Brasileiro de Cirurgiões |
Texto Completo: | http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912020000100191 |
Resumo: | ABSTRACT Objective: to identify predictive factors for lethality and complications of deep fascial space infections of the neck (DFSIN), establishing an early and aggressive treatment in the neck before the progression to descending mediastinitis. Methods: we retrospectively analyzed 133 cases of DFSIN treated at Discipline of Head and Neck Surgery of the Medicine School of Santa Casa de Misericórdia de São Paulo. We accessed demographic characteristics, associated diseases, clinical presentation, laboratorial tests, length of hospital stay, number of involved anatomic neck spaces, intra-operative and microbiology findings. We analyzed these data using logistic regression to predict DFSIN lethality and life threatening complications (mediastinitis, septic shock, pneumonia, pleural empyema, skin necrosis). Results: lethality and complication ratios were 9% and 50.3%, respectively. The logistic regression model showed that patients with septic shock were more likely to have progression to death (p < 0.001) and, the presence of more than two involved neck spaces (p < 0.001) and older individuals (p = 0.017) were more likely to have complicated deep neck infections. Descending necrotizing mediatinitis increased the lethality ratio by 50%, and was associated to necrotizing fasciitis (p=0.012) and pleural empyema (p<0.001). Conclusion: septic shock is a lethal predictive factor and age as well as more than two involved neck spaces are the predictive factors for complications. Necrotizing fasciitis is an important factor for complications and death. Therefore, its surgical treatment must be more aggressive. Descending mediastinitis has a high lethal rate and the successful treatment is based on early diagnosis and aggressive surgical approach. |
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Revista do Colégio Brasileiro de Cirurgiões |
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Predictive factors of lethality and complications of deep fascial space infections of the neckInfectionNeckNecrotizing FasciitisMortalityMediastinitisABSTRACT Objective: to identify predictive factors for lethality and complications of deep fascial space infections of the neck (DFSIN), establishing an early and aggressive treatment in the neck before the progression to descending mediastinitis. Methods: we retrospectively analyzed 133 cases of DFSIN treated at Discipline of Head and Neck Surgery of the Medicine School of Santa Casa de Misericórdia de São Paulo. We accessed demographic characteristics, associated diseases, clinical presentation, laboratorial tests, length of hospital stay, number of involved anatomic neck spaces, intra-operative and microbiology findings. We analyzed these data using logistic regression to predict DFSIN lethality and life threatening complications (mediastinitis, septic shock, pneumonia, pleural empyema, skin necrosis). Results: lethality and complication ratios were 9% and 50.3%, respectively. The logistic regression model showed that patients with septic shock were more likely to have progression to death (p < 0.001) and, the presence of more than two involved neck spaces (p < 0.001) and older individuals (p = 0.017) were more likely to have complicated deep neck infections. Descending necrotizing mediatinitis increased the lethality ratio by 50%, and was associated to necrotizing fasciitis (p=0.012) and pleural empyema (p<0.001). Conclusion: septic shock is a lethal predictive factor and age as well as more than two involved neck spaces are the predictive factors for complications. Necrotizing fasciitis is an important factor for complications and death. Therefore, its surgical treatment must be more aggressive. Descending mediastinitis has a high lethal rate and the successful treatment is based on early diagnosis and aggressive surgical approach.Colégio Brasileiro de Cirurgiões2020-01-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912020000100191Revista do Colégio Brasileiro de Cirurgiões v.47 2020reponame:Revista do Colégio Brasileiro de Cirurgiõesinstname:Colégio Brasileiro de Cirurgiões (CBC)instacron:CBC10.1590/0100-6991e-20202524info:eu-repo/semantics/openAccessSUEHARA,ALEXANDRE BABÁRODRIGUES,ANDRÉ AFONSO NIMITZKAVABATA,NORBERTO KODIMENEZES,MARCELO BENEDITORAMOS,EVELYN DE ALMEIDAKAWAMUKAI,JULIA NASCIMENTOGONÇALVES,ANTONIO JOSÉeng2020-09-02T00:00:00Zoai:scielo:S0100-69912020000100191Revistahttp://www.scielo.br/rcbcONGhttps://old.scielo.br/oai/scielo-oai.php||revistacbc@cbc.org.br1809-45460100-6991opendoar:2020-09-02T00:00Revista do Colégio Brasileiro de Cirurgiões - Colégio Brasileiro de Cirurgiões (CBC)false |
dc.title.none.fl_str_mv |
Predictive factors of lethality and complications of deep fascial space infections of the neck |
title |
Predictive factors of lethality and complications of deep fascial space infections of the neck |
spellingShingle |
Predictive factors of lethality and complications of deep fascial space infections of the neck SUEHARA,ALEXANDRE BABÁ Infection Neck Necrotizing Fasciitis Mortality Mediastinitis |
title_short |
Predictive factors of lethality and complications of deep fascial space infections of the neck |
title_full |
Predictive factors of lethality and complications of deep fascial space infections of the neck |
title_fullStr |
Predictive factors of lethality and complications of deep fascial space infections of the neck |
title_full_unstemmed |
Predictive factors of lethality and complications of deep fascial space infections of the neck |
title_sort |
Predictive factors of lethality and complications of deep fascial space infections of the neck |
author |
SUEHARA,ALEXANDRE BABÁ |
author_facet |
SUEHARA,ALEXANDRE BABÁ RODRIGUES,ANDRÉ AFONSO NIMITZ KAVABATA,NORBERTO KODI MENEZES,MARCELO BENEDITO RAMOS,EVELYN DE ALMEIDA KAWAMUKAI,JULIA NASCIMENTO GONÇALVES,ANTONIO JOSÉ |
author_role |
author |
author2 |
RODRIGUES,ANDRÉ AFONSO NIMITZ KAVABATA,NORBERTO KODI MENEZES,MARCELO BENEDITO RAMOS,EVELYN DE ALMEIDA KAWAMUKAI,JULIA NASCIMENTO GONÇALVES,ANTONIO JOSÉ |
author2_role |
author author author author author author |
dc.contributor.author.fl_str_mv |
SUEHARA,ALEXANDRE BABÁ RODRIGUES,ANDRÉ AFONSO NIMITZ KAVABATA,NORBERTO KODI MENEZES,MARCELO BENEDITO RAMOS,EVELYN DE ALMEIDA KAWAMUKAI,JULIA NASCIMENTO GONÇALVES,ANTONIO JOSÉ |
dc.subject.por.fl_str_mv |
Infection Neck Necrotizing Fasciitis Mortality Mediastinitis |
topic |
Infection Neck Necrotizing Fasciitis Mortality Mediastinitis |
description |
ABSTRACT Objective: to identify predictive factors for lethality and complications of deep fascial space infections of the neck (DFSIN), establishing an early and aggressive treatment in the neck before the progression to descending mediastinitis. Methods: we retrospectively analyzed 133 cases of DFSIN treated at Discipline of Head and Neck Surgery of the Medicine School of Santa Casa de Misericórdia de São Paulo. We accessed demographic characteristics, associated diseases, clinical presentation, laboratorial tests, length of hospital stay, number of involved anatomic neck spaces, intra-operative and microbiology findings. We analyzed these data using logistic regression to predict DFSIN lethality and life threatening complications (mediastinitis, septic shock, pneumonia, pleural empyema, skin necrosis). Results: lethality and complication ratios were 9% and 50.3%, respectively. The logistic regression model showed that patients with septic shock were more likely to have progression to death (p < 0.001) and, the presence of more than two involved neck spaces (p < 0.001) and older individuals (p = 0.017) were more likely to have complicated deep neck infections. Descending necrotizing mediatinitis increased the lethality ratio by 50%, and was associated to necrotizing fasciitis (p=0.012) and pleural empyema (p<0.001). Conclusion: septic shock is a lethal predictive factor and age as well as more than two involved neck spaces are the predictive factors for complications. Necrotizing fasciitis is an important factor for complications and death. Therefore, its surgical treatment must be more aggressive. Descending mediastinitis has a high lethal rate and the successful treatment is based on early diagnosis and aggressive surgical approach. |
publishDate |
2020 |
dc.date.none.fl_str_mv |
2020-01-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912020000100191 |
url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912020000100191 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
10.1590/0100-6991e-20202524 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Colégio Brasileiro de Cirurgiões |
publisher.none.fl_str_mv |
Colégio Brasileiro de Cirurgiões |
dc.source.none.fl_str_mv |
Revista do Colégio Brasileiro de Cirurgiões v.47 2020 reponame:Revista do Colégio Brasileiro de Cirurgiões instname:Colégio Brasileiro de Cirurgiões (CBC) instacron:CBC |
instname_str |
Colégio Brasileiro de Cirurgiões (CBC) |
instacron_str |
CBC |
institution |
CBC |
reponame_str |
Revista do Colégio Brasileiro de Cirurgiões |
collection |
Revista do Colégio Brasileiro de Cirurgiões |
repository.name.fl_str_mv |
Revista do Colégio Brasileiro de Cirurgiões - Colégio Brasileiro de Cirurgiões (CBC) |
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||revistacbc@cbc.org.br |
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1754209214964695040 |