Assessment of Factors Associated With Long-Term Hospitalization in Patients With a Deep Neck Infection.

BACKGROUND: Deep neck infection (DNI) is a severe infectious disorder of deep neck spaces that can cause serious complications. Long-term hospitalization is when a patient spends more time in the hospital than originally expected for a disease. There are few studies assessing the risk factors associated with long-term hospitalization for a DNI. This study investigated the factors causing DNI patients to experience long-term hospitalization. METHODS: Long-term hospitalization is defined as a length of hospital stay exceeding 28 days (> 4 weeks) in this research. A total of 362 subjects with a DNI between October 2017 and November 2022 were recruited. Among these patients, 20 required long-term hospitalization. The relevant clinical variables were assessed. RESULTS: In a univariate analysis, C-reactive protein (odds ratio [OR] = 1.003, 95% CI: 1.000-1.007, P = .044), involvement of ≥3 deep neck spaces (OR = 2.836, 95% CI: 1.140-7.050, P = .024), and mediastinitis (OR = 8.102, 95% CI: 3.041-21.58, P < .001) were significant risk factors for long-term hospitalization in DNI patients. In a multivariate analysis, mediastinitis (OR = 6.018, 95% CI: 2.058-17.59, P = .001) was a significant independent risk factor for long-term hospitalization for a DNI. There were no significant differences in pathogens between the patients with and without long-term hospitalization (all P > .05). However, the rates of no growth of specific pathogens were significantly different between patients with and without long-term hospitalization, and those with long-term hospitalization had greater rates of growth of specific pathogens (P = .032). The rate of tracheostomy in patients with long-term hospitalization was higher than for those without (P < .001). Nevertheless, the rates of surgical incision and drainage between patients with and without long-term hospitalization did not achieve statistical significance (P = .069). CONCLUSIONS: Deep neck infection (DNI) is a critical, life-threatening disease that could lead to long-term hospitalization. The higher CRP and involvement of ≥3 deep neck spaces were significant risk factors in univariate analysis, while concurrent mediastinitis was an independent risk factor associated with long-term hospitalization. We suggest intensive care and prompt airway protection for DNI patients with concurrent mediastinitis.

Factors Creating a Need for Repeated Drainage of Deep Neck Infections.

Deep neck infection (DNI) is associated with morbidity and mortality. Surgical incision and drainage (I&D) of DNI abscesses are essential. Refractory abscesses require repeat I&D. Few studies have assessed the risk factors associated with repeat I&D; here, we investigated such factors. In total, 605 patients with DNI were enrolled between July 2016 and February 2022. Of these patients, 107 underwent repeat I&D. Clinical variables were assessed. On univariate analysis, a high blood sugar level (odds ratio (OR) = 1.006, p < 0.001), the involvement of at least four neck spaces (OR = 15.44, p < 0.001), and mediastinitis (OR = 1.787, p = 0.040) were significant risk factors for repeat I&D. On multivariate analysis, a high blood sugar level (OR = 1.005, p < 0.001) and the involvement of at least four neck spaces (OR = 14.79, p < 0.001) were significant independent risk factors for repeat I&D. Patients who required repeat I&D had longer hospital stays and a higher tracheostomy rate than did other patients (both p < 0.05). The pathogens did not differ between patients who did and did not require repeat surgical I&D (all p > 0.05), but the rates of pathogen non-growth from blood cultures were 19.47% (97/498) in the group without a need for repeat I&D and 0.93% (1/107) in the group with such a need (p < 0.001). DNI can be fatal; a higher blood sugar level and the involvement of at least four neck spaces were independent risk factors for repeat surgical I&D. If at least four neck spaces are involved, we recommend controlling the blood sugar level after admission. We found significant differences in the length of hospital stay and the need for tracheostomy between groups who did and did not require repeat surgical I&D. Although the pathogens did not differ between the groups, pathogen non-growth from blood cultures was less common in the group with for repeat surgical I&D than in the group without such a need.