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Excessive inflammation portends complications: Wound cytokines and head and neck surgery outcomes
Author(s) -
Lassig Amy Anne D.,
Lindgren Bruce R.,
Itabiyi Ridwan,
Joseph Anne M.,
Gupta Kalpna
Publication year - 2019
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.27796
Subject(s) - medicine , vascular endothelial growth factor , wound healing , prospective cohort study , cytokine , malignancy , surgery , cohort , population , gastroenterology , vegf receptors , environmental health
Objectives/Hypothesis Postoperative wound‐healing complications can be devastating after head and neck surgery. Whereas many patients are expected to have more complications, few objective indicators predict these poorer outcomes. We evaluated wound healing in this population by studying the association between biomarkers and surgical outcomes. Study Design Prospective cohort study. Methods A study was performed of head and neck surgery patients at our tertiary care center, from 2012 to 2015. Postsurgical drain fluid was collected 24 hours postoperatively. Biomarkers of wound healing were assayed. These included interleukin (IL)‐1, ‐6, and ‐8; tumor necrosis factor (TNF)‐α; transforming growth factor β; epidermal growth factor; fibroblast growth factor; C‐reactive protein (CRP); vascular endothelial growth factor (VEGF); soluble fms‐like tyrosine kinase‐1; and placental growth factor. Patient characteristics and clinical outcomes were recorded. Two‐sample, two‐sided t tests evaluated differences in cytokine levels by clinical outcomes. Results Twenty‐eight patients were enrolled with drain fluid collection. IL‐1β, IL‐8, and matrix metalloproteinase (MMP)‐9 were significantly higher in the wound fluid of subjects with complications. Patients with longer length of stay in days had statistically higher levels of TNF‐α ( P = .011), IL‐6 ( P = .021), IL‐8 ( P = .004), IL‐1β ( P = .004), MMP‐1 ( P = .002), MMP‐2 ( P = .022), VEGF‐A ( P = .038), and CRP ( P < .001), and longer length of stay was associated with malignancy. There were no statistically significant associations between baseline clinical characteristics and post‐operative complications. Conclusions In this head and neck surgical cohort, higher IL‐1β, IL‐8, and MMP‐9 levels in wound fluid were associated with postoperative complications, and elevation of multiple proinflammatory cytokines was associated with longer length of stay. These findings suggest excessive inflammation in early wound healing may portend poorer clinical outcomes after head and neck surgery. Level of Evidence 2b Laryngoscope , 129:E238–E246, 2019