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Original Article
September 2006

Clean-Contaminated Neck Surgery: Risk of Infection by Intrinsic and Extrinsic Factors

Author Affiliations

Author Affiliations: Departments of Otorhinolaryngology “Giorgio Ferreri” (Drs Fusconi, Gallo, Pagliuca, Pulice, and de Vincentiis) and Statistics (Ms Vitiello), “La Sapienza” University of Rome, Rome, Italy.

Arch Otolaryngol Head Neck Surg. 2006;132(9):953-957. doi:10.1001/archotol.132.9.953

Objective  To evaluate the risk of surgical wound infection (the most common complication in neoplastic clean-contaminated neck surgery) due to 10 intrinsic risk factors and 5 extrinsic risk factors.

Design  Retrospective clinical study.

Setting  Academic tertiary referral medical center.

Patients  The study group included 115 patients with laryngeal carcinomas referred to our department from January 1, 1996, to August 31, 2002.

Intervention  Fifty-seven patients underwent total laryngectomy and 58 underwent subtotal laryngectomy.

Main Outcome Measures  The association between surgical wound infection due to 10 intrinsic risk factors and 5 extrinsic risk factors was evaluated with multivariate models.

Results  Surgical wound infection occurred in 27 patients (23.5%). There was no significant increase in the incidence of infection in patients with extensive tumors (P>.20) and in patients undergoing total laryngectomy and subtotal laryngectomy (P>.20). The incidence of infection was significantly higher in patients with stage IV disease (P<.01), in patients who underwent neck dissections (P<.05), and in those presenting with lymph node metastases (P<.001). Multivariate analysis showed that the presence of higher tumor stage is the best predictor of infection because it is the only significant factor (P<.03) even when adjusting for others. The association between infection and the other factors considered in this study (age [P>1.0], underweight [P = .26], anemia [P = .84], lymphocytopenia [P = .79 by Fisher exact test], number of preoperative hospitalizations [P<1.0], preoperative radiotherapy [P = .57 by Fisher exact test], diabetes mellitus [P = .70 by Fisher exact test], cirrhosis, resection margins infiltrated by the tumor [P = .57 by Fisher exact test], and myocutaneous flap reconstructions [P = .82]) was not significant.

Conclusion  The risk of surgical wound infection is correlated with a higher tumor stage and lymph node metastases; it is not associated with the extent of surgery or other factors considered.