Clean-Contaminated Neck Surgery

Abstract

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.