RISK-FACTORS FOR COMPLICATIONS IN CLEAN-CONTAMINATED HEAD AND NECK SURGICAL-PROCEDURES

Background. Contamination of a head and neck surgical wound with oroph aryngeal secretions has been shown to dramatically increase the incide nce of wound complications. Appropriate perioperative antibiotic proph ylaxis has significantly reduced contaminated wound infection rates in several previous reports. The current study examined multiple patient parameters to determine risk factors for all perioperative complicati ons following clean-contaminated head and neck surgical procedures. Me thods. Retrospective review of medical records from 159 patients who u nderwent clean-contaminated major head and neck surgical procedures at the University of Washington between 1985 and 1991. More than 30 preo perative and operative parameters were evaluated, and all complication s were recorded. The data were examined using a multivariate statistic al analysis. Results. An overall complication rate of 63% included 22% with wound infections (oro/pharyngocutaneous fistula or purulent drai nage), 22% with other types of infections, and 51% with noninfectious complications. The overall perioperative mortality rate was 1.2% (two patients). Prior radiotherapy, operative time, perioperative transfusi on, and flap reconstruction were all associated with a significantly h igher overall complication rate (p less-than-or-equal-to 0.05). Only p rior radiotherapy therapy correlated with an increase in wound infecti on rate (p = 0.05). Conclusions. Prior radiotherapy significantly incr eases the risk of perioperative complications and wound infections fol lowing clean-contaminated head and neck surgical procedures. Other fac tors reflecting the complexity of the procedure also influence the ove rall complication rate. (C) 1995 John Wiley & Sons, Inc.