Clean-contaminated neck surgery - Risk of infection by intrinsic and extrinsic factors

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.