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 [P1.0], underweight [P=.26], anemia [P=.84], lymphocytopenia [P=.79 by Fisher exact test], number of preoperative hospitalizations [P1.0], 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.