Antibiotic Prophylaxis and Postoperative Wound Infection Rates in Salvage Surgery for Head and Neck Cancer

Abstract

Wound infections are the most common complication after free flap reconstruction of head and neck defects. Patients who have undergone prior chemoradiation have higher infection rates following surgery. We hypothesized that patients who undergo salvage surgery for recurrent or persistent head and neck cancer may benefit from prolonged antibiotic prophylaxis. The objectives are to determine the rate of infection in salvage surgery following chemoradiation and to determine type and duration of antibiotic prophylaxis. Retrospective review of patients with recurrent or persistent head and neck cancer who underwent clean-contaminated procedures with violation of the aerodigestive tract mucosa following radiation therapy or chemoradiation between 2010 to 2015 at Loyola University Medical Center. All patients underwent immediate reconstruction using a free flap or regional flap. Univariate analysis was performed. Outcomes measured included duration and type of antibiotic prophylaxis, development of postoperative surgical site infections, and common cultured pathogens. Sixty-six patients underwent salvage surgery with free flap reconstruction of which, 59 patients received antibiotic prophylaxis for more than 24 hours, 6 patients received it for less than 24 hours or less, and 1 patient received no antibiotic prophylaxis. The most common prophylactic antibiotics choices were clindamycin (38%) and ampicillinsulbactam (26%). Surgical site infections occurred in 56% (N=36) of patients, with mucocutaneous fistula as the most common (47.5%). Staphylococcus aureus and Pseudomonas aeruginosa were the most commonly cultured organisms. Eightysix percent of patients receiving perioperative antibiotics for less than 24 hours developed a wound infection compared to 51% of patients receiving antibiotics for greater than 24 hours (p=0.08). There is no benefit to extending antibiotic prophylaxis in patients undergoing salvage surgery beyond 24