Girod D A, McCulloch T M, Tsue T T, Weymuller E A
Department of Otolaryngology-Head and Neck Surgery, Naval Hospital, Oakland, California.
Head Neck. 1995 Jan-Feb;17(1):7-13. doi: 10.1002/hed.2880170103.
Contamination of a head and neck surgical wound with oropharyngeal secretions has been shown to dramatically increase the incidence of wound complications. Appropriate perioperative antibiotic prophylaxis 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 complications following clean-contaminated head and neck surgical procedures.
Retrospective review of medical records from 159 patients who underwent clean-contaminated major head and neck surgical procedures at the University of Washington between 1985 and 1991. More than 30 preoperative and operative parameters were evaluated, and all complications were recorded. The data were examined using a multivariate statistical analysis.
An overall complication rate of 63% included 22% with wound infections (oro/pharyngocutaneous fistula or purulent drainage), 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 transfusion, and flap reconstruction were all associated with a significantly higher overall complication rate (p < or = 0.05). Only prior radiotherapy therapy correlated with an increase in wound infection rate (p = 0.05).
Prior radiotherapy significantly increases the risk of perioperative complications and wound infections following clean-contaminated head and neck surgical procedures. Other factors reflecting the complexity of the procedure also influence the overall complication rate.
头颈部手术伤口被口咽分泌物污染已被证明会显著增加伤口并发症的发生率。在先前的几份报告中，适当的围手术期抗生素预防已显著降低了污染伤口的感染率。本研究检查了多个患者参数，以确定清洁-污染性头颈部外科手术后所有围手术期并发症的危险因素。
回顾性分析1985年至1991年在华盛顿大学接受清洁-污染性头颈部大手术的159例患者的病历。评估了30多个术前和手术参数，并记录了所有并发症。使用多变量统计分析对数据进行检查。
总体并发症发生率为63%，其中伤口感染（口咽皮肤瘘或脓性引流）占22%，其他类型感染占22%，非感染性并发症占51%。围手术期总死亡率为1.2%（2例患者）。既往放疗、手术时间、围手术期输血和皮瓣重建均与总体并发症发生率显著升高相关（p≤0.05）。只有既往放疗与伤口感染率增加相关（p = 0.05）。
既往放疗显著增加了清洁-污染性头颈部外科手术后围手术期并发症和伤口感染的风险。反映手术复杂性的其他因素也会影响总体并发症发生率。
