Surgical site infection (SSI) remains a significant concern in the field of head and neck surgery. We conducted this study to investigate the characteristics, clinical course, and risk factors associated with SSI. Data of a total of 263 patients who underwent head and neck cancer surgery at the University of Fukui Hospital between 2017 and 2023 were retrospectively analyzed. Patient-related and surgery-related factors were assessed separately to explore the risk factors. The cohort included 187 men and 76 women, with a median age of 66.2 years (range, 23–97 years).
SSI occurred in 30 patients (11.4%), including superficial infection in 9 patients, abscess in 9 patients, pharyngocutaneous fistula in 7 patients, flap infection in 3 patients, and orocutaneous fistula in 2 patients. The most frequent primary site was the oropharynx, and the most common surgical procedures that were complicated by SSI were oropharyngectomy and total laryngectomy. In most cases, SSI developed during the second postoperative week. Streptococcal species and other oral bacteria were the most frequently isolated pathogens. The mean hospital stay was significantly longer in the SSI group as compared with the non-SSI group (p < 0.01).
Univariate analysis identified male sex, underlying diabetes mellitus, preoperative chemoradiotherapy, clean-contaminated surgery, prolonged operative time, greater blood loss, and flap reconstruction as significant risk factors for SSI. Multivariate analysis identified underlying diabetes mellitus [p = 0.04, odds ratio (OR) = 2.66] and prolonged operative time [p < 0.01, OR = 10.1] as independent risk factors.
These findings highlight the importance of strict perioperative glycemic control and efforts to shorten the operative time to reduce the incidence of SSI in patients undergoing head and neck cancer surgery.
