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Perioperative Antibiotics in the Setting of Oropharyngeal Reconstruction: Less Is More

Leslie E Cohen1, Brendan M Finnerty, Alyssa Reiffel Golas

  • 1From the *Division of Plastic Surgery, †Department of Surgery, and ‡Department of Otorhinolaryngology, New York Presbyterian Hospital, Weill-Cornell Medical Center, New York, NY.

Annals of Plastic Surgery
|August 22, 2014
PubMed
Abstract

Insights

For oropharyngeal reconstruction, extended antibiotic courses do not improve outcomes. A 48-hour prophylactic antibiotic regimen with broad coverage is recommended to minimize complications and morbidities.

Area of Science:

  • Otolaryngology
  • Surgical Oncology
  • Infectious Disease

Background:

  • Recipient-site infection is a serious complication following oropharyngeal reconstruction.
  • Current antibiotic protocols lack consensus on optimal regimen and duration.
  • Perioperative antibiotics may reduce infection rates but optimal use is unclear.

Purpose of the Study:

  • To evaluate the impact of perioperative antibiotic administration on recipient-site complications after oropharyngeal reconstruction.
  • To identify risk factors associated with post-operative complications.
  • To determine the optimal duration of prophylactic antibiotic therapy.

Main Methods:

  • Retrospective review of 100 oropharyngeal reconstructions (2007-2013).
  • Analysis of perioperative antibiotic use and recipient-site complications.
  • Statistical analysis to identify significant risk factors and predictors.

Main Results:

  • 23% of patients experienced recipient-site complications (cellulitis, fistula, abscess, dehiscence).
  • Antibiotic duration (short vs. long course) was not a significant predictor of complications.
  • Clindamycin use, longer surgery duration, and advanced age were significant risk factors.

Conclusions:

  • Extended perioperative antibiotic courses do not offer additional benefits for oropharyngeal reconstruction.
  • A 48-hour prophylactic antibiotic course with adequate aerobic and anaerobic coverage is recommended.
  • This approach aims to minimize complications and antibiotic-related morbidities.

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