Risk Factors for Postoperative Complications and Mortality in Deep Neck Infections

Complications of infections in maxillofacial surgery are correlated with the spread of infection to deep neck spaces.

The study purpose was to estimate the frequency and severity of postoperative complications and associated risk factors for subjects with deep neck infections (DNIs).

We performed a retrospective cohort study of consecutive subjects surgically treated due to DNI in the Department of Maxillofacial surgery at Clinical Center of Vojvodina from January 2014 to December 2024. Exclusion criteria were incomplete medical data, subjects treated conservatively or under local anesthesia, superficial skin infections, and infected tumors.

The predictor variable was a set of heterogeneous variables grouped into the following categories: demographic, preoperative, and postoperative data.

The primary outcome variable was the status of postoperative complications, coded as present or absent. The secondary outcome was complication severity, scored using 5-grade Clavien-Dindo classification (CDCC) system. Complications were coded as minor or major if CDCC scores were 3< or ≥3, respectively. Death outcome was coded as a CDCC grade 5.

None.

Bivariate analyses were used to evaluate the relationship among study variables. All relevant variables in the bivariate analyses were considered for inclusion in multivariable models. Values of P < .05 were considered statistically significant.

The cohort of 231 subjects included 143 (63%) males and 88 (45%) females with average age of 42.42 ± 17.77 years. Complications were reported with 93 (40%) subjects, of which 51 (22%) were major (CDCC ≥3) and 13 (5.6%) subjects died due to infection. On multivariable regression analysis: age (P = .02), number of infected spaces (P = .01), involvement of retropharyngeal (P = .007), pretracheal (P = .04) and carotid spaces (P = .006), preoperative procalcitonin (PCT) value (P = .009), radiological progression of infection (P = .02), PCT values on third (P = .003) and fifth postoperative days (P = .002) were the risk factors for major complications.

DNI carry a high risk of postoperative morbidity and mortality, particularly when they involve the carotid, retropharyngeal, or pretracheal spaces. Elevated PCT levels, both preoperatively and in the early postoperative period, act as independent predictors of major complications and death. Routine monitoring of PCT levels, combined with radiological follow-up, facilitates the identification of patients requiring intensive surveillance or reintervention.