Presented at the Triological Society Combined Sections Meeting, San Diego, California, U.S.A., April 18–22, 2012.
Head and Neck
Article first published online: 2 AUG 2012
Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 122, Issue 11, pages 2454–2460, November 2012
How to Cite
Shuman, A. G., Shuman, E. K., Hauff, S. J., Fernandes, L. L., Light, E., Chenoweth, C. E. and Bradford, C. R. (2012), Preoperative topical antimicrobial decolonization in head and neck surgery. The Laryngoscope, 122: 2454–2460. doi: 10.1002/lary.23487
One of the study medications was donated by Hibiclens, Mölnlycke Health Care, Inc. All funding was obtained via internal funding sources. Mölnlycke Health Care did not participate in or approve of the design, analysis, or publication of this study.
The authors have no other funding, financial relationships, or conflicts of interest to disclose.
- Issue published online: 25 OCT 2012
- Article first published online: 2 AUG 2012
- Manuscript Accepted: 11 MAY 2012
- Manuscript Revised: 30 APR 2012
- Manuscript Received: 10 FEB 2012
- Surgical site infection;
- antimicrobial decolonization;
- head and neck surgery;
- Level of Evidence: 1b
Surgical site infections (SSIs) are an important cause of morbidity and mortality after head and neck surgery. Our primary objective was to determine the efficacy of preoperative topical antimicrobial decolonization before head and neck surgery.
Prospective, randomized controlled trial.
This study was conducted among 84 patients presenting for head and neck surgery requiring admission to an academic medical center. Preoperative cultures were performed to identify Staphylococcus aureus carriers. Patients were randomized to preoperative topical antimicrobial decolonization with a 5-day regimen of chlorhexidine skin rinses and intranasal mupirocin coupled with standard perioperative systemic antimicrobial prophylaxis, versus standard prophylaxis alone. The main outcome was the incidence of SSIs.
Despite a trend suggesting a decrease in SSIs with perioperative topical antimicrobial decolonization (24% vs. 10%), there was no significant difference (odds ratio, 0.34; 95% confidence interval, 0.10–1.18; P = .079). Patients with a higher American Society of Anesthesiologists score (3 vs. 1; P = .02), with more operative blood loss (P = .05), and who required operative takeback (P = .04) had a higher rate of SSIs; there was a trend suggesting a higher rate of SSIs among patients undergoing clean-contaminated surgery compared to clean cases (P = .08) and among those having received prior radiation (P = .07) or chemotherapy (P = .06).
Preoperative antimicrobial decolonization did not significantly decrease the incidence of SSIs after head and neck surgery, but might be considered for high-risk groups despite the lack of conclusive evidence confirming efficacy. Risk factors for SSIs after head and neck surgery are identified for the first time in a prospective study. Laryngoscope, 2012