title: Surgical site infections after thyroidectomy.
abstract: BACKGROUND
  The history of thyroid surgery starts with Billroth, Kocher, and Halsted, who developed techniques for thyroidectomy between 1873 and 1910. Before 1950, the operative mortality rate approached 50%. The advent of general anesthesia and antisepsis and the development of fine hemostatic instruments rendered thyroid surgery safer, but the potential persists for life-threatening complications. This study was designed to identify specific risk factors for the development of surgical site infections (SSIs); to define high-risk patients; to determine the causative organisms; to illustrate the clinical presentation, treatment, and outcome; and to establish management guidelines.
  
  
  METHODS
  A prospective analysis was carried out of complications affecting 241 consecutive patients (mean age 65+/-19 years; 76% female) undergoing cervical exploration for thyroid disease from 2000 to 2005, with particular attention to infection, and the pertinent literature was reviewed.
  
  
  RESULTS
  Surgical site infections (SSI) affected 2% of patients. The risk of infection depended mainly on the quality of pre-operative and post-operative care and on whether there was a break in sterile technique. The use of drains and pre-operative antibiotics did not affect the incidence of SSI. No pre-operative factor foreshadowed this complication, and the definition of a high-risk population remains obscure. Surgical site infections lengthened the hospital stay.
  
  
  CONCLUSIONS
  Effort should be made to improve sterile technique. Appropriate antibiotic coverage is indicated when infection develops post-operatively. The most important element in the management of SSI is adequate drainage of the incision once infection develops.
authors.affiliation: Department of Surgical Sciences, University of Insubria, Varese, Italy. gianlorenzo.dionigi@uninsubria.it
authors.forename: Gianlorenzo
authors.initials: G
authors.lastname: Dionigi
authors.forename: Francesca
authors.initials: F
authors.lastname: Rovera
authors.forename: Luigi
authors.initials: L
authors.lastname: Boni
authors.forename: Patrizia
authors.initials: P
authors.lastname: Castano
authors.forename: Renzo
authors.initials: R
authors.lastname: Dionigi
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000503:physiopathology; D013211:Staphylococcus aureus; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology* / Q000503:physiopathology; D013965:Thyroidectomy / Q000009:adverse effects*