title: Surgical site infection after thyroidectomy: a rare but significant complication.
abstract: BACKGROUND
  Surgical site infections (SSIs) after thyroidectomy are rare but can have significant consequences. Thyroidectomy is a clean case, and the patterns for use of prophylactic antibiotics vary. We hypothesized that patient and operative characteristics may predict a higher risk of SSI, and that SSI are associated with other complications leading to increased resource utilization.
  
  
  METHODS
  Data from the American College of Surgeons National Surgical Quality Improvement Program dataset for patients who underwent thyroidectomy through cervical incisions from 2005-2011 were included. Bivariate analysis using t-tests and chi-square tests were performed, and variables with P<0.2 were considered for inclusion in a multivariate logistic regression model.
  
  
  RESULTS
  A total of 49,326 patients underwent thyroidectomy from 2005-2011 and 179 (0.36%) had an SSI. On multivariate analysis, the strongest predictors of SSI were operative time (P<0.001) and wound classification clean-contaminated (odds ratio 6.1; 95% confidence interval, 3.6, 10.3). Preoperative factors associated with SSI on multivariate analysis had lower magnitudes of influence on SSI risk but included obesity, alcohol use, and nonindependent functional status. Patients with SSI were more likely to have a wound dehiscence, renal insufficiency, bleeding requiring transfusion, and return to the operating room on a multivariate model of outcomes.
  
  
  CONCLUSIONS
  Although rare, SSI after thyroidectomy are associated with other postoperative complications. We have identified preoperative and intraoperative factors that are associated with SSI, and this may help identify high-risk patients who may benefit from selective use of antibiotics.
authors.affiliation: Section of Endocrine Surgery and Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin, Madison, Wisconsin. Electronic address: elfenbein@surgery.wisc.edu.
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Elfenbein
authors.affiliation: Section of Endocrine Surgery and Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin, Madison, Wisconsin.
authors.forename: David F
authors.initials: DF
authors.lastname: Schneider
authors.affiliation: Section of Endocrine Surgery and Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin, Madison, Wisconsin.
authors.forename: Herbert
authors.initials: H
authors.lastname: Chen
authors.affiliation: Section of Endocrine Surgery and Wisconsin Surgical Outcomes Research (WiSOR) Program, Department of Surgery, University of Wisconsin, Madison, Wisconsin.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Sippel
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D013530:Surgical Wound Infection / Q000209:etiology*; D013965:Thyroidectomy / Q000009:adverse effects*
keywords: Prophylactic antibiotics; Surgical site infection; Thyroidectomy
references.citation: Langenbecks Arch Surg. 2008 Sep;393(5):667-73
references.pmid: 18633639
references.citation: Cochrane Database Syst Rev. 2007 Oct 17;(4):CD006099
references.pmid: 17943885
references.citation: Am J Surg. 2013 Feb;205(2):194-9
references.pmid: 22944390
references.citation: J Am Coll Surg. 2010 Jun;210(6):949-56
references.pmid: 20510804
references.citation: Surg Infect (Larchmt). 2006;7 Suppl 2:S117-20
references.pmid: 16895492
references.citation: Ann R Coll Surg Engl. 2013 Jul;95(5):345-8
references.pmid: 23838497
references.citation: Infect Control Hosp Epidemiol. 1999 Nov;20(11):725-30
references.pmid: 10580621
references.citation: J Surg Oncol. 2007 Aug 1;96(2):124-9
references.pmid: 17443747
references.citation: Am J Surg. 2005 Jul;190(1):9-15
references.pmid: 15972163
references.citation: Am Surg. 2006 Nov;72(11):1010-6; discussion 1021-30, 1133-48
references.pmid: 17120942
references.citation: Surgery. 2010 Dec;148(6):1163-8; discussion 1168-9
references.pmid: 21134547
references.citation: Ann Surg Innov Res. 2009 Aug 05;3:10
references.pmid: 19656389
references.citation: Updates Surg. 2013 Sep;65(3):213-6
references.pmid: 23729319
references.citation: Endocr Pract. 2012 Jul-Aug;18(4):e73-6
references.pmid: 22297061
references.citation: Int J Surg. 2008;6 Suppl 1:S13-5
references.pmid: 19114318
references.citation: Ann Surg Oncol. 2011 Dec;18(13):3529-30
references.pmid: 21755377
references.citation: Surgery. 2011 Nov;150(5):950-8
references.pmid: 21621238
references.citation: JAMA Surg. 2013 Oct;148(10):907-14
references.pmid: 23965750
references.citation: Am J Infect Control. 1999 Apr;27(2):97-132; quiz 133-4; discussion 96
references.pmid: 10196487
references.citation: World J Surg. 2004 Mar;28(3):271-6
references.pmid: 14961204
references.citation: Ann Surg. 2012 Mar;255(3):551-5
references.pmid: 22330036
references.citation: Surg Infect (Larchmt). 2006;7 Suppl 1:S19-22
references.pmid: 16834543