title: Perioperative Antibiotics in the Setting of Oropharyngeal Reconstruction: Less Is More.
abstract: BACKGROUND
  Recipient-site infection after oropharyngeal reconstruction is a potentially disastrous complication. Although studies suggest that perioperative antibiotics reduces infection rates in these patients from 87% to 20%, there is no consensus regarding what constitutes the most appropriate antibiotic regimen and duration of treatment.
  
  
  METHODS
  A retrospective review of perioperative antibiotic administration was performed of all patients who underwent local, pedicled, or free flap oropharyngeal reconstruction after oncologic resection by a single surgeon at a single institution between 2007 and 2013 to assess for recipient-site complications.
  
  
  RESULTS
  Ninety-seven patients underwent 100 reconstructions (61 free flap reconstructions, 39 pedicled/local flap reconstructions) and all received a combination of intravenous (IV) antibiotic agents designed to cover oral flora. There were 23 (23%) recipient-site complications, which included cellulitis (9%), mucocutaneous fistula (5%), abscess (5%), and wound dehiscence (4%). Duration of antibiotic prophylaxis, defined as less than 48 hours (short-course) or greater than 48 hours (long-course), was not a significant predictor of recipient-site complication. Significant risk factors for recipient-site complications were clindamycin prophylaxis (P < 0.008), increased duration of surgery (P < 0.047), and advanced age (P < 0.034). Recipient-site complication was found to be a significant predictor of both increased length of hospital stay (P < 0.001) and increased time to the resumption of enteral feeds (P < 0.035).
  
  
  CONCLUSIONS
  These data suggest that extended courses of perioperative antibiotics do not confer additional benefits in patients undergoing oropharyngeal reconstruction. We recommend a limited 48-hour course of prophylactic antibiotics with sufficient aerobic and anaerobic coverage to help minimize the incidence of antibiotic-related morbidities.
authors.affiliation: From the *Division of Plastic Surgery, †Department of Surgery, and ‡Department of Otorhinolaryngology, New York Presbyterian Hospital, Weill-Cornell Medical Center, New York, NY.
authors.forename: Leslie E
authors.initials: LE
authors.lastname: Cohen
authors.forename: Brendan M
authors.initials: BM
authors.lastname: Finnerty
authors.forename: Alyssa Reiffel
authors.initials: AR
authors.lastname: Golas
authors.forename: Jill J
authors.initials: JJ
authors.lastname: Ketner
authors.forename: Andrew
authors.initials: A
authors.lastname: Weinstein
authors.forename: Tatiana
authors.initials: T
authors.lastname: Boyko
authors.forename: Christine H
authors.initials: CH
authors.lastname: Rohde
authors.forename: David
authors.initials: D
authors.lastname: Kutler
authors.forename: Jason A
authors.initials: JA
authors.lastname: Spector
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000601:surgery*; D019990:Perioperative Care / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D013524:Surgical Flaps; D013529:Surgical Wound Dehiscence / Q000453:epidemiology / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents