Surgical Site Infections Following the Transoral Approach: A Review of 172 Consecutive Cases

Study Design:A retrospective review. Objective:The aim of this study was to discuss the characteristics, treatment, and incidence of surgical site infection (SSI) following transoral approach surgery. Summary of Background Data:One of the primary risks associated with transoral approach surgery is postoperative SSI. Few reports exist detailing the specific circumstances, treatment options, and incidence of SSIs following transoral approach surgery in a large series of consecutive cases. Materials and Methods:From January 2005 to September 2010, 172 consecutive transoral surgeries were performed at a single tertiary referral center. Information on patients, treatment methods, and complication incidence and resolution was collected. Results:There were 6 cases of SSI (3.5%), all in complex craniocervical patients. Of the 6 cases, 2 (1.2%) were isolated local infections, whereas 4 (2.3%) resulted in intracranial infection. Of those with intracranial infections, 3 (75%) were instrumented, whereas 1 (25%) was uninstrumented. Four intraoperative dural lacerations occurred in the entire series (2.3%), all of which developed into intracranial infections. Full SSI resolution occurred in 4 (67%) patients following active treatment: in 3 of 4 patients (75%) with intracranial infections and in 1 of 2 patients (50%) with local infections. Of the 2 remaining unresolved cases, one patient (intracranial) refused removal of instrumentation and subsequently discontinued the treatment, and the other (local) experienced a delayed postoperative infection and died after not receiving treatment because of economic reasons. Following full implementation of care guidelines to avoid SSI in transoral patients, no further SSIs were observed. Conclusions:SSI rate following transoral exposure has increased from the authors’ earlier reports (0%), likely because of the increasing complexity and instrumentation of transoral approach cases. Cerebrospinal fluid leakage caused by dural injury highly predisposes to intracranial infection. Lumbar puncture, cranial computed tomography, continuous drainage diversion, and intrathecal injection of antibiotics are adequate methods of treatment. Strict consideration of surgical indications, adequate preoperative preparation, careful surgical technique to avoid dural injury, and postoperative oropharyngeal care are important steps for preventing SSI through the transoral approach.