An evaluation of the clinical utility of C-reactive protein and antibiotic use in patients undergoing major head and neck reconstructive surgery with outcome assessment

Abstract

Purpose This ambispective observational study aims to evaluate the local utility of peri-operative CRP testing and prophylactic antibiotics in relation to post-operative complications in patients who have undergone major head and neck oncological reconstructive surgery. Results A total of 79 patients were identified for inclusion; CRP testing was undertaken within the first 3 days postoperatively in 78/79 cases. Results demonstrated no benefit of extended prophylactic antibiotic use in reducing post-operative infection. Forty-two post-operative complications arose. In the prospective arm, CRP did not influence the decision to commence antibiotic therapy for any of the surgical site infections. Age, diabetes, smoking, or high body mass index (BMI) did not appear to affect the incidence of postoperative infection ( p > 0.05). There is no evidence that more than 24 h of antibiotic prophylaxis is indicated for patients undergoing head and neck reconstructive surgery. Conclusion Everyone who is involved in peri-operative patient care should be educated regarding the appropriate use of CRP testing, with the implementation of protocols required to standardize CRP testing and prophylactic antibiotic prescription.

Early Predictors of Fistula Formation Following Head and Neck Reconstruction

“…19 20 An elevated CRP level is not a specific infectious reaction in the early postoperative period, and CRP has a delayed response that peaks 3 days after infective symptoms; some researchers have reported that CRP cannot be used as an isolated diagnostic marker in the early postoperative period. 21 22 Detecting fistulas on POD 2 to POD 3 may be difficult; however, if the postoperative course is complicated, CRP levels remain increased and may even increase to higher concentrations. 19 In this study, fistulas became clinically apparent, on average, by POD12, but the postoperative CRP levels in the “fistula” group were statistically higher than the “no-fistula,” starting from POD 2.…”