Extended Antibiotic Prophylaxis Is Not Associated with Improved Outcomes after Traumatic Neck Aerodigestive Repair

Abstract

Background: Extended post antibiotics do not reduce infectious complications after traumatic facial injuries or elective clean-contaminated head and neck operation. However, the optimal duration of antibiotic prophylaxis following operative repair of traumatic neck aerodigestive injuries remains uncertain. This study compared outcomes between perioperative (≤24 hours) and extended (>24 hours) antibiotic prophylaxis and hypothesized that extended prophylaxis would not reduce local infectious complications. Methods: Using a Level I and II university-based trauma system registry, patients undergoing operative repair of traumatic neck aerodigestive injuries (oropharynx, hypopharynx, larynx, esophagus, and trachea) were identified over an 8-year period (2017–2024). Demographics, injury characteristics, management strategies, and antibiotic use were collected. Patients were stratified by antibiotic prophylaxis duration (perioperative vs. extended). The primary outcome was local infectious complications. Secondary outcomes included leak, stenosis, reintervention, length of stay, and mortality. Results: Sixty-five patients with operative penetrating or blunt neck aerodigestive injuries were identified: 35 received perioperative antibiotics and 30 received an extended course. Most injuries were penetrating (93.8%). Extended antibiotics were prescribed more frequently in older patients (40.5 vs. 29 years, p < 0.01), while injury characteristics and adjunctive management strategies were otherwise similar. Local infectious complication rates did not differ significantly between the perioperative and extended antibiotic groups (5.7% vs. 20%, p = 0.13). Rates of leak, stenosis, reintervention, length of stay, and mortality were also similar. No patient, injury, or management factor was associated with local infectious complications. Conclusions: Extended post antibiotic prophylaxis was not associated with lower infection rates or improved clinical outcomes following operative repair of traumatic neck aerodigestive injuries. Prospective multicenter studies are needed to validate these findings and refine antibiotic protocols for these injuries.