{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:35:59Z","timestamp":1761006959614,"version":"build-2065373602"},"reference-count":37,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,8,16]],"date-time":"2022-08-16T00:00:00Z","timestamp":1660608000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine factors associated with restarting therapeutic antibiotics within 30 days of head and neck microvascular free tissue transfer (HN\u2010MFTT).<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective study of consecutive HN\u2010MFTTs performed from January 2015 to July 2020.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Tertiary academic medical center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Thirty\u2010day postoperative antibiotic use and post\u2013HN\u2010MFTT surgical and medical complications were assessed. Univariable analyses and multivariable logistic regression were used to evaluate risk factors associated with restarting antibiotics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>overall 482 patients with 501 HN\u2010MFTTs were stratified by duration of prophylaxis: \u226424 hours (n = 136, 27.1%), 25\u201072 hours (n = 54, 10.8%), and &gt;72 hours (n = 311, 62.1%). Antibiotics were restarted in 199 patients (209 procedures, 42%). The most common indications for antibiotic reinitiation were flap recipient site infection (n = 59, 28%); hospital\u2010acquired pneumonia (n = 44, 21%); and wound dehiscence, fluctuance, or change in quality of drain output (n = 44, 21%). Shorter antibiotic prophylaxis (\u226424 hours) (odds ratio [OR], 1.95; 95% CI, 1.2\u20103.0; <jats:italic>P<\/jats:italic> = .003), osteocutaneous flaps (OR, 2.15; 95% CI, 1.3\u20103.4; <jats:italic>P<\/jats:italic> = .001), and prior immunotherapy\/chemotherapy (OR, 2.29; 95% CI, 1.2\u20104.3; <jats:italic>P<\/jats:italic> = .01) were associated with reinitiation of antibiotics for surgical infections. Restarting antimicrobials for nosocomial infections was associated with aerodigestive defects (OR, 2.45; 95% CI, 1.1\u20105.2; <jats:italic>P<\/jats:italic> = .019), cardiovascular disease (OR, 3.00; 95% CI, 1.5\u20105.9; <jats:italic>P<\/jats:italic> = .001), and medical comorbidities approximated by American Society of Anesthesiologists class 3 or 4 (OR, 2.83; 95% CI, 1.5\u20105.4; <jats:italic>P<\/jats:italic> = .002).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Aerodigestive reconstruction, 24\u2010hour postoperative antimicrobial prophylaxis, American Society of Anesthesiologists class 3 and 4, prior chemotherapy\/immunotherapy, cardiovascular disease, and osteocutaneous flaps are associated with reinitiation of antibiotics within 30 days of HN\u2010MFTT.<\/jats:p><\/jats:sec>","DOI":"10.1177\/01945998221117794","type":"journal-article","created":{"date-parts":[[2022,8,16]],"date-time":"2022-08-16T12:00:57Z","timestamp":1660651257000},"page":"357-365","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Restarting Therapeutic Antibiotics Following Postoperative Prophylaxis in Head and Neck Microvascular Free Tissue Transfer"],"prefix":"10.1002","volume":"168","author":[{"given":"Karolina A.","family":"Plonowska\u2010Hirschfeld","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of California\u2013San Francisco  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron L.","family":"Zebolsky","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of California\u2013San Francisco  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael M.","family":"Lindeborg","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of California\u2013San Francisco  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"McNeill","sequence":"additional","affiliation":[{"name":"Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology\u2013Head and Neck Surgery University of California\u2013San Francisco  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P. Daniel","family":"Knott","sequence":"additional","affiliation":[{"name":"Division of Facial Plastics and Reconstructive Surgery, Department of Otolaryngology\u2013Head and Neck Surgery University of California\u2013San Francisco  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rahul","family":"Seth","sequence":"additional","affiliation":[{"name":"Division of Facial Plastics and Reconstructive Surgery, Department of Otolaryngology\u2013Head and Neck Surgery University of California\u2013San Francisco  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea M.","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Facial Plastics and Reconstructive Surgery, Department of Otolaryngology\u2013Head and Neck Surgery University of California\u2013San Francisco  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chase M.","family":"Heaton","sequence":"additional","affiliation":[{"name":"Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology\u2013Head and Neck Surgery University of California\u2013San Francisco  San Francisco California 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