Complications after craniofacial resection for malignant tumors: Are complication trends changing?

Objective: To determine the rate and type of complications after craniofacial resection (CFR) during the most recent 10-year period in comparison to a historic control. Methods: Patients underwent CFR in 1973-1995 ("earlier" period; n = 114) and in 1996-2005 ("later" period; n = 120) before and after a broad-spectrum antibiotic regime was used. Results: In the later period patients had higher rates of comorbidity, dural invasion, high-grade malignancy, and wide resections (P < 0.02). Complications were identified in 52 percent of the early and 33 percent of the later groups (P = 0.002). There was 20 percent decrease in wound complications in the later period (P < 0.0001), but not in other complications. In the earlier period, complications were evenly distributed between patients younger and older than 50 years. However, in the later period, most complications occurred among elderly patients. Multivariate analysis revealed that a broad-spectrum antibiotic regime was associated with a lower complication rate (P = 0.02). Conclusions: Complication rates decreased during the last 10 years due to a decline in wound infections. Broad-spectrum antibiotic coverage probably contributed to this change.