2018-19 Section 7-Neoplastic and Inflammatory Diseases of the Head and Neck eBook

relevant variables omitted from our data sources, including hour of presentation, hour of surgery, reason for delay in surgery, timing of antibiotic initiation, and some specific complications relevant to deep neck abscess. The specific complications not tracked by ACS–NSQIP and ACS– NSQIPP include development of epidural abscess. Subse- quent neurologic sequelae, although rare, have been described following deep neck space infection, thus our study likely underestimates the influence of these compli- cations. Third, our study includes only patients with deep neck abscess who underwent surgical drainage. Thus, there is potential for selection bias because patients who improved with medical therapy alone and avoided surgery would not be eligible. Along these lines, it is possible that some patients included in our study underwent surgery unnecessarily and would have improved with medical man- agement alone. Finally, like all studies of deep neck infec- tion, our study likely includes cases along the continuum of infection from cellulitis to phlegmon to abscess, and we did not have information available on the radiographic charac- teristics of the abscess. However, despite the above limita- tions, ACS–NSQIP and ACS–NSQIPP offer powerful tools to assess the effect of delay in surgical drainage on short- term M&M with deep neck abscess, given its prospective nature and strict methodology. CONCLUSION We present a large, multicenter study of deep neck abscesses in both adult and pediatric populations. Our study demonstrates that delay in surgical drainage after admission is associated with increased abscess-specific M&M for adult patients, raising concern about potentially delaying surgical drainage for a trial of antibiotic therapy in this population. This association was not present in our analysis of pediatric patients. Further studies are needed to delineate which patients would benefit most from urgent surgical drainage versus more conservative therapy. Acknowledgment The authors thank Amy Yang, MS, for helping with the sta- tistical analysis in the Department of Preventive Medicine, Division of Biostatistics, Northwestern University Fein- berg School of Medicine Chicago, Illinois. BIBLIOGRAPHY 1. Yellon R. Head and neck space infections. In: Bluestone CD, Alper CM, Arjmand EM, et al, eds. Pediatric Otolaryngology. 4th ed. Philadelphia, PA: WB Saunders; 2002: 1681–1701. 2. Carbone PN, Capra GG, Brigger MT. Antibiotic therapy for pediatric deep neck abscesses: a systematic review. Int J Pediatr Otorhinolaryngol 2012;76:1647–1653. 3. Koivunen P, Lopponen H, Syrjala H. Epidural abscess due to deep-neck infection. Clin Infect Dis 1998;26:1461–1462.

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