A predictive risk score for infections following head and neck free flap reconstruction: insights from a multicentre study.

Healthcare-associated infections (HAIs) are common complications in head and neck free flap reconstruction and can negatively impact patient outcomes. This prospective multicentre study, conducted between 2019 and 2022 across three Spanish institutions, included 150 patients. The incidence, characteristics, associated complications, and risk factors of HAIs were assessed. A predictive risk score was developed using logistic regression analysis. The incidence of HAIs was 58%, with surgical site infections being the most prevalent. HAIs were associated with longer hospital stays (odds ratio (OR) 41.52, 95% confidence interval (CI) 14.59-118.11; P < 0.001), reoperations (OR 12.59, 95% CI 4.12-38.49; P < 0.001), and delays in initiating adjuvant radiotherapy (OR 5.76, 95% CI 1.94-17.13; P = 0.002). Independent risk factors included prior radiotherapy, malignant tumour, female sex, and tracheostomy. These risk factors and ASA classification III-IV were included in the predictive score. The score assigned 1 point per risk factor, based on its β-coefficient. The observed incidence of HAIs increased with higher scores: 0% (score 0), 30% (score 1), 41% (score 2), 74% (score 3), 83% (score 4), 100% (score 5). The area under the curve for the score was 0.76, suggesting its utility in identifying high-risk patients. In conclusion, HAIs were associated with worse outcomes and their development could be predicted using the proposed risk score.