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Scientific Oral Presentation

Head and Neck Surgery

Impact of Intravenous Antibiotic Selection on Postoperative Head and Neck Osseous Free Flap Reconstruction Outcomes

Sunday, October 18, 2026
2:48 PM - 2:54 PM PT
Location: West Exhibit Hall A, Learning Zone 3

    Presenting Author(s)

  • Mariam I. Mansuri, BSA

    Medical Student
    The University of Texas Medical Branch
    Houston, TX, United States

    • Co-Author(s)

  • Mariam I. Mansuri, BSA

    Medical Student
    The University of Texas Medical Branch
    Houston, TX, United States

  • IC

    Isabel Chapa, BS

    Medical Student
    The University of Texas Medical Branch
    La Marque, Texas, United States

  • Robert E. Africa, MD

    Resident
    The University of Texas Medical Branch
    Galveston, TX, United States

    • Senior Author(s)

  • Viran J. Ranasinghe, MD

    Assistant Professor
    The University of Texas Medical Branch
    Galveston, TX, United States

Disclosure(s):
Mariam I. Mansuri, BSA:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Viran J. Ranasinghe, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Post-operative intravenous (IV) antibiotics are often administered after head and neck surgery, yet evidence guiding antibiotic selection and its impact on post-operative complications remains limited. This TriNetX retrospective cohort study assesses post-op IV antibiotic-associated complications in adults undergoing head and neck osseous free flap reconstruction.

Methods: Adults aged ≥18 undergoing head and neck osseous free flap reconstruction between 2010-2025 were identified using CPT and ICD-10-CM codes. They were categorized according to post-op IV antibiotic regimen, including Ampicillin-Sulbactam, Cefazolin-Metronidazole, Clindamycin, and Lexofloxacin, administered within 3, 7, or 14 days post-op. Propensity score matching was performed for demographics and co-morbidities.

Results: At 30 days post-op, Unasyn was associated across all treatment durations with lower risk of flap failure, flap revision, cardiovascular complications, pneumonia, and urinary tract infection, but higher risk of surgical site infections. There was a higher risk of pneumonia with 14 day course of Levofloxacin and both 7 and 14 day courses of Cefazolin-Metronidazole. Clindamycin was associated with increased risk of flap failure, flap vessel revision, flap revision, and pneumonia across all treatment durations, and increased risk of surgical site infections at 3 day courses. These findings were supported by confidence intervals and p-values < 0.05, with significant risk and odds ratios.

Conclusions: Unasyn was associated with a decreased overall risk of post-op complications after osseous free flap reconstruction compared to other regimens. These results emphasize the importance of evidence-based post-op antibiotic selection considering complication risks.