(211) Comparative Outcomes of Transoral and Transcervical Drainage Approaches for Deep Neck Space Infections

Introduction: Operative management of deep neck space infections often requires selecting between transoral and transcervical drainage based on the disease extent and patient acuity, yet comparative United States literature remains limited. This study evaluates national differences in patient characteristics and outcomes associated with these two approaches.

Methods: This retrospective cohort study identified cases between 01/2005-12/2020 from the American College of Surgeon’s National Surgical Quality Improvement Program of transoral (CPT 42720) or transcervical (CPT 42725) drainage of deep neck abscesses. Patient demographics, preoperative clinical characteristics, and postoperative outcomes were compared across surgical approaches using chi-squared or t-tests. Right-skewed continuous variables were log-transformed prior to analysis and significance was defined as p< 0.05.

Results: Among 470 cases, 341 (72.6%) were transoral and 129 (27.4%) were transcervical. Transcervical cases were more likely to involve inpatient cases (p=0.008), patients of a higher ASA class (p=0.006), or patients with sepsis (p=0.005), and were less likely to involve patients with an independent functional health status (p=0.018). Transcervical drainages were more likely to return to the operating room (17.8% vs. 9.1%, p=0.014), have significantly longer mean operative times (60.2±54.3 vs. 30.6±39.6 minutes) and lengths of stay (9.89±9.6 vs. 5.4±8 days) compared to transoral drainages (both p< 0.001). Mortality rate (3.1% transcervical vs.1.8% transoral, p=0.47) and discharge disposition did not vary significantly between groups (p=0.275).

Conclusions: In this national retrospective study, transcervical drainage was associated with longer operative times, higher reoperation rates, and prolonged hospitalization but was more often performed in patients with a higher ASA class, sepsis, and reduced functional status. These findings suggest that outcome differences may reflect patient acuity rather than surgical approach alone, supporting individualized surgical decision-making for deep neck space infections.