Surgical site infections in oral cavity carcinoma: predictive factors, microbiological trends, and clinical implications—experience of a major Italian medical center

Objective Surgical site infections (SSI) are a common but clinically significant postoperative complication in oral squamous cell carcinoma (OSCC) surgery with center-specific microbiology. This study aimed to quantify SSI incidence, identify independent predictors as a pre-ERAS baseline, with an exploratory estimate of ERAS impact. Study Design Retrospective cohort at a major Italian center, including 575 adults undergoing OSCC resection. SSI were defined per Centers for Disease Control and Prevention (CDC/NHSN) criteria with a 30-day surveillance window. Cultures/susceptibility testing were obtained when infection was suspected. Multivariable logistic regression with Lasso and Cox models estimated odds and hazard ratios; receiver operating characteristic analyses assessed discrimination. Results SSI occurred in 24.3% patients with a median onset 7 days. Independent predictors were age per 10 years, smoking, alcohol use, and radical neck dissection (RND) as supported by Cox estimates. Exploratorily, the ERAS period (late-2022 onward) was associated with lower SSI hazard. Microbiology was predominantly polymicrobial (71.4%), led by Staphylococcus aureus and Pseudomonas aeruginosa . Conclusion s: Age, smoking, alcohol use, and RND predict SSI. ERAS pathway was introduced in 2022. Future prospective studies are needed to improve outcomes, considering that microbiological findings and resistance rates reflect the local ecology of a tertiary Italian center and may differ in other settings.