Ultrasound-guided percutaneous catheter drainage of deep neck space abscesses: outcomes and predictors of treatment failure.

objectivesClinical evidence supporting ultrasound-guided percutaneous catheter drainage (US-PCD) as a first-line treatment for deep neck space abscesses (DNSAs) remains limited. This study aimed to evaluate the outcomes of US-PCD as initial management for DNSAs and to identify factors associated with treatment efficacy. MATERIALS AND

methodsThis multicenter retrospective cohort study included patients with DNSAs who underwent US-PCD as a first-line treatment at four tertiary hospitals in China between 2015 and 2022. All patients were hemodynamically stable and had a stable airway, with preprocedural contrast-enhanced CT/MRI confirming no extensive mediastinal involvement beyond the anterosuperior compartment. Univariable and multivariable logistic regression analyses were used to identify preprocedural predictors of US-PCD efficacy.

resultsUS-PCD was performed in 117 patients. The procedure was technically accessible in 116 (98%) patients, among whom 12 (10%) had descending mediastinitis confined to the anterosuperior mediastinum. No procedure-related major complications occurred. Drainage success was achieved in 98 patients (84%). Among the 18 patients (16%) in whom US-PCD failed, three (3%) died and the remaining 15 (13%) required open surgical drainage. Multiple septations and leukocyte count were significant in univariate but not multivariable analysis. The only independent predictor of drainage failure was the presence of serious associated events-a composite variable including descending mediastinitis, sepsis, airway compromise, and vascular thrombosis (OR = 5.7, 95% CI: 1.9-17.4, p = 0.002).

conclusionUltrasound-guided percutaneous catheter drainage represents an effective minimally invasive first-line option for selected patients with deep neck space abscesses; however, open surgery should be prioritized when serious associated events are present. KEY POINTS: Question For deep neck space abscesses (DNSAs), ultrasound-guided percutaneous drainage (US-PCD) is a common surgical alternative, but its outcomes and predictors as a first-line treatment remain unclear. Findings US-PCD was effective as a first-line treatment for selected DNSAs. Only serious associated events-mediastinitis, sepsis, airway compromise, and thrombosis-independently predicted drainage failure. Clinical relevance US-PCD may be considered a first-line minimally invasive option for hemodynamically and airway-stable DNSA patients, even with anterosuperior mediastinal extension. Surgical drainage remains prioritized for cases with serious associated events to achieve rapid infection control.