The history of thyroid surgery starts with Billroth, Kocher, and Halsted, who developed techniques for thyroidectomy between 1873 and 1910. Before 1950, the operative mortality rate approached 50%. The advent of general anesthesia and antisepsis and the development of fine hemostatic instruments rendered thyroid surgery safer, but the potential persists for life-threatening complications. This study was designed to identify specific risk factors for the development of surgical site infections (SSIs); to define high-risk patients; to determine the causative organisms; to illustrate the clinical presentation, treatment, and outcome; and to establish management guidelines.A prospective analysis was carried out of complications affecting 241 consecutive patients (mean age 65+/-19 years; 76% female) undergoing cervical exploration for thyroid disease from 2000 to 2005, with particular attention to infection, and the pertinent literature was reviewed.Surgical site infections (SSI) affected 2% of patients. The risk of infection depended mainly on the quality of pre-operative and post-operative care and on whether there was a break in sterile technique. The use of drains and pre-operative antibiotics did not affect the incidence of SSI. No pre-operative factor foreshadowed this complication, and the definition of a high-risk population remains obscure. Surgical site infections lengthened the hospital stay.Effort should be made to improve sterile technique. Appropriate antibiotic coverage is indicated when infection develops post-operatively. The most important element in the management of SSI is adequate drainage of the incision once infection develops.