Objectives <p>Surgical site infections (SSIs) are one of the most common post-operative complications and can be associated with significant morbidity and mortality. They place a significant burden on healthcare system. Existing guidelines are based on non-head and neck procedures. This study aims to investigate factors affecting SSIs in the head and neck.</p> Methods <p>A multi-centre retrospective cohort across otolaryngology departments in Yorkshire (Bradford, Doncaster, Hull, Leeds). All patients undergoing an operation requiring a skin incision in the year 2021 were included. Electronic patient notes were used as the data source. Data on demographics, comorbidities, smoking and alcohol use, operation undertaken, diagnosis, closure material and use of antibiotic prophylaxis were recorded.</p> Results <p>827 patients were included. The mean age was 51.4 years. The rate of SSI was 4.2% (<i>n</i> = 34/827). 30-day mortality was 0.6% (<i>n</i> = 5/827). There was no significant difference in development of SSI depending on antiseptic preparation choice. Diabetes significantly increased the risk of SSI. Suture choice did not affect rate of SSI. Intravenous drug use and cardiovascular disease were not significantly associated with 30-day mortality.</p> Conclusion <p>This is the only study that assessed the rate of SSIs in the head and neck region. The NICE guidance for antiseptic preparation choice is not applicable in the head and neck. Absorbable sutures should be used when appropriate. Peri-operative comorbidities should be optimised. For more robust evidence, a larger cohort would be recommended or a randomised controlled trial assessing individual factors can be considered.</p> Level of evidence <p>- Level 3.</p>