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Majority of surgical site infections occur later than 30 days after immediate breast reconstruction
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The majority of surgical site infections in immediate implant-based breast reconstructions occurred later than 30 days following either first or second-stage procedures, according to study results published in Plastic and Reconstructive Surgery.
The study included 1,662 breast reconstructions in 1,024 patients with 171 direct-to-implant single-stage procedures and 1,491 two-stage procedures. Mean patient age was 48 years and mean BMI was 25.8 kg/m2. A small percentage of patients were smokers at the time of reconstruction (2.1%), had diabetes (3.5%) or had more than one comorbid condition (9.6%).
“The National Surgical Quality Improvement Program database captures data limited to 30 days after surgery and may underreport surgical-site infection complications in this patient population,” the researchers wrote. “Thus, many recently published surgical-site infection complication rates in implant-based breast reconstruction are limited solely to early infections.”
In the direct-to-implant group, the researchers observed 17 surgical site infections. Of those, 11 were major infections requiring inpatient hospitalization and/or operative treatment. Six were minor infections successfully treated with outpatient oral antibiotics. Five of the major infections and three of the minor infections presented later than 30 days.
In the two-stage group that received tissues expanders there were 114 surgical site infections. Fifty-one of those were considered major infections and 35 were minor. Twenty-six of the major infections and 17 of the minor infections presented later than 30 days from the first stage.
Of the 1,266 patients who continued onto second-stage implant replacement, 31 presented with surgical site infections. Twenty-two of those presented later than 30 days after the procedure.
The researchers found two significant predictors of late surgical site infections following first-stage tissue expander placement: radiation therapy (P = .001) and increased BMI (P = .000).
“Preoperative counseling when considering implant-based breast reconstruction should incorporate discussions regarding the risk of late surgical-site infections and its specific risk factors — radiotherapy and obesity,” the researchers concluded. – by Talitha Bennett
Disclosure: The researchers report no relevant financial disclosures.
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