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Mastectomy with immediate reconstruction doubles risk for SSI
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Women undergoing mastectomy with immediate reconstruction were at twice the risk for surgical site infections than women undergoing mastectomy alone, according to researchers from Washington University School of Medicine.
Although the National Healthcare Safety Network (NHSN) estimates the incidence of surgical site infections (SSIs) following breast operations in the United States to be around 1% to 2%, SSI rates vary widely across institutions. According to Margaret A. Olsen, PhD, MPH, and colleagues, this may be due to “the type of breast operation, definitions used for infection, surveillance methods to identify infections, and the length of postoperative follow-up.”
The researchers examined the incidence of infection in a much larger population of women treated at numerous facilities. Participants included 18,085 women with private health insurance who underwent 18,696 mastectomy procedures with and without immediate implant or flap reconstruction from 2004 to 2011.
Olsen and colleagues observed an overall SSI rate of 8.1%. The incidence of SSI after mastectomy was 5%, which is consistent with most infection rates reported in the last decade from individual facilities in the U.S., according to the researchers. However, SSI rates were 10.3% after mastectomy plus implant, 10.7% after mastectomy plus flap, and 10.3% after mastectomy plus flap and implant (P < .001).
Additionally, the researchers found a significantly higher risk for SSI in women with bilateral vs. unilateral mastectomy, both with and without immediate reconstruction.
The NHSN estimates for SSIs are much lower, the researchers wrote, because the tracking system includes simpler procedures with inherently lower risks for infection within a single category of breast surgical procedures. Therefore, evaluating the risk for SSI by the type of breast operation should be taken into consideration.
“Our finding of variation in SSI incidence for mastectomy only compared to mastectomy with immediate reconstruction suggests that stratification of SSI rates by type of procedure is important,” Olsen and colleagues wrote. – by John Schoen
Disclosure: Olsen reports being a consultant for Merck, Pfizer and Sanofi Pasteur and receiving grant funding through Cubist Pharmaceuticals, Pfizer and Sanofi Pasteur for work outside of the study. The other researchers report no relevant financial disclosures.
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