Incidence of Surgical-Site Infection Is Not Affected by Method of Immediate Breast Reconstruction

Costa, Melinda A.; Rommer, Elizabeth; Perić, Miroslav; Nguyen, T. JoAnna; Shahabi, Ahva; Davis, Glenn M.; Vidar, Evan N.; Chan, Linda S.; Wong, Alex K.

doi:10.1097/prs.0b013e318290f87e

Cited by 15 publications

(8 citation statements)

References 17 publications

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“…The cumulative incidence of SSI within 180 days we found in this study was high compared to that reported by the National Surgical Improvement Project (NSQIP), 11;47 although the surveillance period to identify SSI is much shorter in NSQIP (30 days) and also shorter in the National Healthcare Safety Network surveillance system (30 days, 90 days with an implant). To avoid misclassification, we used ICD-9-CM diagnosis codes in our algorithm specific for SSI.…”

Section: Discussioncontrasting

confidence: 57%

Development of a Risk Prediction Model to Individualize Risk Factors for Surgical Site Infection After Mastectomy

et al. 2016

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Background Little data are available regarding individual patients’ risk of surgical site infection (SSI) following mastectomy with or without immediate reconstruction. Our objective was to develop a risk prediction model for mastectomy-related SSI. Methods We established a cohort of women < 65 years of age with mastectomy from 1/1/2004–12/31/2011 using commercial claims data. ICD-9-CM diagnosis codes were used to identify SSI within 180 days after surgery. SSI risk factors were determined with multivariable logistic regression using derivation data from 2004-2008 and validated with 2009–2011 data using discrimination and calibration measures. Results In the derivation cohort 595 SSIs were identified in 7,607 (7.8%) women, and 396 SSIs were coded in 4,366 (9.1%) women in the validation cohort. Independent risk factors for SSIs included rural residence, rheumatologic disease, depression, diabetes, hypertension, liver disease, obesity, preexisting pneumonia or urinary tract infection, tobacco use disorder, smoking-related diseases, bilateral mastectomy, and immediate reconstruction. Receipt of home health care was associated with lower risk. The model performed equally in the validation cohort per discrimination (C statistics 0.657 and 0.649) and calibration (Hosmer-Lemeshow P=0.091 and 0.462 for derivation and validation, respectively). Three risk strata were created based on predicted SSI risk, which demonstrated good correlation with the proportion of observed infections in the strata. Conclusions We developed and internally validated an SSI risk prediction model that can be used to counsel women concerning their individual risk of SSI post-mastectomy. Immediate reconstruction, diabetes, and smoking-related diseases were important risk factors for SSI in this nonelderly population of women undergoing mastectomy.

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Section: Discussioncontrasting

confidence: 57%

Development of a Risk Prediction Model to Individualize Risk Factors for Surgical Site Infection After Mastectomy

et al. 2016

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“…5 Mioton reported an SSI rate of 3.4% after mastectomy with immediate implant reconstruction from 2006–2010, 31 and Costa found that the SSI rate after immediate flap reconstruction was 4.9% using 2005–2009 NSQIP data. 32 …”

Section: Discussionmentioning

confidence: 99%

Incidence of Surgical Site Infection Following Mastectomy With and Without Immediate Reconstruction Using Private Insurer Claims Data

Olsen

Nickel

Fox

et al. 2015

Infect. Control Hosp. Epidemiol.

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Objective The National Healthcare Safety Network classifies breast operations as clean procedures with an expected 1–2% surgical site infection (SSI) incidence. We assessed differences in SSI incidence following mastectomy with and without immediate reconstruction in a large, geographically diverse population. Design Retrospective cohort study. Patients Commercially-insured women aged 18–64 years with ICD-9-CM procedure or CPT-4 codes for mastectomy from 1/1/2004–12/31/2011. Methods Incident SSIs within 180 days after surgery were identified by ICD-9-CM diagnosis codes. The incidence of SSI after mastectomy +/− immediate reconstruction was compared by the chi-square test. Results From 2004–2011, 18,696 mastectomy procedures among 18,085 women were identified, with immediate reconstruction in 10,836 (58%) procedures. The 180-day incidence of SSI following mastectomy with or without reconstruction was 8.1% (1,520/18,696). Forty-nine percent of SSIs were identified within 30 days post-mastectomy, 24.5% between 31–60 days, 10.5% between 61–90 days, and 15.7% between 91–180 days. The incidence of SSI was 5.0% (395/7,860) after mastectomy-only, 10.3% (848/8,217) after mastectomy plus implant, 10.7% (207/1,942) after mastectomy plus flap, and 10.3% (70/677) after mastectomy plus flap and implant (p<0.001). The SSI risk was higher after bilateral compared with unilateral mastectomy with (11.4% vs. 9.4%, p=0.001) and without (6.1% vs. 4.7%, p=0.021) immediate reconstruction. Conclusions SSI incidence was two-fold higher after mastectomy with immediate reconstruction than after mastectomy alone. Only 49% of SSIs were coded within 30 days after operation. Our results suggest stratification by procedure type will facilitate comparison of SSI rates after breast operations between facilities.

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“…This intuitively makes sense as patients with pre/intraoperative indications of compromised health status are more likely to experience postoperative complications that may require additional surgical attention. Specifically, the close correlation of BMI, preoperative open wound/wound infection, and advanced ASA class with post-operative complications, including infection, has been widely discussed in a diverse operating room environment [24][25][26][27][28][29][30][31]. A multi-centre review of 48,393 mastectomy cases by Nguyen et al [26] found that higher preoperative BMI and ASA class greater than 2 are significantly associated with increased risk of postoperative SSI [26].…”

Section: Discussionmentioning

confidence: 99%

Predictors and causes of unplanned re-operations in outpatient plastic surgery: a multi-institutional analysis of 6749 patients using the 2011 NSQIP database

Lim

Jordan

Jain

et al. 2014

Journal of Plastic Surgery and Hand Surgery

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Studies that evaluate the predictors and causes of unplanned re-operation in outpatient plastic surgery. This study retrospectively reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and identified all plastic surgery outpatient cases performed in 2011. Multiple logistic regression analysis was utilised to identify independent risk factors and causes of unplanned reoperations. Of the 6749 outpatient plastic surgery cases identified, there were 125 (1.9%) unplanned re-operations (UR). Regression analysis demonstrated that body mass index (BMI, OR = 1.041, 95% CI = 1.019-1.065), preoperative open wound/wound infection (OR = 3.498, 95% CI = 1.593-7.678), American Society of Anesthesiologists (ASA) class 3 (OR = 2.235, 95% CI = 1.048-4.765), and total work relative value units (RVU, OR = 1.014, 95% CI = 1.005-1.024) were significantly predictive of UR. Additionally, the presence of any complication was significantly associated with UR (OR = 15.065, 95% CI = 5.705-39.781). In an era of outcomes-driven medicine, unplanned re-operation is a critical quality indicator for ambulatory plastic surgery facilities. The identified risk factors will aid in surgical planning and risk adjustment.

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Incidence of Surgical-Site Infection Is Not Affected by Method of Immediate Breast Reconstruction

Abstract: Risk, III.

Cited by 15 publications

References 17 publications

Development of a Risk Prediction Model to Individualize Risk Factors for Surgical Site Infection After Mastectomy

Development of a Risk Prediction Model to Individualize Risk Factors for Surgical Site Infection After Mastectomy

Incidence of Surgical Site Infection Following Mastectomy With and Without Immediate Reconstruction Using Private Insurer Claims Data

Predictors and causes of unplanned re-operations in outpatient plastic surgery: a multi-institutional analysis of 6749 patients using the 2011 NSQIP database

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