Risk Factors and Risk Scoring Tool for Infection during Tissue Expansion in Tissue Expander and Implant Breast Reconstruction

Abstract

Tissue expander and implant (TE/I) breast reconstruction has been increasing recently. In TE/I breast reconstruction, infection leads to reconstruction failure and is the most serious complication. The infection rate was reported to be higher during the tissue expander period than the implant period. However, few studies have investigated the risk factors for infection during tissue expansion following TE/I breast reconstruction. The goal of this study was to identify risk factors for infection during tissue expansion in TE/I breast reconstruction and to develop a simple risk scoring tool for infection that can be used for clinical application. In this retrospective cohort study, 981 patients who received TE/I breast reconstruction were surveyed and analyzed at one of the main clinics performing TE/I breast reconstruction in Japan. Numerous potential risk factors were collected from the clinical charts. Multiple logistic regression analyses were used to identify risk factors for infection. To develop a risk scoring tool, we converted the coefficients of the identified predictors estimated in the multiple logistic regression analyses into simplified risk scores. We assessed the tool discrimination by drawing a receiver operating characteristic curve and calculating the area under the curve. Infection was noted in 47 patients (4.79%) during tissue expansion. In multiple logistic regression analyses, diabetes, repeated expander insertions, larger expander size (≥400 cc), postoperative hormone therapy before silicone implant surgery, preoperative chemotherapy, and nipple-sparing mastectomy were identified as risk factors for infection during expansion. The area under the curve of the risk scoring tool for infection was 0.734 (95% CI: 0.662-0.807). We have revealed risk factors and proposed a risk scoring tool for infection during tissue expansion in TE/I breast reconstruction. This study may contribute to the prevention and prediction of infection.

A single pre-operative antibiotic dose is as effective as continued antibiotic prophylaxis in implant-based breast reconstruction: A matched cohort study

“…Tissue expander size has been correlated directly with an increased risk of surgical site infection although there was no association in our study. 14 The greatest strength of our study is that it mirrored an experimental design despite being an observational study. The two surgical groups represented two arms of the experiment e one group undergoing limited aggressive infective preventions compared to the other group undergoing maximally aggressive infective prevention measures.…”

Patient determinants as independent risk factors for postoperative complications of breast reconstruction

“…It is well established that high body mass index (BMI) increases the risk for surgical complications and overall morbidity in all types of breast reconstructions, both implant-based and autologous (46)(47)(48)(49)(50)(51)(52)(53)(54). It is also well established that smoking has a negative influence on free flap breast reconstruction (6,45,(55)(56)(57)(58)(59), although some studies have failed to establish this relationship (4,(60)(61)(62).…”

“…It is also well established that smoking has a negative influence on free flap breast reconstruction (6,45,(55)(56)(57)(58)(59), although some studies have failed to establish this relationship (4,(60)(61)(62). The same seems to be true for implant-based reconstructions (16,35,44,(63)(64)(65), but not all studies can confirm these findings (52). Many studies show no relationship between age and risk for complications (45,57,(60)(61)(62)(66)(67)(68)(69)(70)(71), while other studies show that elderly patients have more risk (44,53,63).…”

“…Many studies show no relationship between age and risk for complications (45,57,(60)(61)(62)(66)(67)(68)(69)(70)(71), while other studies show that elderly patients have more risk (44,53,63). Diabetes has been associated with postoperative complications after autologous reconstruction, but the results after implantbased breast reconstruction are more conflicting (52,(72)(73)(74)(75). Patients with renal disease seem to be more prone to complications (75,76).…”

The Impact of Surgical Complications on Cancer Recurrence Rates: A Literature Review

“…Continuing antibiotic prophylaxis into the post-operative period may be beneficial in reducing post-operative wound infection [55]. Predictive risk-scoring tools are available to identify patients at risk of infection [56]. A fall in lymphocytes postoperatively may be predictive of complications and could merit consideration of antibiotics [57].…”