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DOES TYPE OF IMMEDIATE BREAST RECONSTRUCTION AFFECT SURGICAL SITE INFECTION?
Melinda A. Costa, MD, Joanna Nguyen, MD, Ahva Shahabi, MPH, Evan N. Vidar, MA, Gabrielle Davis, MD, Linda S. Chan, MPH, Alex K. Wong, MD.
University of Southern California, Los Angeles, CA, USA.

PURPOSE: To date, there is little data regarding whether type of immediate breast reconstruction affects the incidence of surgical site infection (SSI) in women undergoing mastectomy. Here, we examine how the risk of SSI may be affected by type of immediate reconstruction and seek to identify risk factors for SSI in patients undergoing immediate breast reconstruction.
METHODS: Using the National Surgical Quality Improvement Program (NSQIP) database, all female patients undergoing mastectomy, with or without immediate reconstruction, from 2005 - 2009 were identified. Only clean procedures were analyzed, excluding clean-contaminated, contaminated and dirty-infected procedures. Type of reconstruction was classified as implant, autologous, or latissimus based reconstruction. The latissimus group includes procedures consisting of latissimus flap(s) with or without implant(s). The primary outcome was incidence of SSI within 30 days of operation. Stepwise regression analysis was used to identify risk factors associated with SSI. Multivariate logistic regression analysis was used to determine risk of SSI among the various types of reconstruction while adjusting for risk factors associated with SSI.
RESULTS: A total of 41,208 patients underwent mastectomy during the study period; 8,650 had immediate breast reconstruction. 3.59% (95%CI: 3.19-4.03) of patients who underwent immediate reconstruction developed SSI compared with 2.45% (95% CI: 3.19-4.01) of patients who underwent mastectomy without immediate reconstruction. The incidence of SSI was 3.35% (95%CI: 2.92-3.83) in patients undergoing mastectomy and implant based reconstruction, 5.84% (95% CI: 4.45-7.56) in patients undergoing mastectomy and autologous based reconstruction, and 2.13% (95% CI: 1.05-3.80) in patients undergoing latissimus dorsi based reconstruction. After adjustment for risk factors, individuals in the autologous reconstruction groups were 31% more likely (OR: 1.31, 95% CI: 0.92-1.87, p<0.134) compared to individuals in the implant based reconstruction group. Patients who underwent latissimus based reconstruction were 50% less likely (OR=0.50, 95%CI: 0.27-0.93, p=0.029), to develop SSI compared to individuals in the implant based group. Statistically significant (p<0.2) independent risk factors for SSI include preoperative increased BMI (OR:1.46; CI:1.3-1.63, p<0.001), and ASA class 3 or greater (OR:1.47; CI:1.11-1.93, p=0.006), and increased operative time (OR:1.23; CI:1.01-1.49).
CONCLUSION: Immediate breast reconstruction is associated with a minimal increase in risk of SSI in women undergoing mastectomy. The risk of SSI among patients undergoing immediate reconstruction is highest among autologous and lowest among latissimus based methods of reconstruction. This information may be useful in discussing reconstructive options with patients and indicates a need to investigate reasons for these differences.
Disclaimer: American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.


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