by Banuelos,
Joseph; Sabbagh, M. Diya; Roh, Si-Gyun; Nguyen, Minh-Doan T.; Lemaine, Valerie;
Tran, Nho V.; Jacobson, Steven R.; Boughey, Judy C.; Jakub, James W.; Hieken,
Tina J.; Degnim, Amy C.; Mandrekar, Jay; Berbari, Elie; Sharaf, Basel
Background: Surgical-site infection after implant-based breast reconstruction
adversely affects surgical outcomes and increases health care costs. This
11-year case-control study examines risk factors specific for surgical-site
infection after immediate tissue expander/implant-based breast reconstruction.
Methods: The authors performed a retrospective review to identify all
consecutive patients with breast implant infections between 2006 and 2016.
Patients who developed surgical-site infection after immediate tissue
expander/implant-based breast reconstruction were included. Surgical-site
infection was defined using the Centers for Disease Control and Prevention
criteria; specifically, infections requiring hospital admission, intravenous
antibiotics, or surgical intervention were included. The authors matched a
control patient to each infection case by patient age and date of surgery.
Patient demographics, medical comorbidities, and perioperative surgical
variables were examined. Univariate and multivariable conditional logistic
regression models were constructed. Results:
A total of 270 breasts in 252 patients were evaluated. On multivariate
analysis, patients with a higher body mass index (OR, 1.1 per 1 body mass index
point increase; 95 percent CI, 1.0 to 1.2; p = 0.02), hypertension (OR, 6.5; 95
percent CI, 1.9 to 22.3; p = 0.002), neoadjuvant chemotherapy (OR, 2.6; 95
percent CI, 1.0 to 6.3; p = 0.04), axillary lymph node dissection (OR, 7.1; 95
percent CI, 1.7 to 29.2; p = 0.006), seroma formation (OR, 15.34; 95 percent
CI, 3.7 to 62.5; p = 0.0001), and wound healing complications (OR, 23.91; 95
percent CI, 6.1 to 93.4; p < 0.0001) were significantly associated with
surgical-site infection.
Conclusions: Women with obesity, women with hypertension,
and those treated with neoadjuvant chemotherapy are at increased risk of
surgical-site infection. Further risks are also associated with postoperative
seroma and wound complications. This may help patient selection and counseling,
adjusted based on risk factors regarding complications of immediate
implant-based breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk,
III.
