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DOI: 10.5999/aps.2015.42.2.194
Early Surgical Site Infection Following Tissue Expander Breast Reconstruction with or without Acellular Dermal Matrix: National Benchmarking Using National Surgical Quality Improvement Program
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Background Surgical site infections (SSIs) result in significant patient morbidity following immediate tissue expander breast reconstruction (ITEBR). This study determined a single institution's 30-day SSI rate and benchmarked it against that among national institutions participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP).
Methods Women who underwent ITEBR with/without acellular dermal matrix (ADM) were identified using the ACS-NSQIP database between 2005 and 2011. Patient characteristics associated with the 30-day SSI rate were determined, and differences in rates between our institution and the national database were assessed.
Results 12,163 patients underwent ITEBR, including 263 at our institution. SSIs occurred in 416 (3.4%) patients nationwide excluding our institution, with lower rates observed at our institution (1.9%). Nationwide, SSIs were significantly more common in ITEBR patients with ADM (4.5%) compared to non-ADM patients (3.2%, P=0.005), and this trend was observed at our institution (2.1% vs. 1.6%, P=1.00). A multivariable analysis of all institutions identified age ≥50 years (odds ratio [OR], 1.4; confidence interval [CI], 1.1-1.7), body mass index ≥30 kg/m2 vs. <25 kg/m2 (OR, 3.4; CI, 2.6-4.5), and operative time >4.25 hours (OR, 1.9; CI, 1.5-2.4) as risk factors for SSIs. Our institutional SSI rate was lower than the nationwide rate (OR, 0.4; CI, 0.2-1.1), although this difference was not statistically significant (P=0.07).
Conclusions The 30-day SSI rate at our institution in patients who underwent ITEBR was lower than the nation. SSIs occurred more frequently in procedures involving ADM both nationally and at our institution.
This paper was presented at the Plastic Surgery Research Council on March 7-9, 2014 in New York, NY, USA.
Publikationsverlauf
Eingereicht: 16. August 2014
Angenommen: 18. November 2014
Artikel online veröffentlicht:
05. Mai 2022
© 2015. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)
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REFERENCES
- 1 Albornoz CR, Bach PB, Mehrara BJ. et al. A paradigm shift in U.S. Breast reconstruction: increasing implant rates. Plast Reconstr Surg 2013; 131: 15-23
- 2 Cemal Y, Albornoz CR, Disa JJ. et al. A paradigm shift in U.S. breast reconstruction: Part 2. The influence of changing mastectomy patterns on reconstructive rate and method. Plast Reconstr Surg 2013; 131: 320e-326e
- 3 Gurunluoglu R, Gurunluoglu A, Williams SA. et al. Current trends in breast reconstruction: survey of American Society of Plastic Surgeons 2010. Ann Plast Surg 2013; 70: 103-110
- 4 Fischer JP, Nelson JA, Serletti JM. et al. Peri-operative risk factors associated with early tissue expander (TE) loss following immediate breast reconstruction (IBR): a review of 9305 patients from the 2005-2010 ACS-NSQIP datasets. J Plast Reconstr Aesthet Surg 2013; 66: 1504-1512
- 5 Fischer JP, Sieber B, Nelson JA. et al. Comprehensive outcome and cost analysis of free tissue transfer for breast reconstruction: an experience with 1303 flaps. Plast Reconstr Surg 2013; 131: 195-203
- 6 ACS NSQIP. American College of Surgeons National Surgical Quality Improvement Program [Internet]. Chicago, IL: American College of Surgeons; 2014. cited 2014 Dec 9 Available from: https://www.acsnsqip.org/
- 7 Shiloach M, Frencher Jr SK, Steeger JE. et al. Toward robust information: data quality and inter-rater reliability in the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg 2010; 210: 6-16
- 8 American College of Surgeons. User guide for the 2011 participant use data file [Internet]. Chicago, IL: American College of Surgeons; 2012. cited 2014 Dec 9 Available from: https://site.acsnsqip.org/wp-content/uploads/2012/03/2011-User-Guide_Final.pdf
- 9 Spear SL, Parikh PM, Reisin E. et al. Acellular dermis-assisted breast reconstruction. Aesthetic Plast Surg 2008; 32: 418-425
- 10 Colwell AS, Damjanovic B, Zahedi B. et al. Retrospective review of 331 consecutive immediate single-stage implant reconstructions with acellular dermal matrix: indications, complications, trends, and costs. Plast Reconstr Surg 2011; 128: 1170-1178
- 11 Zienowicz RJ, Karacaoglu E. Implant-based breast reconstruction with allograft. Plast Reconstr Surg 2007; 120: 373-381
- 12 Kim JY, Davila AA, Persing S. et al. A meta-analysis of human acellular dermis and submuscular tissue expander breast reconstruction. Plast Reconstr Surg 2012; 129: 28-41
- 13 Ganske I, Verma K, Rosen H. et al. Minimizing complications with the use of acellular dermal matrix for immediate implant-based breast reconstruction. Ann Plast Surg 2013; 71: 464-470
- 14 Francis SH, Ruberg RL, Stevenson KB. et al. Independent risk factors for infection in tissue expander breast reconstruction. Plast Reconstr Surg 2009; 124: 1790-1796
- 15 Chun YS, Verma K, Rosen H. et al. Implant-based breast reconstruction using acellular dermal matrix and the risk of postoperative complications. Plast Reconstr Surg 2010; 125: 429-436
- 16 Pittet B, Montandon D, Pittet D. Infection in breast implants. Lancet Infect Dis 2005; 5: 94-106
- 17 Weichman KE, Wilson SC, Saadeh PB. et al. Sterile "ready-to-use" AlloDerm decreases postoperative infectious complications in patients undergoing immediate implant-based breast reconstruction with acellular dermal matrix. Plast Reconstr Surg 2013; 132: 725-736
- 18 Fischer JP, Nelson JA, Kovach SJ. et al. Impact of obesity on outcomes in breast reconstruction: analysis of 15,937 patients from the ACS-NSQIP datasets. J Am Coll Surg 2013; 217: 656-664
- 19 McCarthy CM, Mehrara BJ, Riedel E. et al. Predicting complications following expander/implant breast reconstruction: an outcomes analysis based on preoperative clinical risk. Plast Reconstr Surg 2008; 121: 1886-1892
- 20 Shermak MA, Chang D, Buretta K. et al. Increasing age impairs outcomes in breast reduction surgery. Plast Reconstr Surg 2011; 128: 1182-1187
- 21 Kaye KS, Schmit K, Pieper C. et al. The effect of increasing age on the risk of surgical site infection. J Infect Dis 2005; 191: 1056-1062
- 22 Procter LD, Davenport DL, Bernard AC. et al. General surgical operative duration is associated with increased risk-adjusted infectious complication rates and length of hospital stay. J Am Coll Surg 2010; 210: 60 5.e1-2
- 23 Manilich E, Vogel JD, Kiran RP. et al. Key factors associated with postoperative complications in patients undergoing colorectal surgery. Dis Colon Rectum 2013; 56: 64-71
- 24 Fogarty BJ, Khan K, Ashall G. et al. Complications of long operations: a prospective study of morbidity associated with prolonged operative time (> 6 h). Br J Plast Surg 1999; 52: 33-36