PRS AAPS Oral Proofs 2016
Indranil Sinha, MD,* Andrea Pusic, MD, MHS,† Edwin Wilkins, MD, MS,‡ Hyungjin Myra Kim, ScD,§ Jennifer B. Hamill, MPH,§ Xiaoxue Chen, MPH,§ Gretchen Guldbrandsen, BA,* Yoon S. Chun, MD*
From the *Brigham and Women’s Hospital, Boston, Mass.; †Memorial Sloan Kettering Cancer Center, New York, N.Y.; ‡University of Michigan Health System, Ann Arbor, Mich.; and §University of Michigan, Ann Arbor, Mich.
PURPOSE: Surgical site infection (SSI) can cause devastating reconstructive failure in implant-based breast reconstructions. Many large national database studies have offered insights into complication rates but only captured early outcomes within 30 days postoperatively. This study evaluates both early and late SSI in immediate implant-based reconstruction and identifies predictors.
METHODS: By using a multicenter, prospective cohort, 863 implant-based breast reconstructions in 525 patients were evaluated. Early SSI was defined as infection occurring postoperatively within 30 days and late SSI as new infection occurring 31 to 365 days postoperatively. Minor infection required oral antibiotics only, and major infection required hospitalization and/or surgical treatment. Direct-to-implant (DTI) patients had 1-year follow-up, and tissue expander (TE) patients had 1-year postexchange follow-up.
RESULTS: Among 733 TE and 130 DTI reconstructions, overall SSI rate for TE was 7.2% in first stage, 2.0% in second stage, and 10.8% for DTI. More than 50% to 86% of SSI complications occurred as late SSI. Multivariate analysis identified radiotherapy with TE [odds ratio (OR) = 4.1, P < 0.01], breast cancer (OR = 3.1, P = 0.02), and body mass index (OR = 1.1, P = 0.01) as significant predictors of late SSI.
CONCLUSIONS: The majority of SSI among implant-based reconstructions occur later than 30 days after both first- and second-stage procedures. Radiotherapy, breast cancer, and body mass index are significantly associated with late-onset SSI. Current studies limited to early complications may not present an accurate assessment of infection complications for implant-based reconstructions or their long-term outcomes.