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Thirty Days of Reporting Is Not Enough: Late Periprosthetic Infections are More Frequent and Different than Early Ones
Lauren O. Roussel, BA1, Peter F. Koltz, MD1, Merisa Piper, MD2, Hani Sbitany, MD2, Howard N. Langstein, MD1.
1University of Rochester Medical Center, Rochester, NY, USA, 2University of California San Francisco, San Francisco, CA, USA.

PURPOSE:
Current guidelines only require reporting 30-day postoperative outcomes to standardized databases, including National Surgical Quality Improvement Program (NSQIP). Here we aim to define the scope and characteristics associated with development of late periprosthetic infections following implant-based breast reconstruction.
METHODS:
We conducted a retrospective analysis of all women undergoing expander or implant reconstruction from 2005-2014. Early (<30 days) and late (>30 days) infection was defined as any episode where antibiotic treatment was initiated, or a prosthetic device was explanted due to any clinical signs of infection.
RESULTS:
Of 1,820 patients and 2,980 breasts identified, 421 breast infections were present(14%). Of these infections, 173(41.1%) were early and 248(58.9%) were late (mean time to infection=66.4 days, range=1-1,023 days). Patients with late infections were more likely to have a history of adjuvant radiation therapy than patients with early infections(p<0.001). Infections caused by Gram negative bacteria and antimicrobial-resistant strains of Staphylococcus were significantly more common in the early infection group(p<0.002 for both) whereas antibiotic-sensitive Staphylococcus species were most common in the late infection group(37.9%). Invasive drainage was significantly associated with early infections(p =0.0363). Medical comorbidities, smoking status, BMI, ASA class, history of chemotherapy, oral or IV antibiotics, history of inciting events, and surgical history were unassociated with early or late infection.
CONCLUSIONS:
Late periprosthetic infections following implant-based breast reconstruction are common and underestimated in national outcome databases. They are different microbiologically than early infections. A system-level change in reevaluating and redefining a timeline for reporting and treating implant infections is necessary for complete reporting.


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