Late Surgical Site Infection in Immediate Implant-Based Breast Reconstruction
Indranil Sinha, MD1, Andrea Pusic, MD, MHS2, Edwin Wilkins, MD, MS3, Hyungjin Myra Kim, Sc.D.4, Jennifer B. Hamill, MPH4, Xiaoxue Chen, MPH4, Gretchen Guldbrandsen, BA1, Yoon S. Chun, M.D.1.
1Brigham and Women's Hospital, Boston, MA, USA, 2Memorial Sloan Kettering Cancer Center, New York, NY, USA, 3University of Michigan Health System, Ann Arbor, MI, USA, 4University of Michigan, Ann Arbor, MI, USA.
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 capture early outcomes within 30-days post-operatively. This study evaluates both early and late SSI in immediate implant-based reconstruction and identifies predictors.
Using a multi-center, prospective cohort, 863 implant-based breast reconstructions in 525 patients were evaluated. Early SSI was defined as infection occurring post-operatively within 30 days and late SSI as new infection occurring 31-365 days post-operatively. Minor infection required oral antibiotics only, and major infection required hospitalization and/or surgical treatment. Direct-to-implant (DTI) patients had one-year follow-up, and tissue-expander (TE) patients had one-year post-exchange follow-up.
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. Over 50-86% of SSI complications occurred as late SSI (Figure 1). Multivariate analysis identified radiotherapy with TE (OR=4.1, p<0.01), breast cancer (OR=3.1, p=0.02), and BMI (OR=1.1, p=0.01) as significant predictors of late SSI.
The majority of SSI among implant-based reconstructions occur later than 30 days following both first and second-stage procedures. Radiotherapy, breast cancer, and BMI 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.
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