Hostname: page-component-76fb5796d-22dnz Total loading time: 0 Render date: 2024-04-26T16:29:26.725Z Has data issue: false hasContentIssue false
  • English
  • Français

Incidence of Surgical Site Infection Following Mastectomy With and Without Immediate Reconstruction Using Private Insurer Claims Data

Published online by Cambridge University Press:  03 June 2015

Margaret A. Olsen ,
Katelin B. Nickel ,
Ida K. Fox ,
Julie A. Margenthaler ,
Kelly E. Ball ,
Daniel Mines ,
Anna E. Wallace  and
Victoria J. Fraser
Margaret A. Olsen*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
Katelin B. Nickel
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
Ida K. Fox
Affiliation:
Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
Julie A. Margenthaler
Affiliation:
Division of General Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
Kelly E. Ball
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
Daniel Mines
Affiliation:
HealthCore, Inc., Wilmington, Delaware
Anna E. Wallace
Affiliation:
HealthCore, Inc., Wilmington, Delaware
Victoria J. Fraser
Affiliation:
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
*
Address correspondence to Margaret A. Olsen, PhD, MPH, Division of Infectious Diseases, Campus Box 8051, Washington University, 660 S. Euclid Ave., St. Louis, MO 63110 (molsen@dom.wustl.edu).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

The National Healthcare Safety Network classifies breast operations as clean procedures with an expected 1%–2% surgical site infection (SSI) incidence. We assessed differences in SSI incidence following mastectomy with and without immediate reconstruction in a large, geographically diverse population.

DESIGN

Retrospective cohort study

PATIENTS

Commercially insured women aged 18–64 years with ICD-9-CM procedure or CPT-4 codes for mastectomy from January 1, 2004 through December 31, 2011

METHODS

Incident SSIs within 180 days after surgery were identified by ICD-9-CM diagnosis codes. The incidences of SSI after mastectomy with and without immediate reconstruction were compared using the χ2 test.

RESULTS

From 2004 to 2011, 18,696 mastectomy procedures among 18,085 women were identified, with immediate reconstruction in 10,836 procedures (58%). The incidence of SSI within 180 days following mastectomy with or without reconstruction was 8.1% (1,520 of 18,696). In total, 49% of SSIs were identified within 30 days post-mastectomy, 24.5% were identified 31–60 days post-mastectomy, 10.5% were identified 61–90 days post-mastectomy, and 15.7% were identified 91–180 days post-mastectomy. The incidences of SSI were 5.0% (395 of 7,860) after mastectomy only, 10.3% (848 of 8,217) after mastectomy plus implant, 10.7% (207 of 1,942) after mastectomy plus flap, and 10.3% (70 of 677) after mastectomy plus flap and implant (P<.001). The SSI risk was higher after bilateral compared with unilateral mastectomy with immediate reconstruction (11.4% vs 9.4%, P=.001) than without (6.1% vs 4.7%, P=.021) immediate reconstruction.

CONCLUSIONS

SSI incidence was twice that after mastectomy with immediate reconstruction than after mastectomy alone. Only 49% of SSIs were coded within 30 days after operation. Our results suggest that stratification by procedure type facilitates comparison of SSI rates after breast operations between facilities.

Infect Control Hosp Epidemiol 2015;36(8):907–914

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Supplement 8 , August 2015 , pp. 907 - 914
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Anderson, DJ, Pyatt, DG, Weber, DJ, Rutala, WA. Statewide costs of health care-associated infections: estimates for acute care hospitals in North Carolina. Am J Infect Control 2013;41:764–768.Google Scholar
2. Edwards, JR, Peterson, KD, Mu, Y, et al. National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control 2009;37:783–805.Google Scholar
3. National Healthcare Safety Network (NHSN) procedure-associated (PA) module: surgical site infection (SSI) event. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf. Published 2013. Accessed November 14, 2013.Google Scholar
4. Hall, JC, Hall, JL. The measurement of wound infection after breast surgery. Breast J 2004;10:412–415.Google Scholar
5. Olsen, MA, Chu-Ongsakul, S, Brandt, KE, Dietz, JR, Mayfield, J, Fraser, VJ. Hospital-associated costs due to surgical site infection after breast surgery. Arch Surg 2008;143:53–60.Google Scholar
6. Lankiewicz, JD, Yokoe, DS, Olsen, MA, et al. Beyond 30 days: does limiting the duration of surgical site infection follow-up limit detection? Infect Control Hosp Epidemiol 2012;33:202–204.Google Scholar
7. Warren, DK, Nickel, KB, Wallace, AE, Mines, D, Fraser, VJ, Olsen, MA. Can additional information be obtained from claims data to support surgical site infection diagnosis codes? Infect Control Hosp Epidemiol 2014;35(Suppl 3):S124–S132.Google Scholar
8. Nickel, KB, Wallace, AE, Warren, DK, Mines, D, Olsen, MA. Using claims data to perform surveillance for surgical site infection: the devil is in the details. In: Battles JB, Cleeman JI, Kahn KK, Weinberg DA, eds. Advances in the Prevention and Control of HAIs. Rockville, MD: Agency for Healthcare Research and Quality (US) Publication No. 14–0003; 2014.Google Scholar
9. Olsen, MA, Nickel, KB, Margenthaler, JA, et al. Increased risk of surgical site infection among breast-conserving surgery re-excisions. Ann Surg Oncol 2015;22:2003–2009.Google Scholar
10. Li, X, King, C, deGara, C, White, J, Winget, M. Validation of colorectal cancer surgery data from administrative data sources. BMC Med Res Methodol 2012;12:97.Google Scholar
11. Gao, X, Fisher, SG, Emami, B. Risk of second primary cancer in the contralateral breast in women treated for early-stage breast cancer: a population-based study. Int J Radiat Oncol Biol Phys 2003;56:1038–1045.Google Scholar
12. Nichols, HB, Berrington de, GA, Lacey, JV Jr, Rosenberg, PS, Anderson, WF. Declining incidence of contralateral breast cancer in the United States from 1975 to 2006. J Clin Oncol 2011;29:1564–1569.Google Scholar
13. Olsen, MA, Fraser, VJ. Use of diagnosis codes and/or wound culture results for surveillance of surgical site infection after mastectomy and breast reconstruction. Infect Control Hosp Epidemiol 2010;31:544–547.Google Scholar
14. Mortenson, MM, Schneider, PD, Khatri, VP, et al. Immediate breast reconstruction after mastectomy increases wound complications: however, initiation of adjuvant chemotherapy is not delayed. Arch Surg 2004;139:988–991.Google Scholar
15. Edwards, BL, Stukenborg, GJ, Brenin, DR, Schroen, AT. Use of prophylactic postoperative antibiotics during surgical drain presence following mastectomy. Ann Surg Oncol 2014;21:3249–3255.CrossRefGoogle ScholarPubMed
16. Cordeiro, PG, McCarthy, CM. A single surgeon’s 12-year experience with tissue expander/implant breast reconstruction: part I. A prospective analysis of early complications. Plast Reconstr Surg 2006;118:825–831.Google Scholar
17. Sbitany, H, Sandeen, SN, Amalfi, AN, Davenport, MS, Langstein, HN. Acellular dermis-assisted prosthetic breast reconstruction versus complete submuscular coverage: a head-to-head comparison of outcomes. Plast Reconstr Surg 2009;124:1735–1740.CrossRefGoogle ScholarPubMed
18. Reish, RG, Damjanovic, B, Austen, WG Jr, et al. Infection following implant-based reconstruction in 1952 consecutive breast reconstructions: salvage rates and predictors of success. Plast Reconstr Surg 2013;131:1223–1230.Google Scholar
19. 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.Google Scholar
20. McCullough, MC, Chu, CK, Duggal, CS, Losken, A, Carlson, GW. Antibiotic prophylaxis and resistance in surgical site infection after immediate tissue expander reconstruction of the breast. A nn Plast Surg 2014; Epub ahead of print.Google Scholar
21. Rundell, VL, Beck, RT, Wang, CE, et al. Complication prevalence following use of tutoplast-derived human acellular dermal matrix in prosthetic breast reconstruction: A retrospective review of 203 patients. J Plast Reconstr Aesthet Surg 2014;67:1345–1351.Google Scholar
22. Crosby, MA, Garvey, PB, Selber, JC, et al. Reconstructive outcomes in patients undergoing contralateral prophylactic mastectomy. Plast Reconstr Surg 2011;128:1025–1033.Google Scholar
23. Halvorson, EG, Disa, JJ, Mehrara, BJ, Burkey, BA, Pusic, AL, Cordeiro, PG. Outcome following removal of infected tissue expanders in breast reconstruction: a 10-year experience. Ann Plast Surg 2007;59:131–136.Google Scholar
24. Mitchell, RE. Porcine acellular dermis-assisted breast reconstruction: influence of adjuvant radiotherapy on complications and outcomes. Plast Reconstr Surg Glob Open 2013;1:e77.Google Scholar
25. Bristol, SG, Lennox, PA, Clugston, PA. A comparison of ipsilateral pedicled TRAM flap with and without previous irradiation. Ann Plast Surg 2006;56:589–592.Google Scholar
26. Meretoja, TJ, Rasia, S, von Smitten, KA, Asko-Seljavaara, SL, Kuokkanen, HO, Jahkola, TA. Late results of skin-sparing mastectomy followed by immediate breast reconstruction. Br J Surg 2007;94:1220–1225.Google Scholar
27. Chun, YS, Sinha, I, Turko, A, Lipsitz, S, Pribaz, JJ. Outcomes and patient satisfaction following breast reconstruction with bilateral pedicled TRAM flaps in 105 consecutive patients. Plast Reconstr Surg 2010;125:1–9.Google Scholar
28. Kim, EK, Eom, JS, Ahn, SH, Son, BH, Lee, TJ. Evolution of the pedicled TRAM flap: a prospective study of 500 consecutive cases by a single surgeon in Asian patients. Ann Plast Surg 2009;63:378–382.Google Scholar
29. de Blacam, C, Ogunleye, AA, Momoh, AO, et al. High body mass index and smoking predict morbidity in breast cancer surgery: a multivariate analysis of 26,988 patients from the national surgical quality improvement program database. Ann Surg 2012;255:551–555.Google Scholar
30. Nguyen, TJ, Costa, MA, Vidar, EN, et al. Effect of immediate reconstruction on postmastectomy surgical site infection. Ann Surg 2012;256:326–333.Google Scholar
31. Mioton, LM, Smetona, JT, Hanwright, PJ, et al. Comparing thirty-day outcomes in prosthetic and autologous breast reconstruction: a multivariate analysis of 13,082 patients? J Plast Reconstr Aesthet Surg 2013;66:917–925.Google Scholar
32. Costa, MA, Rommer, E, Peric, M, et al. Incidence of surgical-site infection is not affected by method of immediate breast reconstruction. Plast Reconstr Surg 2013;132:20e–29e.Google Scholar
33. Osman, F, Saleh, F, Jackson, TD, Corrigan, MA, Cil, T. Increased postoperative complications in bilateral mastectomy patients compared to unilateral mastectomy: an analysis of the NSQIP database. Ann Surg Oncol 2013;20:3212–3217.Google Scholar
34. Fischer, JP, Tuggle, CT, Au, A, Kovach, SJ. A 30-day risk assessment of mastectomy alone compared to immediate breast reconstruction (IBR). J Plast Surg Hand Surg 2014;48:209–215.Google Scholar
35. 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.Google Scholar
36. Pesce, CE, Liederbach, E, Czechura, T, Winchester, DJ, Yao, K. Changing surgical trends in young patients with early stage breast cancer, 2003 to 2010: a report from the National Cancer Data Base. J Am Coll Surg 2014;219:19–28.Google Scholar
37. Global surgery fact sheet. Centers for Medicare and Medicaid Services website. http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/GloballSurgery-ICN907166.pdf. Published 2013. Accessed November 14, 2013.Google Scholar
Supplementary material: File

Olsen supplementary material S1

Appendix

Download Olsen supplementary material S1(File)
File 20.6 KB