Infections following Immediate Implant-Based Breast Reconstruction: A Case-Control Study over 11 Years

Joseph Banuelos, M. Diya Sabbagh, Si Gyun Roh, Minh Doan T. Nguyen, Valerie Lemaine, Nho V. Tran, Steven R. Jacobson, Judy C. Boughey, James W. Jakub, Tina J. Hieken, Amy C. Degnim, Jay Mandrekar, Elie Berbari, Basel Sharaf

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Surgical-site infection after implant-based breast reconstruction adversely affects surgical outcomes and increases health care costs. This 11-year case-control study examines risk factors specific for surgical-site infection after immediate tissue expander/implant-based breast reconstruction. METHODS: The authors performed a retrospective review to identify all consecutive patients with breast implant infections between 2006 and 2016. Patients who developed surgical-site infection after immediate tissue expander/implant-based breast reconstruction were included. Surgical-site infection was defined using the Centers for Disease Control and Prevention criteria; specifically, infections requiring hospital admission, intravenous antibiotics, or surgical intervention were included. The authors matched a control patient to each infection case by patient age and date of surgery. Patient demographics, medical comorbidities, and perioperative surgical variables were examined. Univariate and multivariable conditional logistic regression models were constructed. RESULTS: A total of 270 breasts in 252 patients were evaluated. On multivariate analysis, patients with a higher body mass index (OR, 1.1 per 1 body mass index point increase; 95 percent CI, 1.0 to 1.2; p = 0.02), hypertension (OR, 6.5; 95 percent CI, 1.9 to 22.3; p = 0.002), neoadjuvant chemotherapy (OR, 2.6; 95 percent CI, 1.0 to 6.3; p = 0.04), axillary lymph node dissection (OR, 7.1; 95 percent CI, 1.7 to 29.2; p = 0.006), seroma formation (OR, 15.34; 95 percent CI, 3.7 to 62.5; p = 0.0001), and wound healing complications (OR, 23.91; 95 percent CI, 6.1 to 93.4; p < 0.0001) were significantly associated with surgical-site infection. CONCLUSIONS: Women with obesity, women with hypertension, and those treated with neoadjuvant chemotherapy are at increased risk of surgical-site infection. Further risks are also associated with postoperative seroma and wound complications. This may help patient selection and counseling, adjusted based on risk factors regarding complications of immediate implant-based breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Original languageEnglish (US)
Pages (from-to)1270-1277
Number of pages8
JournalPlastic and reconstructive surgery
Volume144
Issue number6
DOIs
StatePublished - Dec 1 2019

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Mammaplasty
Surgical Wound Infection
Case-Control Studies
Infection
Tissue Expansion Devices
Seroma
Body Mass Index
Logistic Models
Hypertension
Breast Implants
Drug Therapy
Centers for Disease Control and Prevention (U.S.)
Cross Infection
Lymph Node Excision
Health Care Costs
Wound Healing
Patient Selection
Comorbidity
Counseling
Breast

ASJC Scopus subject areas

  • Surgery

Cite this

Banuelos, J., Sabbagh, M. D., Roh, S. G., Nguyen, M. D. T., Lemaine, V., Tran, N. V., ... Sharaf, B. (2019). Infections following Immediate Implant-Based Breast Reconstruction: A Case-Control Study over 11 Years. Plastic and reconstructive surgery, 144(6), 1270-1277. https://doi.org/10.1097/PRS.0000000000006202

Infections following Immediate Implant-Based Breast Reconstruction : A Case-Control Study over 11 Years. / Banuelos, Joseph; Sabbagh, M. Diya; Roh, Si Gyun; Nguyen, Minh Doan T.; Lemaine, Valerie; Tran, Nho V.; Jacobson, Steven R.; Boughey, Judy C.; Jakub, James W.; Hieken, Tina J.; Degnim, Amy C.; Mandrekar, Jay; Berbari, Elie; Sharaf, Basel.

In: Plastic and reconstructive surgery, Vol. 144, No. 6, 01.12.2019, p. 1270-1277.

Research output: Contribution to journalArticle

Banuelos, J, Sabbagh, MD, Roh, SG, Nguyen, MDT, Lemaine, V, Tran, NV, Jacobson, SR, Boughey, JC, Jakub, JW, Hieken, TJ, Degnim, AC, Mandrekar, J, Berbari, E & Sharaf, B 2019, 'Infections following Immediate Implant-Based Breast Reconstruction: A Case-Control Study over 11 Years', Plastic and reconstructive surgery, vol. 144, no. 6, pp. 1270-1277. https://doi.org/10.1097/PRS.0000000000006202
Banuelos, Joseph ; Sabbagh, M. Diya ; Roh, Si Gyun ; Nguyen, Minh Doan T. ; Lemaine, Valerie ; Tran, Nho V. ; Jacobson, Steven R. ; Boughey, Judy C. ; Jakub, James W. ; Hieken, Tina J. ; Degnim, Amy C. ; Mandrekar, Jay ; Berbari, Elie ; Sharaf, Basel. / Infections following Immediate Implant-Based Breast Reconstruction : A Case-Control Study over 11 Years. In: Plastic and reconstructive surgery. 2019 ; Vol. 144, No. 6. pp. 1270-1277.
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abstract = "BACKGROUND: Surgical-site infection after implant-based breast reconstruction adversely affects surgical outcomes and increases health care costs. This 11-year case-control study examines risk factors specific for surgical-site infection after immediate tissue expander/implant-based breast reconstruction. METHODS: The authors performed a retrospective review to identify all consecutive patients with breast implant infections between 2006 and 2016. Patients who developed surgical-site infection after immediate tissue expander/implant-based breast reconstruction were included. Surgical-site infection was defined using the Centers for Disease Control and Prevention criteria; specifically, infections requiring hospital admission, intravenous antibiotics, or surgical intervention were included. The authors matched a control patient to each infection case by patient age and date of surgery. Patient demographics, medical comorbidities, and perioperative surgical variables were examined. Univariate and multivariable conditional logistic regression models were constructed. RESULTS: A total of 270 breasts in 252 patients were evaluated. On multivariate analysis, patients with a higher body mass index (OR, 1.1 per 1 body mass index point increase; 95 percent CI, 1.0 to 1.2; p = 0.02), hypertension (OR, 6.5; 95 percent CI, 1.9 to 22.3; p = 0.002), neoadjuvant chemotherapy (OR, 2.6; 95 percent CI, 1.0 to 6.3; p = 0.04), axillary lymph node dissection (OR, 7.1; 95 percent CI, 1.7 to 29.2; p = 0.006), seroma formation (OR, 15.34; 95 percent CI, 3.7 to 62.5; p = 0.0001), and wound healing complications (OR, 23.91; 95 percent CI, 6.1 to 93.4; p < 0.0001) were significantly associated with surgical-site infection. CONCLUSIONS: Women with obesity, women with hypertension, and those treated with neoadjuvant chemotherapy are at increased risk of surgical-site infection. Further risks are also associated with postoperative seroma and wound complications. This may help patient selection and counseling, adjusted based on risk factors regarding complications of immediate implant-based breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.",
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AU - Banuelos, Joseph

AU - Sabbagh, M. Diya

AU - Roh, Si Gyun

AU - Nguyen, Minh Doan T.

AU - Lemaine, Valerie

AU - Tran, Nho V.

AU - Jacobson, Steven R.

AU - Boughey, Judy C.

AU - Jakub, James W.

AU - Hieken, Tina J.

AU - Degnim, Amy C.

AU - Mandrekar, Jay

AU - Berbari, Elie

AU - Sharaf, Basel

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N2 - BACKGROUND: Surgical-site infection after implant-based breast reconstruction adversely affects surgical outcomes and increases health care costs. This 11-year case-control study examines risk factors specific for surgical-site infection after immediate tissue expander/implant-based breast reconstruction. METHODS: The authors performed a retrospective review to identify all consecutive patients with breast implant infections between 2006 and 2016. Patients who developed surgical-site infection after immediate tissue expander/implant-based breast reconstruction were included. Surgical-site infection was defined using the Centers for Disease Control and Prevention criteria; specifically, infections requiring hospital admission, intravenous antibiotics, or surgical intervention were included. The authors matched a control patient to each infection case by patient age and date of surgery. Patient demographics, medical comorbidities, and perioperative surgical variables were examined. Univariate and multivariable conditional logistic regression models were constructed. RESULTS: A total of 270 breasts in 252 patients were evaluated. On multivariate analysis, patients with a higher body mass index (OR, 1.1 per 1 body mass index point increase; 95 percent CI, 1.0 to 1.2; p = 0.02), hypertension (OR, 6.5; 95 percent CI, 1.9 to 22.3; p = 0.002), neoadjuvant chemotherapy (OR, 2.6; 95 percent CI, 1.0 to 6.3; p = 0.04), axillary lymph node dissection (OR, 7.1; 95 percent CI, 1.7 to 29.2; p = 0.006), seroma formation (OR, 15.34; 95 percent CI, 3.7 to 62.5; p = 0.0001), and wound healing complications (OR, 23.91; 95 percent CI, 6.1 to 93.4; p < 0.0001) were significantly associated with surgical-site infection. CONCLUSIONS: Women with obesity, women with hypertension, and those treated with neoadjuvant chemotherapy are at increased risk of surgical-site infection. Further risks are also associated with postoperative seroma and wound complications. This may help patient selection and counseling, adjusted based on risk factors regarding complications of immediate implant-based breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

AB - BACKGROUND: Surgical-site infection after implant-based breast reconstruction adversely affects surgical outcomes and increases health care costs. This 11-year case-control study examines risk factors specific for surgical-site infection after immediate tissue expander/implant-based breast reconstruction. METHODS: The authors performed a retrospective review to identify all consecutive patients with breast implant infections between 2006 and 2016. Patients who developed surgical-site infection after immediate tissue expander/implant-based breast reconstruction were included. Surgical-site infection was defined using the Centers for Disease Control and Prevention criteria; specifically, infections requiring hospital admission, intravenous antibiotics, or surgical intervention were included. The authors matched a control patient to each infection case by patient age and date of surgery. Patient demographics, medical comorbidities, and perioperative surgical variables were examined. Univariate and multivariable conditional logistic regression models were constructed. RESULTS: A total of 270 breasts in 252 patients were evaluated. On multivariate analysis, patients with a higher body mass index (OR, 1.1 per 1 body mass index point increase; 95 percent CI, 1.0 to 1.2; p = 0.02), hypertension (OR, 6.5; 95 percent CI, 1.9 to 22.3; p = 0.002), neoadjuvant chemotherapy (OR, 2.6; 95 percent CI, 1.0 to 6.3; p = 0.04), axillary lymph node dissection (OR, 7.1; 95 percent CI, 1.7 to 29.2; p = 0.006), seroma formation (OR, 15.34; 95 percent CI, 3.7 to 62.5; p = 0.0001), and wound healing complications (OR, 23.91; 95 percent CI, 6.1 to 93.4; p < 0.0001) were significantly associated with surgical-site infection. CONCLUSIONS: Women with obesity, women with hypertension, and those treated with neoadjuvant chemotherapy are at increased risk of surgical-site infection. Further risks are also associated with postoperative seroma and wound complications. This may help patient selection and counseling, adjusted based on risk factors regarding complications of immediate implant-based breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

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