Increased Risk of Surgical Site Infection Among Breast-Conserving Surgery Re-Excisions
Published Date:Oct 31 2014
Source:Ann Surg Oncol. 22(6):2003-2009.
Carcinoma, Ductal, Breast
Carcinoma, Intraductal, Noninfiltrating
Surgical Wound Infection
Pubmed Central ID:PMC4693603
Funding:5R01HS019713/HS/AHRQ HHS/United States
U54 CK000162/CK/NCEZID CDC HHS/United States
U54CK000162/CK/NCEZID CDC HHS/United States
To determine the risk of surgical site infection (SSI) after primary breast-conserving surgery (BCS) versus re-excision among women with carcinoma in situ or invasive breast cancer.
We established a retrospective cohort of women aged 18–64 years with ICD-9-CM procedure or CPT-4 codes for BCS from 6/29/2004–12/31/2010. Prior insurance plan enrollment of at least 180 days was required to establish the index BCS; subsequent re-excisions within 180 days were identified. SSIs occurring 2–90 days after BCS were identified by ICD-9-CM diagnosis codes. The attributable surgery was defined based on SSI onset compared to the BCS date(s). A chi-square test and generalized estimating equations model were used to compare the incidence of SSI after index and re-excision BCS procedures.
23,001 women with 28,827 BCS were identified; 23.2% of women had &gt;1 BCS. The incidence of SSI was 1.82% (418/23,001) for the index BCS and 2.44% (142/5,826) for re-excision BCS (p=0.002). The risk of SSI after re-excision remained significantly higher after accounting for multiple procedures within a woman (odds ratio 1.34, 95% confidence interval, 1.07–1.68).
Surgeons need to be aware of the increased risk of SSI after re-excision BCS compared to the initial procedure. Our results suggest that risk adjustment of SSI rates for re-excision would allow for better comparison of BCS SSI rates between institutions.
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