Increased Risk of Surgical Site Infection Among Breast-Conserving Surgery Re-Excisions

Details

• Alternative Title:
  Ann Surg Oncol
• Personal Author:
  Olsen, Margaret A. ; Nickel, Katelin B. ; Margenthaler, Julie A. ; Wallace, Anna E. ; Mines, Daniel ; Miller, J. Philip ; Fraser, Victoria J. ; Warren, David K.
• Description:
  Purpose
  
  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.
  
  Methods
  
  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.
  
  Results
  
  23,001 women with 28,827 BCS were identified; 23.2% of women had >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).
  
  Conclusions
  
  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.
  
  
• Subjects:
  Adolescent Adult Article Breast Neoplasms Carcinoma, Ductal, Breast Carcinoma, Intraductal, Noninfiltrating Female Follow-Up Studies Humans Incidence Mastectomy, Segmental Middle Aged Missouri Neoplasm Invasiveness Neoplasm Staging Prognosis Reoperation Retrospective Studies Risk Factors Surgical Wound Infection Young Adult

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• Source:
  Ann Surg Oncol. 22(6):2003-2009.
• Pubmed ID:
  25358666
• Pubmed Central ID:
  PMC4693603
• Document Type:
  Journal Article
• Funding:
  5R01HS019713/HS/AHRQ HHS/United States ; U54 CK000162/CK/NCEZID CDC HHS/United States ; U54CK000162/CK/NCEZID CDC HHS/United States
• Volume:
  22
• Issue:
  6
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:fa681b0b81eee1eb26987055f932c6e8bc0422be414cf4e82063495bd51b2964
• Download URL:
  https://stacks.cdc.gov/view/cdc/37121/cdc_37121_DS1.pdf
• File Type:
  [PDF - 139.80 KB ]