Abstract
Surgical site infection in implant-based breast reconstruction is a complication with variable incidence reported in the literature. Due to potential loss of implant and reconstruction, it can have a strong psychological impact on patients. Background and objectives: This study aimed primarily at analyzing the current status of the surgical site infection (SSI), (type, time of onset, clinical presentation, pathogens and management) in patients who underwent implant-based breast reconstruction at our Breast Unit. Secondarily, we wanted to establish whether introduction of a new, updated evidence-based protocol for infection prevention can reduce SSI in implant-based breast reconstruction. Materials and Methods: A single-center retrospective study was performed primarily to evaluate the incidence and features of SSI after implant-based breast reconstruction from 2007 to 2020. In June 2020, a protocol for prevention of SSI in implant-based breast reconstruction was introduced in clinical practice. Secondarily, a data analysis of all patients who underwent implant-based breast reconstruction in compliance with this protocol was performed after preliminarily assessing its efficacy. Results: 756 women were evaluated after mastectomy and implant-based breast reconstruction for breast cancer. A total of 26 surgical site infections were detected. The annual incidence of SSI decreased over time (range 0–11.76%). Data relating to infections’ features, involved pathogens and implemented treatments were obtained. Since the introduction of the protocol, 22 patients have been evaluated, for a total of 29 implants. No early infections occurred. Conclusions: Surgical site infection rates at our Breast Unit are comparable to those reported in the literature. The SSI rates have shown a decreasing trend over the years. No SSI has occurred since the introduction of the prevention protocol for surgical site infection in June 2020.
Highlights
Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs) and a major cause of increased hospital stay and mortality
Prevention Protocol for SSIs involves a pre-operative phase, reported in Box 1, concerning MSSA/Methicillinresistant S. aureus (MRSA) screening (Methicillin-sensitive S. aureus); an intra-operative phase with several advices to observe during surgery, resumed in Box 2; and antibiotic therapy timing outlined in Box 3
SSI is clearly a significant surgical complication in implant-based breast reconstruction as it may lead to a longer hospital stay with increasing costs for the national health system, and it may result in the loss of reconstruction, a potentially devastating complication for the patient
Summary
Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs) and a major cause of increased hospital stay and mortality. SSI is a significant surgical complication in prosthetic breast reconstruction. The incidence reported in literature ranges from less than 1% up to 43% [1,2,3,4]. This variability can be explained by the absence of a unique definition, which could allow a diagnosis based on standardized criteria. According to the National Nosocomial Infection Surveillance System (NNIS), SSI is related to the surgical procedure and typically occurs within 30 days after surgery. In the case of implant-based breast reconstruction, this interval is prolonged to one year after surgery [5]. Three types of SSI are proposed by the Centers for Disease Control and Prevention (CDC): superficial incisional, deep incisional and organ and space SSI
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