The effect of extra safety measures on incidence of surgical site infection after alloplastic breast reconstruction

Abstract

This study aimed to evaluate whether the implementation of extra perioperative safety measures and precautions through adopted standard operating procedures (SOPs) to ensure optimal anti-microbial conditions has led to less surgical site infections (SSI) after alloplastic breast reconstruction (BR). This retrospective study compared two Cohorts of patients treated before and after the implementation of new SOPs (2009-2014: Cohort 1 versus 2014-2019: Cohort 2). Multivariate logistic regression analyses, adjusting for patient confounders, were implemented to compare SSI incidence between both Cohorts. Overall, SSI incidence was equal in both groups (10%, p=0.545). The incidence of deep SSI was 9% for Cohort 1 and 5% for Cohort 2 (p=0.074). Incidence of SSI-related explantation was 8% and 5%, respectively (p=0.136). After adjusting for patient confounders, no statistically significant difference was seen between both Cohorts in overall SSI, deep SSI incidence, and explantation due to SSI (ORadjusted: -0.31, p=0.452, ORadjusted: 0.16, p=0.747 and ORadjusted: 0.18, p=0.712). Higher BMI, smoking, one-stage BR, and immediate BR were associated with the risk for SSI (p<0.001, p=0.036, p<0.001, and p=0.022, respectively). Extra safety measures to assure optimal anti-microbial conditions did not contribute to lower SSI incidence or SSI-related explantation after alloplastic BR. Confounders such as BMI, smoking, immediate BR, and one-stage BR were correlated to an increased risk for overall SSI, deep SSI, and SSI-related explantation of TE/implants.