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

• Published in: Annals of surgical oncology 2015-06, Vol.22 (6), p.2003-2009
• Main Authors: Olsen, Margaret A., Nickel, Katelin B., Margenthaler, Julie A., Wallace, Anna E., Mines, Daniel, Miller, J. Philip, Fraser, Victoria J., Warren, David K.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Breast Neoplasms - complications; Breast Neoplasms - surgery; Breast Oncology; Carcinoma, Ductal, Breast - complications; Carcinoma, Ductal, Breast - surgery; Carcinoma, Intraductal, Noninfiltrating - complications; Carcinoma, Intraductal, Noninfiltrating - surgery; Female; Follow-Up Studies; Humans; Incidence; Mastectomy, Segmental - adverse effects; Medicine; Medicine & Public Health; Middle Aged; Missouri - epidemiology; Neoplasm Invasiveness; Neoplasm Staging; Oncology; Prognosis; Reoperation; Retrospective Studies; Risk Factors; Surgery; Surgical Oncology; Surgical Wound Infection - epidemiology; Surgical Wound Infection - etiology; Young Adult
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-014-4200-x

Purpose The aim of this study was 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 International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure or Current Procedural Terminology, 4th edition (CPT-4) codes for BCS from 29 June 2004 to 31 December 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 with the BCS date(s). A χ 2 test and generalized estimating equations model were used to compare the incidence of SSI after index and re-excision BCS procedures. Results Overall, 23,001 women with 28,827 BCSs were identified; 23.2 % of women had more than one 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 with 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.