Incidence of Surgical Site Infection Following Mastectomy With and Without Immediate Reconstruction Using Private Insurer Claims Data

• Published in: Infection control and hospital epidemiology 2015-08, Vol.36 (8), p.907-914
• Main Authors: Olsen, Margaret A, Nickel, Katelin B, Fox, Ida K, Margenthaler, Julie A, Ball, Kelly E, Mines, Daniel, Wallace, Anna E, Fraser, Victoria J
• Format: Article
• Language: English
• Subjects: Administrative Claims, Healthcare; Adolescent; Adult; Antibiotics; Breast cancer; Breast Implants - adverse effects; Breast Implants - statistics & numerical data; Breast surgery; Cellulitis; Female; Hospitals; Humans; Incidence; Insurance, Health; International Classification of Diseases; Mammaplasty - adverse effects; Mammaplasty - statistics & numerical data; Mastectomy; Mastectomy - adverse effects; Mastectomy - statistics & numerical data; Metastasis; Middle Aged; Nursing; Pathology; Retrospective Studies; Surgeons; Surgical Flaps - adverse effects; Surgical Flaps - statistics & numerical data; Surgical site infections; Surgical Wound Infection - epidemiology; Surgical Wound Infection - etiology; Surveillance; Time Factors; Transplants & implants; United States - epidemiology; Womens health; Young Adult
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1017/ice.2015.108

The National Healthcare Safety Network classifies breast operations as clean procedures with an expected 1%-2% surgical site infection (SSI) incidence. We assessed differences in SSI incidence following mastectomy with and without immediate reconstruction in a large, geographically diverse population. Retrospective cohort study. Commercially insured women aged 18-64 years with ICD-9-CM procedure or CPT-4 codes for mastectomy from January 1, 2004 through December 31, 2011 METHODS: Incident SSIs within 180 days after surgery were identified by ICD-9-CM diagnosis codes. The incidences of SSI after mastectomy with and without immediate reconstruction were compared using the χ2 test. From 2004 to 2011, 18,696 mastectomy procedures among 18,085 women were identified, with immediate reconstruction in 10,836 procedures (58%). The incidence of SSI within 180 days following mastectomy with or without reconstruction was 8.1% (1,520 of 18,696). In total, 49% of SSIs were identified within 30 days post-mastectomy, 24.5% were identified 31-60 days post-mastectomy, 10.5% were identified 61-90 days post-mastectomy, and 15.7% were identified 91-180 days post-mastectomy. The incidences of SSI were 5.0% (395 of 7,860) after mastectomy only, 10.3% (848 of 8,217) after mastectomy plus implant, 10.7% (207 of 1,942) after mastectomy plus flap, and 10.3% (70 of 677) after mastectomy plus flap and implant (P