Risk of infection is associated more with drain duration than daily drainage volume in prosthesis-based breast reconstruction

Abstract

In prosthesis-based breast reconstruction, drains are used to prevent seroma formation and to reduce the risk of infection. However, prolonged drainage increases the risk of ascending infection. Although the volume often accepted for drain removal is ≤30 mL per day, the optimal timing to remove the drain for best clinical outcome remains controversial.We did a retrospective cohort study of 569 patients of prosthesis-based breast reconstruction with infection rate as the outcome variable; drain duration and last daily drainage volume as the main independent variables. Data on age, smoking history, diabetes mellitus history, body mass index, breast weight, tissue expander size, drain size, number of retrieved lymph nodes, tumor size, number of metastatic lymph nodes, tumor stage, mastectomy type, reconstruction type, submuscular implantation, skin defect, operative time, duration of antibiotics use, chemotherapy, and radiotherapy were collected as covariates. Multivariable logistic regression analysis was used to control for confounding.The total infection rate was 5.1% (29/569). The daily drainage volume ≥30 mL/d at the time of drain removal was not found associated with increased infection rate (P = 0.32). Of the various cutoff values of last daily drainage volume, none was found to be a determinant for drain removal where the risk of infection was concerned. By contrast, drain duration over 21 days significantly increased infection rate (P = 0.001). The multivariable logistic regression analysis showed an increase of 76.2% in the infection rate with each additional week of drain retention (P = 0.001). Breast weight also had a significant influence on risk of infection. Chemotherapy and drain size showed borderline effect on risk of infection whereas the last daily drainage volume was not associated with risk of infectionIn summary, our study revealed that drain duration, rather than the last daily drainage volume, significantly affects the infection rate in prosthesis-based breast reconstruction. We recommend that the drain is better removed no longer than 3 weeks postoperatively and can be removed as early as postoperative day 7, even when the drainage is over 30 mL in a 24-hour period.

Surveillance and Prevention of Surgical Site Infections in Breast Oncologic Surgery with Immediate Reconstruction

“…Risk factors identified repeatedly in multivariate analyses using institutional data or the most recent NSQIP data include obesity or increased body mass index (BMI),[38, 61–72] larger breast size,[21, 47, 66] diabetes[32, 61, 68, 69, 72, 73] or hyperglycemia,[74] smoking, [16, 42, 61, 67–69, 72, 73, 75–78] heavy alcohol use,[61, 79] older age,[16, 62, 74, 78], higher ASA score,[57, 69, 79] history of radiotherapy,[21, 42, 64, 77], duration of operation (mastectomy-only),[16, 62, 69], bilateral operation,[21, 68] and drain duration. [47, 80]. In studies that included all operations (with and without immediate reconstruction), implant[68, 77] or autologous flap[68] reconstruction were associated with increased risk of SSI.…”

Surgical site infection in immediate breast reconstruction: Does chemotherapy timing make a difference?

“…The low complication profile of immediate breast reconstruction following chemotherapy has been well documented . However, in other surgical fields, chemotherapy has been shown to adversely affect post‐operative outcomes, including delaying wound healing, and increasing susceptibility to infections . Despite this, within post‐mastectomy breast reconstruction, the impact of chemotherapy timing is less well‐characterized and there is a conflict in the literature as to whether timing of chemotherapy increases the risk of complications.…”

Surgeon’s preference of subcutaneous tissue resection: most important factor for short-term complications in subcutaneous implant placement after mastectomy—results of a cohort study

“…Several studies found a correlation between drain duration and infections. However, this influence could only be observed for a drain duration of 21 days or longer [33][34][35]. The drain duration of our study population was much shorter (Q1 5 days, Q3 8 days)-therefore, waiting a few more days before removing the drains is unlikely to cause significant more infections.…”