Surgical Site Infections after Free Flap Breast Reconstruction: An Analysis of 2,899 Patients from the ACS-NSQIP Datasets

Chung, Cyndi U.; Wink, Jason D.; Nelson, Jonas A.; Fischer, John P.; Serletti, Joseph M.; Kanchwala, Suhail

doi:10.1055/s-0035-1548739

Cited by 31 publications

(22 citation statements)

References 16 publications

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“…With a more constricted definition of smoking, and with a larger study group, risk ratios may be higher. Our findings regarding the interrelation between smoking and microsurgical breast reconstruction are in keeping with prior results [5][6][7][8]11,12]. Together, these outcomes are helpful to improve preoperative patient information as to the risk involved in ex-smokers.…”

Section: Discussionsupporting

confidence: 85%

“…Over time there have been attempts to define risk factors for postoperative complications in order to better select patients suitable for DIEP reconstruction. The impacts of smoking and body mass index (BMI, kg/ m 2 ) on complication rates in reconstructive breast surgery have been described in several studies, but conclusions are not always congruent [3][4][5][6][7][8][9][10][11]. A clear association between smoking and postoperative wound infections after abdominoplasties has been described by Araco et al [12].…”

Section: Introductionmentioning

confidence: 99%

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Smoking increases donor site complications in breast reconstruction with DIEP flap

Klasson

Nyman

Svensson

et al. 2016

Journal of Plastic Surgery and Hand Surgery

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Smoking increases donor site complications in breast reconstruction with DIEP flap

Klasson

Nyman

Svensson

et al. 2016

Journal of Plastic Surgery and Hand Surgery

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“…9 Specifically, in autologous reconstructions, smoking is independently associated with wound complications and surgical site infections. 8,10 In our study, a history of smoking was independently associated with overall readmissions in the 0-to90-day postoperative period, in the 0-30-day readmission period and the 31-to 90-day readmission period. The OR for smoking and late readmissions was greater than in the early readmission group.…”

Section: Discussionsupporting

confidence: 46%

“…[3][4][5][6][7] Although the benefits of autologous reconstruction have been established, infection and wound complications have been cited to occur in 1 to 6% of patients, leading to morbidity and additional hospital costs. 2,[8][9][10][11] In both policy and research settings, the 30-day postoperative period has been emphasized when tracking complications of breast reconstruction. The application of this 30-day benchmark can be seen in the Hospital Readmissions Reduction Program that was established in 2012 in an attempt to combat the unacceptably high readmission rates of Medicare patients.…”

mentioning

confidence: 99%

A Nationwide Analysis of Early and Late Readmissions following Free Tissue Transfer for Breast Reconstruction

Magno-Padron

Collier

Kim

et al. 2020

J Reconstr Microsurg

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Background Traditionally, surgical quality outcomes are assessed using a 30-day postoperative window. For breast cancer patients undergoing free tissue transfer for breast reconstruction, we sought to describe the distribution of and specific risk factors for early and late readmissions within a 0- to 90-day postoperative period. Patients and Methods The Nationwide Readmissions Database was used to conduct a retrospective cohort study. Breast cancer patients undergoing free tissue transfer for breast reconstruction were identified using International Classification of Diseases -9 diagnosis and procedure codes. Ninety-day readmissions related to infection or wound complications were identified. Univariable and multivariable logistic regression models were used to identify patient risk factors for readmissions that occurred early (0–30 days) and late (31–90 days) after their index procedure. Results In the weighted sample, we identified approximately 7,305 free flap breast reconstructions and a surgical wound-related readmission rate of 4.3% (n = 312): 65.4% of the readmissions occurred early while 34.6% occurred late after surgery. The mean days to readmission was 26, and 75% of all readmissions occurred within the first 36 days after surgery. Variables independently associated with readmissions during the 0- to 90-day postoperative period included: history of chronic obstructive pulmonary disease (p = 0.036), hypertension (p = 0.03), obesity (p ≤ 0.001), and history of smoking (p = 0.004). The variables independently associated with the early readmission period were the same as those identified for the 0- to 90-day postoperative period. The variables independently associated with late readmissions were different: history of depression (p = 0.001) and history of smoking (p = 0.001). Conclusion The conventional 30-day hospital readmission rate classically used as a quality metric is overlooking a significant portion of admissions after free flap-based breast reconstruction. Different variables were found to be associated with readmission in the early versus late cohorts. Interventions targeting these variables could decrease readmissions and their associated costs.

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“…Smoking is established to increase complication rates in breast surgery (5,(31)(32)(33)(34)(35)(36). In a prospective study published by Matsen et al (33) examining skin flap necrosis rates following any mastectomy with reconstruction, 14% of patients had some level of skin flap necrosis (33).…”

Section: Discussionmentioning

confidence: 99%

Nipple-sparing mastectomies: Clinical outcomes from a single academic institution

Dull

Conant

Myckatyn

et al. 2017

Molecular and Clinical Oncology

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Abstract. Nipple-sparing mastectomies (NSMs) are increasingly used in the surgical treatment of patients with breast cancer and for prevention of breast cancer. The present study was performed to review the outcomes of patients undergoing NSMs at a single large university setting. A retrospective chart review was performed on all patients undergoing NSMs from 2008-2014. Charts were reviewed for demographic data and patient characteristics. Tumor and breast size, cancer recurrence and complications were also evaluated. Descriptive statistics were utilized to summarize the findings. From 2008From -2014 NSMs. The mean patient age was 44.4 years (range, 20-77). The average body mass index was 24 (range, 18-47). Breast weight was available for 106 specimens, with a mean weight of 475.5 g (range, 124.1-1,625.0 g). Seventy-three NSMs were performed for cancer and 124 were performed prophylactically. The mean tumor width was 1.38 cm (range, 0-6.0 cm), with an average nipple to tumor distance of 5.87 cm (range, 2.93-10.0 cm). Three (4%) patients required removal of the nipple areolar complex (NAC) due to pathological extension of the tumor. A total of 34 (17.2%) complications occurred, including infections, hematomas and nipple necrosis, with 9 requiring removal of the NAC and 13 requiring removal of the tissue expander or implant. Smokers had a 36.0% (9/25) complication rate, compared with 14.5% (25/172) of nonsmokers (P<0.05). During follow-up, one recurrence was noted, located on the chest wall. There were no recurrences in the NAC group. Therefore, NSMs may safely be performed without compromising oncologic outcomes or increasing complication rates in properly selected patients.

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Surgical Site Infections after Free Flap Breast Reconstruction: An Analysis of 2,899 Patients from the ACS-NSQIP Datasets

Abstract: This study demonstrates that patients who are active smokers or have hypertension are at the highest risk for SSIs. Preoperative identification and tailored postoperative management of these patients may decrease the incidence of this complication.

Cited by 31 publications

References 16 publications

Smoking increases donor site complications in breast reconstruction with DIEP flap

Smoking increases donor site complications in breast reconstruction with DIEP flap

A Nationwide Analysis of Early and Late Readmissions following Free Tissue Transfer for Breast Reconstruction

Nipple-sparing mastectomies: Clinical outcomes from a single academic institution

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