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Thirty Days of Reporting in Periprosthetic Breast Infections is Not Enough
Merisa Piper, MD1, Lauren Roussel, B.S.2, Peter F. Koltz, M.D.2, Frederick Wang, M.D.1, Kyra Singh, B.S.2, Robin Chin, B.S.1, Howard N. Langstein, M.D.2, Hani Sbitany, M.D.1.
1University of California, San Francisco, San Francisco, CA, USA, 2University of Rochester Medical Center, Rochester, NY, USA.

PURPOSE:
Current national databases, such as the National Surgical Quality
Improvement Program (NSQIP), only report 30-day postoperative outcomes. Thus, many breast implant related complications go unreported in standard databases. We sought to characterize late periprosthetic infections following implant-based breast reconstruction.
METHODS:
We conducted a retrospective analysis of all women undergoing
expander/implant breast reconstruction from 2005-2014 at two institutions. Periprosthetic infections were defined as any episode when antibiotics were initiated or when a prosthetic device was explanted due to infection, and they were classified as occurring early (≤ 30 days) or late (> 30 days).
RESULTS:
Of the 1,820 patients and 2,980 breasts identified, 421 periprosthetic
infections occurred (14%). Of these, 173 (41.1%) were early and 248 (58.9%) were late (mean time to infection = 66.4 ± 101.9 days). Patients with late infections were more likely to be current smokers or diabetics than patients with early infections (p <0.034 for both). Infections caused by Gram-negative bacteria and antimicrobial-resistant strains of Staphylococcus were more common in the early infection group (p <0.001 for both). Implant-loss due to infection was more common in the late infection group (p = 0.037).
CONCLUSION:
Late periprosthetic infections following implant-based breast reconstruction are underestimated in national outcome databases, and have unique risk factors and microbiology compared to early infections. A system-level change in reevaluating and redefining a timeline for tracking and treating implant infections is necessary given the substantial morbidity associated with, and frequency of, late periprosthetic infections.


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