Reducing Infection Rates in Implant Based Breast Reconstruction: Impact of an Evidence-Based Protocol
Kasandra R. Hanna, MD1, Jessica Wang, BS2, Jenna Thuman, BS2, Idorenyin Ndem, BA2, Christine Schaeffer, MD2, Madeline Stovall, BS1, Alexandra Tilt, MD1, Andy Lee, MD1, David B. Drake, MD1, Kant Y. Lin, MD1, Christopher A. Campbell, MD2.
1University of Virginia, charlottesville, VA, USA, 2University of Virginia, Charlottesville, VA, USA.
PURPOSE: Infection is the most significant complication in implant based breast reconstruction, potentially leading to reconstructive failure. We hypothesized that implementation of an evidence-based protocol marked by preoperative decolonization and sterility optimization would result in a decline in post-operative infection rates.
METHODS: Informed by a literature review, we developed an evidence-based, peri-operative infection prevention protocol, implemented in 2015. Surgical outcomes were compared between patients who had undergone implant based breast reconstruction before and after protocol implementation. A Fisher’s exact test was used to compare infection rates before and after protocol implementation. A logistic regression analysis was modeled to evaluate the impact of the protocol on infection rate while controlling for non-modifiable risk factors.
RESULTS: 358 breasts underwent reconstruction before protocol implementation and 135 afterwards. Patients were similar in terms of demographics and surgical characteristics. There was a significantly reduced incidence of clinically relevant infection after protocol implementation (10.1% to 2.9%, p= 0.009). Logistic regression analysis confirmed that the protocol was independently associated with a decrease in infection risk (OR 0.244, p=0.017). Post-protocol, no gram positive bacteria were isolated among cultures obtained from infected periprosthetic fluid. Radiation and drain duration greater than 21 days were independently associated with greater risk for infection.
CONCLUSIONS: Our evidence-based protocol was associated with a significant decline in infection rates among implant based breast reconstruction patients, and was particularly effective
for gram-positive infections. We will continue to employ this protocol in our practice, and will consider future directions for addressing gram negative infections as well.
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