TABLE 3.
Methods and Surgical Site Infection (SSI) Incidence Rates by Mastectomy and Type of Reconstruction
| Reference | Time frame for surveillance | Definition of SSI | N patients | SSI n (%) |
|---|---|---|---|---|
| Mastectomy-only | ||||
| Olsen 2008 | 12 months | NHSN | 296 | 13 (4.4) |
| Mortenson 2004 | ND, mean 36 months follow up | ND | 66 | 3 (4.5) |
| Edwards 2014 | Until postoperative evaluation | NHSN, or clinical diagnosis of cellulitis | 425 | 31 (7.3) |
| Mastectomy plus implanta | ||||
| Olsen 2008 | 12 months | NHSN | 121 | 15 (12.4) |
| Cordeiro 2006 | 12 months | ND | 1,176 | 37 (3.1) |
| Sbitany 2009 | ND | Infection requiring implant removal | 100 | 7 (7.0) |
| Reish 2013 | At least 1 year | Erythema suspicious for infection, treated with intravenous antibiotics or implant removal | 1,241 | 94 (7.6) |
| Weichman 2013 | ND | Infection requiring oral antibiotics (minor) or hospital readmission and intravenous antibiotics (major) | 345 | 47 (8.6)b |
| McCullough 2014 | ND, median time to infection 29 days | NHSN | 378 | 48 (12.7) |
| Rundell 2014 | ND, mean follow up 12 months | Infection requiring oral antibiotics (minor) or hospitalization, intravenous antibiotics, or debridement (major) | 203 | 23 (11.3) |
| Crosby 2011 | ND, mean follow up 13 months | Erythema plus intravenous antibiotics | 334c | 20 (6.0) cancer breast 18 (5.4) prophylactic breast |
| Halvorson 2007 | At least 1 year | Infection requiring implant removal | 2,539 | 39 (1.5) |
| Mitchell 2013 | At least 1 year | ND | 103 | 9 (8.7) |
| Mastectomy plus TRAM flapd | ||||
| Olsen 2008 | 12 months | NHSN | 162 | 10 (6.2)e |
| Crosby 2011 | ND, mean follow up 13 months | Erythema plus intravenous antibiotics | 142c | 2 (1.4) cancer breast 3 ( 2.1) prophylactic breast |
| Bristol 2006 | ND | Cellulitis or purulent discharge plus antibiotics | 247 | 17 (6.9) |
| Meretoja 2007 | 5 years | ND | 151 | 5 (3.3) |
| Chun 2010 | At least 11 months, mean follow up 6 years | ND | 105 | 4 (3.8) breast 2 (1.9) donor site |
| Kim 2009 | At least 1 year, mean follow up 41 months | ND | 500 | 4 (0.8) breast 5 (1.0) donor site |
NOTE. ND, not described; NHSN, National Healthcare Safety Network; TRAM, Transverse Rectus Abdominis Myocutaneous.
a
Sbitany (2009), unclear if all implants were immediate reconstruction.
b
SSI and incidence is per breast (n=546) rather than per person (n=345).
c
All procedures were bilateral; SSI and incidence are per side (i.e., cancer side and prophylactic side).
d
Bristol (2006) and Chun (2010), not all TRAMs were immediate reconstruction.
e
10 infections at the person level; 6 breast SSI, 7 donor site SSI, 3 women had dual infections.