Skip to main content

Advertisement

SpringerLink
Log in

Increased Risk of Surgical Site Infection Among Breast-Conserving Surgery Re-excisions

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to determine the risk of surgical site infection (SSI) after primary breast-conserving surgery (BCS) versus re-excision among women with carcinoma in situ or invasive breast cancer.

Methods

We established a retrospective cohort of women aged 18–64 years with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure or Current Procedural Terminology, 4th edition (CPT-4) codes for BCS from 29 June 2004 to 31 December 2010. Prior insurance plan enrollment of at least 180 days was required to establish the index BCS; subsequent re-excisions within 180 days were identified. SSIs occurring 2–90 days after BCS were identified by ICD-9-CM diagnosis codes. The attributable surgery was defined based on SSI onset compared with the BCS date(s). A χ 2 test and generalized estimating equations model were used to compare the incidence of SSI after index and re-excision BCS procedures.

Results

Overall, 23,001 women with 28,827 BCSs were identified; 23.2 % of women had more than one BCS. The incidence of SSI was 1.82 % (418/23,001) for the index BCS and 2.44 % (142/5,826) for re-excision BCS (p = 0.002). The risk of SSI after re-excision remained significantly higher after accounting for multiple procedures within a woman (odds ratio 1.34, 95 % confidence interval 1.07–1.68).

Conclusions

Surgeons need to be aware of the increased risk of SSI after re-excision BCS compared with the initial procedure. Our results suggest that risk adjustment of SSI rates for re-excision would allow for better comparison of BCS SSI rates between institutions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Jeevan R, Cromwell DA, Trivella M, et al. Reoperation rates after breast conserving surgery for breast cancer among women in England: retrospective study of hospital episode statistics. BMJ. 2012;345:e4505.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Jung W, Kang E, Kim SM, et al. Factors associated with re-excision after breast-conserving surgery for early-stage breast cancer. J Breast Cancer. 2012;15:412–19.

    Article  PubMed Central  PubMed  Google Scholar 

  3. McCahill LE, Single RM, Aiello Bowles EJ, et al. Variability in reexcision following breast conservation surgery. JAMA. 2012;307:467–75.

    Article  PubMed  Google Scholar 

  4. de Camargo CM, Comber H, Sharp L. Hospital and surgeon caseload are associated with risk of re-operation following breast-conserving surgery. Breast Cancer Res Treat. 2013;140:535–44.

    Article  Google Scholar 

  5. Waljee JF, Hu ES, Newman LA, Alderman AK. Predictors of re-excision among women undergoing breast-conserving surgery for cancer. Ann Surg Oncol. 2008;15:1297–303.

    Article  PubMed  Google Scholar 

  6. Leekha S, Sampathkumar P, Berry DJ, Thompson RL. Should national standards for reporting surgical site infections distinguish between primary and revision orthopedic surgeries? Infect Control Hosp Epidemiol. 2010;31:503–8.

    Article  PubMed  Google Scholar 

  7. Peersman G, Laskin R, Davis J, Peterson M. Infection in total knee replacement: a retrospective review of 6489 total knee replacements. Clin Orthop Relat Res. 2001;392:15–23.

    Article  PubMed  Google Scholar 

  8. Katz JN, Wright EA, Wright J, et al. Twelve-year risk of revision after primary total hip replacement in the U.S. Medicare population. J Bone Joint Surg Am. 2012;94:1825–32.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Kurtz SM, Lau E, Ong KL. et al. Infection risk for primary and revision instrumented lumbar spine fusion in the Medicare population. J Neurosurg Spine. 2012;17:342–47.

    Article  PubMed  Google Scholar 

  10. Ottino G, De PR, Pansini S, et al. Major sternal wound infection after open-heart surgery: a multivariate analysis of risk factors in 2,579 consecutive operative procedures. Ann Thorac Surg. 1987;44:173–9.

    Article  CAS  PubMed  Google Scholar 

  11. Ashraf M, Biswas J, Gupta S, Alam N. Determinants of wound infections for breast procedures: assessment of the risk of wound infection posed by an invasive procedure for subsequent operation. Int J Surg. 2009;7:543–6.

    Article  CAS  PubMed  Google Scholar 

  12. Teija-Kaisa A, Eija M, Marja S, Outi L. Risk factors for surgical site infection in breast surgery. J Clin Nurs. 2013;22:948–57.

    Article  PubMed  Google Scholar 

  13. Tran CL, Langer S, Broderick-Villa G, DiFronzo LA. Does reoperation predispose to postoperative wound infection in women undergoing operation for breast cancer? Am Surg. 2003;69:852–6.

    PubMed  Google Scholar 

  14. Nickel KB, Wallace AE, Warren DK, Mines D, Olsen MA. Using claims data to perform surveillance for surgical site infection: the devil is in the details. In: Battles JB, Cleeman JI, Kahn KK, Weinberg DA, eds. Advances in the prevention and control of HAIs. Rockville: Agency for Healthcare Research and Quality (US), publication no. 14-0003; 2014.

  15. Centers for Disease Control and Prevention. National Healthcare Safety Network (NHSN) procedure-associated (PA) module: surgical site infection (SSI) event. Atlanta: Centers for Disease Control and Prevention; 2013. http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf. Accessed 14 Nov 2013.

  16. Li X, King C, deGara C, White J, Winget M. Validation of colorectal cancer surgery data from administrative data sources. BMC Med Res Methodol. 2012;12:97.

    Article  PubMed Central  PubMed  Google Scholar 

  17. The Coding Institute. Pathology/lab coding alert: receive fair payment for physician interpretation of pap smear. Durham: The Coding Institute; 2001. http://www.cap.org/apps/docs/pathology_reporting/Enhance_Compliance_with_Chart_Audits.pdf. Accessed 25 Aug 2014.

  18. Olsen MA, Fraser VJ. Use of diagnosis codes and/or wound culture results for surveillance of surgical site infection after mastectomy and breast reconstruction. Infect Control Hosp Epidemiol. 2010;31:544–7.

    Article  PubMed Central  PubMed  Google Scholar 

  19. de Blacam C, Ogunleye AA, Momoh AO, et al. High body mass index and smoking predict morbidity in breast cancer surgery: a multivariate analysis of 26,988 patients from the National Surgical Quality Improvement Program database. Ann Surg. 2012;255:551–5.

    Article  PubMed  Google Scholar 

  20. Moran MS, Schnitt SJ, Giuliano AE, et al. Society of Surgical Oncology–American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Int J Radiat Oncol Biol Phys. 2014;88:553–64.

    Article  PubMed  Google Scholar 

  21. Centers for Medicare & Medicaid Services. Global surgery fact sheet. Centers for Medicare & Medicaid Services; 2013. http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/GloballSurgery-ICN907166.pdf. Accessed 14 Nov 2013.

  22. Olsen MA, Chu-Ongsakul S, Brandt KE, Dietz JR, Mayfield J, Fraser VJ. Hospital-associated costs due to surgical site infection after breast surgery. Arch Surg. 2008;143:53–60.

    Article  PubMed  Google Scholar 

  23. Angarita FA, Acuna SA, Torregrosa L, Tawil M, Escallon J, Ruiz A. Perioperative variables associated with surgical site infection in breast cancer surgery. J Hosp Infect. 2011;79:328–32.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgment

We thank Cherie Hill for database and computer management support. Funding for this project was provided by the Agency for Healthcare Research and Quality (AHRQ) Grant 5R01HS019713 to Margaret A. Olsen. Margaret A. Olsen, Victoria J. Fraser, and David K. Warren were also supported in part by Grant U54CK000162 from the Centers for Disease Control and Prevention (CDC). The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of the AHRQ or CDC.

Author information

Authors and Affiliations

  1. Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA

    Margaret A. Olsen PhD, MPH, Katelin B. Nickel MPH, Victoria J. Fraser MD & David K. Warren MD, MPH

  2. Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Margaret A. Olsen PhD, MPH

  3. Division of General Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Julie A. Margenthaler MD

  4. HealthCore, Inc, Wilmington, DE, USA

    Anna E. Wallace MPH & Daniel Mines MD, MSCE

  5. Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA

    J. Philip Miller AB

Authors
  1. Margaret A. Olsen PhD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Katelin B. Nickel MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Julie A. Margenthaler MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anna E. Wallace MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniel Mines MD, MSCE
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Philip Miller AB
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Victoria J. Fraser MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. David K. Warren MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Margaret A. Olsen PhD, MPH.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Olsen, M.A., Nickel, K.B., Margenthaler, J.A. et al. Increased Risk of Surgical Site Infection Among Breast-Conserving Surgery Re-excisions. Ann Surg Oncol 22, 2003–2009 (2015). https://doi.org/10.1245/s10434-014-4200-x

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-014-4200-x

Keywords

Search

Navigation