Annals of Surgical Oncology

, Volume 22, Issue 6, pp 2003–2009 | Cite as

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

  • Margaret A. Olsen
  • Katelin B. Nickel
  • Julie A. Margenthaler
  • Anna E. Wallace
  • Daniel Mines
  • J. Philip Miller
  • Victoria J. Fraser
  • David K. Warren
Breast Oncology



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.


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.


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).


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.


Surgical Site Infection Diagnosis Code Sentinel Lymph Node Dissection Surgical Site Infection Rate Surgical Site Infection Incidence 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



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.


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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Margaret A. Olsen
    • 1
    • 2
  • Katelin B. Nickel
    • 1
  • Julie A. Margenthaler
    • 3
  • Anna E. Wallace
    • 4
  • Daniel Mines
    • 4
  • J. Philip Miller
    • 5
  • Victoria J. Fraser
    • 1
  • David K. Warren
    • 1
  1. 1.Division of Infectious Diseases, Department of MedicineWashington University School of MedicineSt. LouisUSA
  2. 2.Division of Public Health Sciences, Department of SurgeryWashington University School of MedicineSt. LouisUSA
  3. 3.Division of General Surgery, Department of SurgeryWashington University School of MedicineSt. LouisUSA
  4. 4.HealthCore, IncWilmingtonUSA
  5. 5.Division of BiostatisticsWashington University School of MedicineSt. LouisUSA

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