Increased Risk of Surgical Site Infection Among Breast-Conserving Surgery Re-excisions
- 334 Downloads
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.
KeywordsSurgical Site Infection Diagnosis Code Sentinel Lymph Node Dissection Surgical Site Infection Rate Surgical Site Infection Incidence
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.
- 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.Google Scholar
- 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.
- 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.
- 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.CrossRefPubMedGoogle 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.