Surgical Site Infections in Breast Surgery: Case-control Study

The purpose of this study was to estimate the frequency of surgical site infections (SSIs) and identify associated risk factors for each type of breast surgery at a cancer hospital. We used a nested case-control design. Between February 1, 2000 and July 31, 2000, all breast surgeries performed were recorded on a daily basis. After hospital discharge, we evaluated patients simultaneously with surgeons three times a week for 30 days or longer. The odds ratio (OR) was estimated using logistic regression analysis. The study followed 280 patients (298 wounds). Altogether, 77 SSIs were detected, for an overall SSI rate of 25.8% (77/298). For excisions, conservative surgery, and radical mastectomies the SSI rates were 1.4%, 18.0%, and 38.3%, respectively. Excisions were excluded (n = 68) for risk factor analysis. After multivariate analysis, risk factors associated with SSIs were obesity [OR 2.5, 95% confidence interval (CI) 1.2–4.3], concomitant chemotherapy and radiation (OR 2.3, 95% CI 1.2–4.3), radical surgery (OR 3.1, 95% CI 1.1–8.6), insertion of a second drain during the late postoperative period (OR 3.7, 95% CI 1.8–7.8), and drainage duration ≥ 19 days (OR 2.9, 95% CI 1.5–5.6). The bacteria most frequently isolated were Pseudomonas aeruginosa (n = 18), Serratia sp. (n = 18), Staphylococcus aureus (n = 10), and Staphylococcus epidermidis (n = 10). Poor compliance with infection control practices and wound management was detected throughout the study period. The overall frequency of SSIs for mastectomies was higher than the reported rates, which was principally related to the more radical surgery required for advanced-stage disease, preoperative irradiation, and inadequate wound and drain care.