Surgical Site Infections More Common Than Expected Following Breast Procedures

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Health Lover

http://www.sciencedaily.com/releases...0121164111.htm

ScienceDaily (Jan. 22, 2008) — Infections at the incision site
occurred in more than 5 percent of patients following breast surgery
and cost them more than $4,000 each in hospital-related expenses,
according to a new article.

Reported surgical site infection rates following mastectomy (surgical
removal of the breast) and other breast procedures range from 1
percent to 28 percent, according to background information in the
article. "Given the state of fiscal constraints within the U.S. health
care system, it is important to calculate the cost-effectiveness of
infection control interventions to justify their use from an economic
perspective," the authors write. "Cost-effectiveness analyses require
accurate estimates for the attributable costs of hospital-acquired
infections, which are lacking for surgical site infections."

Margaret A. Olsen, Ph.D., M.P.H., of the Washington University School
of Medicine, St. Louis, and colleagues studied 949 hospital admissions
for mastectomy or breast reconstruction procedures at a
university-affiliated hospital between 1999 and 2002. Surgical site
infections were identified in an electronic hospital database and
verified by review of medical records. Costs were taken from the
hospital accounting database and included those from the original
admission to the hospital for surgery as well as any readmissions
within one year of surgery.

Surgical site infections were identified in 50 women within one year
of surgery (5.3 percent). Infections were more common in patients
undergoing cancer-related procedures, and occurred following 12.4
percent of mastectomies with immediate breast reconstruction using an
implant; 6.2 percent of mastectomies with immediate breast
reconstruction using abdominal tissue; 4.4 percent of mastectomies
only and 1.1 percent of breast reduction surgeries. The average time
between surgery and infection diagnosis was 46.6 days.

"Patients with surgical site infections had significantly higher
hospital costs associated with surgery and during the one-year period
after surgery compared with uninfected patients, and they had a
significantly longer total length of hospital stay," the authors
write. After adjusting for the type of surgical procedure performed,
breast cancer stage and other variables that influence cost, the cost
of surgical site infections was $4,091 per patient.

"Potential interventions to reduce the incidence of surgical site
infections in this patient population include strategies to optimize
the timing and dosage of prophylactic antibiotics administered before
the surgical incision, glucose control in diabetic patients, promotion
of meticulous hand hygiene and strategies to promote timely removal of
drains, among others," the authors conclude. "Interventions to reduce
the incidence of surgical site infections following breast cancer
surgical procedures are essential to reduce not only morbidity in
these patient populations but also costs to the individuals and to
society."

Journal reference: Arch Surg. 2008;143[1]53-60.

This study was supported by an Epicenter Prevention Program
Cooperative Agreement from the Centers for Disease Control and
Prevention.