Chung Cyndi U, Wink Jason D, Nelson Jonas A, Fischer John P, Serletti Joseph M, Kanchwala Suhail K
Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
J Reconstr Microsurg. 2015 Jul;31(6):434-41. doi: 10.1055/s-0035-1548739. Epub 2015 Apr 24.
Surgical site infections (SSIs) are a costly complication, resulting in lower patient satisfaction and higher health care expenditures. Incidence varies widely in the literature by surgery type, yet few studies focus exclusively on autologous breast reconstruction, an increasingly common surgery. The aim of this study is to identify risk factors for SSIs in free flap breast reconstruction using the National Surgical Quality Improvement Program Database (NSQIP).
Patients undergoing breast reconstruction with any flap type were identified by Current Procedural Terminology codes in the NSQIP database. Patients with superficial or deep SSIs within 30 days of surgery were compared with controls by univariate analysis and multivariate logistic regression across various characteristics.
Overall, 2,899 patients undergoing autologous reconstruction were identified. Of these, 143 (4.9%) patients developed SSIs. Those who developed wound complications were more likely smokers (18.2 vs. 8.4%, p < 0.001) and diabetics (9.8 vs. 3.4%, p < 0.001) with hypertension (38.2 vs. 25.4%, p < 0.001) and pulmonary (4.5 vs. 1.3%, p = 0.01) history. SSIs occurred in patients with higher American Society of Anesthesiologists (p = 0.003) and the World Health Organization obesity (p < 0.001) classes. On multivariate regression, SSIs were significantly associated with smoking (odds ratio [OR] = 3.59, p < 0.001) and hypertension (OR = 1.86, p = 0.03).
This study demonstrates that patients who are active smokers or have hypertension are at the highest risk for SSIs. Preoperative identification and tailored postoperative management of these patients may decrease the incidence of this complication.
手术部位感染（SSIs）是一种代价高昂的并发症，会导致患者满意度降低和医疗保健支出增加。根据文献记载，其发病率因手术类型不同而有很大差异，但很少有研究专门关注自体乳房重建这一日益常见的手术。本研究的目的是利用国家外科质量改进计划数据库（NSQIP）确定游离皮瓣乳房重建中手术部位感染的风险因素。
通过NSQIP数据库中的当前手术操作术语代码识别接受任何皮瓣类型乳房重建的患者。对术后30天内发生浅表或深部手术部位感染的患者与对照组进行单因素分析和多因素逻辑回归分析，比较各种特征。
总体而言，共识别出2899例接受自体重建的患者。其中，143例（4.9%）患者发生了手术部位感染。发生伤口并发症的患者更可能是吸烟者（18.2%对8.4%，p＜0.001）、糖尿病患者（9.8%对3.4%，p＜0.001），有高血压病史（38.2%对25.4%，p＜0.001）和肺部疾病史（4.5%对1.3%，p = 0.01）。手术部位感染发生在麻醉医师协会分级较高（p = 0.003）和世界卫生组织肥胖分级较高（p＜0.001）的患者中。多因素回归分析显示，手术部位感染与吸烟（比值比[OR]=3.59，p＜0.001）和高血压（OR = 1.86，p = 0.03）显著相关。
本研究表明，当前吸烟者或患有高血压的患者发生手术部位感染的风险最高。对这些患者进行术前识别和针对性的术后管理可能会降低这种并发症的发生率。
