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Breast Reconstruction with Tissue Expanders: Implementation of a Standardized Best-Practices Protocol to Reduce Infection Rates
Ibrahim Khansa, MD
Russell G Hendrick Jr, MD
Alison Shore, MD
Joseph Meyerson, MD
Maelee Yang, BS
James H. Boehmler IV, MD
The Ohio State University Wexner Medical Center
2014-03-15
Presenter: Ibrahim khansa, MD
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. This work entirely represents the original work of the resident
Director Name: Gregory D. Pearson, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background: Periprosthetic infections remain a frustrating and costly complication of breast reconstruction with tissue expanders. While some specific steps have been previously shown to reduce periprosthetic infections, no comprehensive protocol addressing all aspects of preoperative, intraoperative and postoperative patient management has been evaluated in the literature. Our goal was to evaluate the effectiveness of our comprehensive, best-practices protocol, at reducing periprosthetic infections.
Methods: A comprehensive, best-practices protocol was introduced and implemented in November 2010. All patients undergoing breast reconstruction using tissue expanders at our institution in the five years prior to the protocol, and in the two years after, were analyzed. Patient characteristics and surgical outcomes were analyzed.
Results: 305 patients underwent 456 tissue expander reconstructions in the five years prior to the introduction of the protocol, and 198 patients underwent 313 reconstructions in the two years after. Significantly fewer patients developed a periprosthetic infection after the introduction of the protocol (11.6% vs. 18.4%, p=0.042), and the number of infected tissue expanders trended towards a decrease (9.3% vs. 13.2%, p=0.097). On multivariate analysis, our protocol significantly reduced the odds of periprosthetic infection (OR=0.45, p=0.022). Predictors of infection included obesity (OR=2.01, p=0.045) and preoperative breast size larger than C cup (OR=2.83, p=0.006).
Conclusions: Our comprehensive, best-practices protocol allowed us to reduce the odds of tissue expander infections by 55% (OR=0.45, p=0.022). By analyzing our outcomes with this protocol, we were able to identify several potential areas of improvements that may help us lower our rate of infection further in the future.
