5% Of Breast Surgery Patients Become Infected At Incision Site

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Main Category: Breast Cancer
Also Included In: Women's Health / Gynecology;  Infectious Diseases / Bacteria / Viruses
Article Date: 21 Jan 2008 - 16:00 PDT

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5% of patients who undergo breast surgery have infections at the incision site and incur costs of over $4,000 in hospital-related expenses, according to an article in Archives of Surgery (JAMA/Archives), January issue.

The authors explain that reported infections at surgical sites following breast removals (mastectomies) and other breast procedures range from 1% to 28%. "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. 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., Washington University School of Medicine, St. Louis, and team looked at 94 hospital admissions for breast reconstruction or mastectomy at a teaching hospital during the period 1999-2002. They were able to count how many had surgical site infections by looking at the electronic hospital database and verifying by review of medical records. The hospital's accounting database was used to work out costs, which included those from the original hospital admission for surgery as well as any further readmission within 12 months of surgery.

5.3% (50) of the women had surgical site infections. The most common infections were for -

-- 12.4% of mastectomies with immediate breast reconstruction using an implant
-- 6.2% of mastectomies with immediate breast reconstruction using abdominal tissue
-- 4.4% of mastectomies only
-- 1.1% of breast reduction surgeries

There was an average period of 46.6 days between surgery and diagnosis of infection.

The researchers wrote "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." They worked out that the cost of surgical site infection per patient was $4,091, after adjusting for type of surgical procedure performed, breast cancer stage and other variables that might influence cost.

The authors concluded "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. 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."

"Hospital-Associated Costs Due to Surgical Site Infection After Breast Surgery"
Margaret A. Olsen, PhD, MPH; Sorawuth Chu-Ongsakul, MD, MSc, MHA; Keith E. Brandt, MD; Jill R. Dietz, MD; Jennie Mayfield, BSN, MPH, CIC; Victoria J. Fraser, MD
Arch Surg. Vol. 143 No. 1, January 2008
Click here to view abstract online

Written by - Christian Nordqvist
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