Breast Operations Trigger More Infections Than Previously Thought

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Main Category: Breast Cancer
Also Included In: Cancer / Oncology;  Infectious Diseases / Bacteria / Viruses;  Cosmetic Medicine / Plastic Surgery
Article Date: 22 Jan 2008 - 8:00 PDT

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A woman who undergoes breast surgery runs a one-in-twenty chance of developing an infection at the incision site, which will add approximately $4,000 to her hospital-related expenses, says an article in Archives of Surgery (JAMA/Archives), January issue.

The authors explained that infection rates at the incision site after the surgical removal of a breast (mastectomy) or 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," the authors wrote. "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 examined 949 hospital admissions for breast reconstruction surgeries or mastectomies at a teaching hospital between 1999 and 2002. The researchers looked at an electronic hospital database, and cross-checked that data with each patient's medical record, in order to identify surgical site infections. They also collected information from the hospital accounting database, which included all costs incurred during their initial hospital stay and surgeries, as well as any further admissions and surgeries which took place within twelve months of the first operation.

The researchers report that 5.3% of the women experienced a surgical site infection within one year of surgery - a total of 50 patients. The risk of infection was highest for breast cancer patients. The risks of infection at the incision site were as follows -

-- 12.4% of patients undergoing a mastectomy with immediate breast reconstruction using an implant

-- 6.2% of patients undergoing of mastectomies with immediate breast reconstruction using abdominal tissue

-- 4.4% of patients undergoing just a mastectomy

-- 1.1% of patients undergoing a breast reduction surgery

On average, those with an incision site infection became infected 46.6 days after surgery.

The researchers explained "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 found that the average extra cost for patients with surgical site infections was $4,091, after taking into account such factors as the type of operation, how far advanced their cancer was, plus some other variables.

They 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. 2008;143(1):53-60.
Click here to view abstract online

Written by - Christian Nordqvist
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