Impact of Surgical Care Bundle on Surgical Site Infection After Non-Reconstructive Breast Cancer Surgery: A Single-Centre Retrospective Comparative Cohort Study

Overview

Journal Cancers (Basel)

Publisher MDPI

Specialty Oncology

Date 2023 Feb 11

PMID 36765876

Authors

Kian Chin

Fredrik Warnberg

Aniko Kovacs

Roger Olofsson Bagge

Affiliations

Soon will be listed here.

Abstract

Background: Surgical-site infections (SSIs) are the commonest cause of healthcare-related infections. Although a surgical care bundle (SCB), defined as a group of preventative measures, is effective in reducing SSIs, it has not been well documented in breast cancer surgery. We aimed to investigate the impact of SCB on SSI.

Methods: A single-centre retrospective comparative cohort study between 2016 and 2020 was carried out. An SCB including eight different measures was implemented in October 2018 at Sahlgrenska University Hospital, Sweden. Patients who underwent non-reconstructive breast cancer surgery were included for analysis. The primary endpoint was SSI within 30 days after surgery.

Results: Overall, 10.4% of patients (100/958) developed SSI. After SCB implementation, the overall SSI rate reduced from 11.8% to 8.9% ( = 0.15). The largest SSI rate reduction was seen in the subgroup that underwent breast conservation and sentinel lymph node biopsy (SLNB), from 18.8% to 9.8% ( = 0.01). In this multivariable analysis adjusting for patient and treatment factors, the implementation of SCB resulted in a statistically significant reduction in SSI risk (OR 0.63, 95% CI 0.40-0.99, = 0.04).

Conclusions: The implementation of a SCB could reduce the incidence of SSI in breast cancer surgery.

References

Lorentzen T, Heidemann L, Moller S, Bille C . Impact of neoadjuvant chemotherapy on surgical complications in breast cancer: A systematic review and meta-analysis. Eur J Surg Oncol. 2021; 48(1):44-52. DOI: 10.1016/j.ejso.2021.09.007. View

Weiser M, Gonen M, Usiak S, Pottinger T, Samedy P, Patel D . Effectiveness of a multidisciplinary patient care bundle for reducing surgical-site infections. Br J Surg. 2018; 105(12):1680-1687. PMC: 6190910. DOI: 10.1002/bjs.10896. View

Palubicka A, Jaworski R, Wekwejt M, Swieczko-Zurek B, Pikula M, Jaskiewicz J . Surgical Site Infection after Breast Surgery: A Retrospective Analysis of 5-Year Postoperative Data from a Single Center in Poland. Medicina (Kaunas). 2019; 55(9). PMC: 6780406. DOI: 10.3390/medicina55090512. View

Liu Z, Dumville J, Norman G, Westby M, Blazeby J, McFarlane E . Intraoperative interventions for preventing surgical site infection: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2018; 2:CD012653. PMC: 6491077. DOI: 10.1002/14651858.CD012653.pub2. View

Wolfhagen N, Boldingh Q, Boermeester M, de Jonge S . Perioperative care bundles for the prevention of surgical-site infections: meta-analysis. Br J Surg. 2022; 109(10):933-942. PMC: 10364698. DOI: 10.1093/bjs/znac196. View

de Boniface J, Szulkin R, Johansson A . Major surgical postoperative complications and survival in breast cancer: Swedish population-based register study in 57 152 women. Br J Surg. 2022; 109(10):977-983. PMC: 10364684. DOI: 10.1093/bjs/znac275. View

Tanner J, Kiernan M, Hilliam R, Davey S, Collins E, Wood T . Effectiveness of a care bundle to reduce surgical site infections in patients having open colorectal surgery. Ann R Coll Surg Engl. 2016; 98(4):270-4. PMC: 5226025. DOI: 10.1308/rcsann.2016.0072. View

Kesici U, Demirci M, Kesici S . Antimicrobial effects of local anaesthetics. Int Wound J. 2019; 16(4):1029-1033. PMC: 7948660. DOI: 10.1111/iwj.13153. View

Zhang P, Li C, Wu C, Jiao G, Yan F, Zhu H . Comparison of immediate breast reconstruction after mastectomy and mastectomy alone for breast cancer: A meta-analysis. Eur J Surg Oncol. 2016; 43(2):285-293. DOI: 10.1016/j.ejso.2016.07.006. View

10.

Onesti M, Carella S, Scuderi N . Effectiveness of antimicrobial-coated sutures for the prevention of surgical site infection: a review of the literature. Eur Rev Med Pharmacol Sci. 2018; 22(17):5729-5739. DOI: 10.26355/eurrev_201809_15841. View

11.

Adwall L, Pantiora E, Hultin H, Norlen O . Association of postoperative infection and oncological outcome after breast cancer surgery. BJS Open. 2021; 5(4). PMC: 8266532. DOI: 10.1093/bjsopen/zrab052. View

12.

Razavi B, Bazzaz B . A review and new insights to antimicrobial action of local anesthetics. Eur J Clin Microbiol Infect Dis. 2019; 38(6):991-1002. DOI: 10.1007/s10096-018-03460-4. View

13.

OConnor R, Kiely P, Dunne C . The relationship between post-surgery infection and breast cancer recurrence. J Hosp Infect. 2020; 106(3):522-535. DOI: 10.1016/j.jhin.2020.08.004. View

14.

Potter S, Trickey A, Rattay T, OConnell R, Dave R, Baker E . Therapeutic mammaplasty is a safe and effective alternative to mastectomy with or without immediate breast reconstruction. Br J Surg. 2020; 107(7):832-844. DOI: 10.1002/bjs.11468. View

15.

Abt N, Flores J, Baltodano P, Sarhane K, Abreu F, Cooney C . Neoadjuvant chemotherapy and short-term morbidity in patients undergoing mastectomy with and without breast reconstruction. JAMA Surg. 2014; 149(10):1068-76. PMC: 4352300. DOI: 10.1001/jamasurg.2014.1076. View

16.

Peled A, Sbitany H, Foster R, Esserman L . Oncoplastic mammoplasty as a strategy for reducing reconstructive complications associated with postmastectomy radiation therapy. Breast J. 2014; 20(3):302-7. DOI: 10.1111/tbj.12257. View

17.

Gallagher M, Jones D, Bell-Syer S . Prophylactic antibiotics to prevent surgical site infection after breast cancer surgery. Cochrane Database Syst Rev. 2019; 9:CD005360. PMC: 6953223. DOI: 10.1002/14651858.CD005360.pub5. View

18.

Edmiston Jr C, Daoud F, Leaper D . Is there an evidence-based argument for embracing an antimicrobial (triclosan)-coated suture technology to reduce the risk for surgical-site infections?: A meta-analysis. Surgery. 2013; 154(1):89-100. DOI: 10.1016/j.surg.2013.03.008. View

19.

Papa G, Frasca A, Renzi N, Stocco C, Pizzolato G, Ramella V . Protocol for Prevention and Monitoring of Surgical Site Infections in Implant-Based Breast Reconstruction: Preliminary Results. Medicina (Kaunas). 2021; 57(2). PMC: 7915384. DOI: 10.3390/medicina57020151. View

20.

Baker N, Brown O, Hart A, Danko D, Stewart C, Thompson P . Preventing Infection in Implant-based Breast Reconstruction: Evaluating the Evidence for Common Practices and Standardized Protocols. Plast Reconstr Surg Glob Open. 2022; 10(3):e4208. PMC: 8939924. DOI: 10.1097/GOX.0000000000004208. View