%0 Journal Article
%T Characterizing infections in prosthetic breast reconstruction: A validity assessment of national health databases.
%A Piper ML
%A Roussel LO
%A Koltz PF
%A Wang F
%A Singh K
%A Chin R
%A Sbitany H
%A Langstein HN
%J J Plast Reconstr Aesthet Surg
%V 70
%N 10
%D Oct 2017
%M 28619483
%F 3.022
%R 10.1016/j.bjps.2017.05.004
%X <B>BACKGROUND: </B>Current guidelines in the United States require reporting only the 30-day postoperative outcomes to standardized databases, including the National Surgical Quality Improvement Program (NSQIP). Thus, many breast implant-related complications go unreported in standard databases. We sought to characterize late periprosthetic infections following implant-based breast reconstruction.<BR><B>METHODS: </B>We conducted a retrospective analysis of all women who underwent expander/implant reconstruction from 2005 to 2014 at two institutions. All periprosthetic infections were identified and divided into early and late cohorts (≤30 days or >30 days). Infection was defined as any episode where antibiotics were initiated or a prosthetic device was explanted because of clinical evidence of the infection.<BR><B>RESULTS: </B>In the 1820 patients (2980 breasts) identified, 421 periprosthetic infections occurred (14%). Of these, 173 (41%) were early and 248 (59%) were late (mean time to infection = 66.4 ± 101.9 days). Patients with late infections were more likely to be current smokers or have diabetes than patients with early infections (p < 0.034 for both). Infections caused by gram-negative bacteria and antimicrobial-resistant strains of Staphylococcus were more common in the early infection group (p < 0.001 for both). Implant loss due to infection was more common in the late infection group (p = 0.037).<BR><B>CONCLUSIONS: </B>Late periprosthetic infections following implant-based breast reconstruction are underestimated in national outcome databases and have unique risk factors and microbiology compared to early infections. A system-level change in reevaluating and redefining a timeline for tracking and treating implant infections is necessary, given the substantial morbidity associated with, and frequency of, late periprosthetic infections.