{Reference Type}: Journal Article
{Title}: Characterizing infections in prosthetic breast reconstruction: A validity assessment of national health databases.
{Author}: Piper ML;Roussel LO;Koltz PF;Wang F;Singh K;Chin R;Sbitany H;Langstein HN;
{Journal}: J Plast Reconstr Aesthet Surg
{Volume}: 70
{Issue}: 10
{Year}: Oct 2017
{Factor}: 3.022
{DOI}: 10.1016/j.bjps.2017.05.004
{Abstract}: <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.