Early Surgical Site Infection Following Tissue Expander Breast Reconstruction with or without Acellular Dermal Matrix: National Benchmarking Using National Surgical Quality Improvement Program원문보기
Winocour, Sebastian
(Division of Plastic Surgery, Department of Surgery, Mayo Clinic)
,
Martinez-Jorge, Jorys
(Division of Plastic Surgery, Department of Surgery, Mayo Clinic)
,
Habermann, Elizabeth
(Department of Health Sciences Research)
,
Thomsen, Kristine
(Department of Health Sciences Research)
,
Lemaine, Valerie
(Division of Plastic Surgery, Department of Surgery, Mayo Clinic)
Background Surgical site infections (SSIs) result in significant patient morbidity following immediate tissue expander breast reconstruction (ITEBR). This study determined a single institution's 30-day SSI rate and benchmarked it against that among national institutions participating in the American...
Background Surgical site infections (SSIs) result in significant patient morbidity following immediate tissue expander breast reconstruction (ITEBR). This study determined a single institution's 30-day SSI rate and benchmarked it against that among national institutions participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Methods Women who underwent ITEBR with/without acellular dermal matrix (ADM) were identified using the ACS-NSQIP database between 2005 and 2011. Patient characteristics associated with the 30-day SSI rate were determined, and differences in rates between our institution and the national database were assessed. Results 12,163 patients underwent ITEBR, including 263 at our institution. SSIs occurred in 416 (3.4%) patients nationwide excluding our institution, with lower rates observed at our institution (1.9%). Nationwide, SSIs were significantly more common in ITEBR patients with ADM (4.5%) compared to non-ADM patients (3.2%, P=0.005), and this trend was observed at our institution (2.1% vs. 1.6%, P=1.00). A multivariable analysis of all institutions identified age ${\geq}50$ years (odds ratio [OR], 1.4; confidence interval [CI], 1.1-1.7), body mass index ${\geq}30kg/m^2$ vs. < $25kg/m^2$ (OR, 3.4; CI, 2.6-4.5), and operative time >4.25 hours (OR, 1.9; CI, 1.5-2.4) as risk factors for SSIs. Our institutional SSI rate was lower than the nationwide rate (OR, 0.4; CI, 0.2-1.1), although this difference was not statistically significant (P=0.07). Conclusions The 30-day SSI rate at our institution in patients who underwent ITEBR was lower than the nation. SSIs occurred more frequently in procedures involving ADM both nationally and at our institution.
Background Surgical site infections (SSIs) result in significant patient morbidity following immediate tissue expander breast reconstruction (ITEBR). This study determined a single institution's 30-day SSI rate and benchmarked it against that among national institutions participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Methods Women who underwent ITEBR with/without acellular dermal matrix (ADM) were identified using the ACS-NSQIP database between 2005 and 2011. Patient characteristics associated with the 30-day SSI rate were determined, and differences in rates between our institution and the national database were assessed. Results 12,163 patients underwent ITEBR, including 263 at our institution. SSIs occurred in 416 (3.4%) patients nationwide excluding our institution, with lower rates observed at our institution (1.9%). Nationwide, SSIs were significantly more common in ITEBR patients with ADM (4.5%) compared to non-ADM patients (3.2%, P=0.005), and this trend was observed at our institution (2.1% vs. 1.6%, P=1.00). A multivariable analysis of all institutions identified age ${\geq}50$ years (odds ratio [OR], 1.4; confidence interval [CI], 1.1-1.7), body mass index ${\geq}30kg/m^2$ vs. < $25kg/m^2$ (OR, 3.4; CI, 2.6-4.5), and operative time >4.25 hours (OR, 1.9; CI, 1.5-2.4) as risk factors for SSIs. Our institutional SSI rate was lower than the nationwide rate (OR, 0.4; CI, 0.2-1.1), although this difference was not statistically significant (P=0.07). Conclusions The 30-day SSI rate at our institution in patients who underwent ITEBR was lower than the nation. SSIs occurred more frequently in procedures involving ADM both nationally and at our institution.
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문제 정의
Our goal was to determine the 30-day SSI rate of our institution among patients who underwent ITEBR with or without the use of ADM and to compare our institution’s rate to that of other institutions on a national level.
25 hours quartiles), focusing on the longest operations. The primary goal of this study was to assess the postoperative 30-day SSI rate. Three types of SSIs have been defined: superficial (limited to the skin and subcutaneous tissue), deep (involving deep tissues including fascia and muscle), and organ space (involving the surrounding organs) [8].
As a result, individual institutions are increasingly interested in benchmarking their outcomes against national standards in an attempt to improve quality of care and patient safety. This study aims to determine the 30-day SSI rate of a single institution and benchmark it against that among participating national institutions for quality improvement purposes.
제안 방법
Demographic, clinical, and procedural characteristics of patients who did and did not develop SSIs were compared using chisquare tests; Fisher’s exact tests were used when low expected cell counts were observed. Multivariable logistic regression was used to determine patient characteristics independently predictive of 30-day SSIs and to assess the difference in likelihood of SSIs at our institution compared to other institutions in the ACS-NSQIP database. Results were considered significant if P-values were less than 0.
Patient variables included age, body mass index (BMI) ( < 25, 25–29.9, and ≥ 30 kg/m2), smoking status, steroid use, diabetes mellitus, preoperative radiation, year of operation, and operative time ( > 4.25 hours vs. ≤ 4.25 hours quartiles), focusing on the longest operations.
The ACS-NSQIP program has developed a large, prospective, nationally validated, multi-institutional database that collects variables from patients undergoing inpatient and outpatient procedures at over 250 participating university and private hospitals. The variables analyzed in this study included patient demographics, preoperative comorbidities, intraoperative proceedings, and postoperative morbidities for the 30-day period after the procedure. The definitions of the variables collected by the ACS-NSQIP program can be found on their website [6].
대상 데이터
A total of 12,163 patients underwent ITEBR between 2005 and 2011, including 263 patients at our institution (Table 1). Over that period, ADM was used in 15.
데이터처리
Patient characteristics that resulted in a P < 0.05 in the univariate analysis or that were deemed to be clinically relevant were included in the multivariable logistic regression model as independent variables, with the SSI rate as the dependent variable.
성능/효과
After adjusting for clinical and procedural characteristics, our institutional SSI risk was lower than other institutions in the ACS-NSQIP database (OR, 0.4; CI, 0.2–1.1), although this difference was not statistically significant (P = 0.07) (Table 5).
This study has several limitations. First, this analysis was limited to 30-day outcomes and a potentially significant group of patients can present with SSIs more than 30 days after the operation. These patients may also have drains in place, theoretically increasing their risk of SSIs.
Several risk factors for SSIs were identified in this study, including increased BMI, age, and total operative time. Obesity is a well-established risk factor for surgical complications and wound healing.
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