Methods: We used 2004–2011 commercial claims data to create a retrospective cohort of women aged 18-64 years with ICD-9-CM procedure or CPT-4 codes for mastectomy. Reconstruction at the time of mastectomy was considered immediate (IR); reconstruction > 7 days after mastectomy was considered delayed (DR). Follow-up reconstructive procedures in women who had IR were considered second-stage reconstruction (SSR). Incident SSIs ≤ 90 days post-mastectomy (± IR) and ≤ 90 days after DR or SSR were identified by ICD-9-CM diagnosis codes. We used χ2, McNemar's, or Kruskal-Wallis tests to examine associations with SSIs.
Results: 18,085 women with mastectomy were identified; of these, 10,464 (58%) had IR. The incidence of SSI after flap reconstruction was similar for mastectomy + IR-flap (9.3% [232/2,501]), DR-flap (10.6% [21/199]), and SSR-flap (9.5% [17/179], p=0.837). The incidence of SSI was higher for mastectomy + IR-implant (8.8% [700/7,963]) versus DR-implant (5.9% [25/424]; p=0.039) or SSR-implant in women whose initial surgery was mastectomy + IR-implant (3.3% [163/4,950]; p<0.001). Women with an SSI after mastectomy + IR had a greater number of subsequent breast procedures (e.g., any mastopexy, implant insertion) within 2 years than women without previous SSI (mean 1.7 vs. 1.2 procedures; p<0.001). Women with SSI after mastectomy + IR-implant were more likely to also have an SSI after SSR-implant than those without previous SSI (10.9% vs. 2.7%, p<0.001).
Conclusion: SSI after mastectomy + IR with implant was associated with subsequent infection after SSR and a larger number of additional breast procedures. SSI incidence was highest for immediate implant reconstruction and higher for implant DR compared to implant SSR. Identification of modifiable risk factors in patients with SSI after implant IR is needed to prevent SSI after future procedures. Select high risk patients may benefit from counseling to consider delayed rather than immediate implant reconstruction to decrease risk of SSI, particularly when adjuvant oncologic treatment is required.
M. A. Olsen,
I. K. Fox, None
A. E. Wallace, None
V. J. Fraser, None