Katelin B Nickel1, Ida K Fox2, Julie A Margenthaler3, Anna E Wallace4, Victoria J Fraser1, Margaret A Olsen5. 1. Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, MO. 2. Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO. 3. Division of General Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO. 4. HealthCore, Inc., Wilmington, DE. 5. Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, MO; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO. Electronic address: molsen@dom.wustl.edu.
Abstract
BACKGROUND: Noninfectious wound complications (NIWCs) after mastectomy are not routinely tracked and data are generally limited to single-center studies. Our objective was to determine the rates of NIWCs among women undergoing mastectomy and assess the impact of immediate reconstruction (IR). STUDY DESIGN: We established a retrospective cohort using commercial claims data of women aged 18 to 64 years with procedure codes for mastectomy from January 2004 through December 2011. Noninfectious wound complications within 180 days after operation were identified by ICD-9-CM diagnosis codes and rates were compared among mastectomy with and without autologous flap and/or implant IR. RESULTS: There were 18,696 procedures (10,836 [58%] with IR) among 18,085 women identified. The overall NIWC rate was 9.2% (1,714 of 18,696); 56% required surgical treatment. The NIWC rates were 5.8% (455 of 7,860) after mastectomy only, 10.3% (843 of 8,217) after mastectomy plus implant, 17.4% (337 of 1,942) after mastectomy plus flap, and 11.7% (79 of 677) after mastectomy plus flap and implant (p < 0.001). Rates of individual NIWCs varied by specific complication and procedure type, ranging from 0.5% for fat necrosis after mastectomy only, to 7.2% for dehiscence after mastectomy plus flap. The percentage of NIWCs resulting in surgical wound care varied from 50% (210 of 416) for mastectomy plus flap, to 60% (507 of 843) for mastectomy plus implant. Early implant removal within 60 days occurred after 6.2% of mastectomy plus implant; 66% of the early implant removals were due to NIWCs and/or surgical site infection. CONCLUSIONS: The rate of NIWC was approximately 2-fold higher after mastectomy with IR than after mastectomy only. Noninfectious wound complications were associated with additional surgical treatment, particularly in women with implant reconstruction, and with early implant loss.
BACKGROUND: Noninfectious wound complications (NIWCs) after mastectomy are not routinely tracked and data are generally limited to single-center studies. Our objective was to determine the rates of NIWCs among women undergoing mastectomy and assess the impact of immediate reconstruction (IR). STUDY DESIGN: We established a retrospective cohort using commercial claims data of women aged 18 to 64 years with procedure codes for mastectomy from January 2004 through December 2011. Noninfectious wound complications within 180 days after operation were identified by ICD-9-CM diagnosis codes and rates were compared among mastectomy with and without autologous flap and/or implant IR. RESULTS: There were 18,696 procedures (10,836 [58%] with IR) among 18,085 women identified. The overall NIWC rate was 9.2% (1,714 of 18,696); 56% required surgical treatment. The NIWC rates were 5.8% (455 of 7,860) after mastectomy only, 10.3% (843 of 8,217) after mastectomy plus implant, 17.4% (337 of 1,942) after mastectomy plus flap, and 11.7% (79 of 677) after mastectomy plus flap and implant (p < 0.001). Rates of individual NIWCs varied by specific complication and procedure type, ranging from 0.5% for fat necrosis after mastectomy only, to 7.2% for dehiscence after mastectomy plus flap. The percentage of NIWCs resulting in surgical wound care varied from 50% (210 of 416) for mastectomy plus flap, to 60% (507 of 843) for mastectomy plus implant. Early implant removal within 60 days occurred after 6.2% of mastectomy plus implant; 66% of the early implant removals were due to NIWCs and/or surgical site infection. CONCLUSIONS: The rate of NIWC was approximately 2-fold higher after mastectomy with IR than after mastectomy only. Noninfectious wound complications were associated with additional surgical treatment, particularly in women with implant reconstruction, and with early implant loss.
Authors: C Andrew Salzberg; Andrew Y Ashikari; R Michael Koch; Elizabeth Chabner-Thompson Journal: Plast Reconstr Surg Date: 2011-02 Impact factor: 4.730
Authors: Randy B Miller; Gregory Reece; Stephen S Kroll; David Chang; Howard Langstein; Argyrios Ziogas; Geoffrey Robb; Gregory R D Evans Journal: Plast Reconstr Surg Date: 2007-01 Impact factor: 4.730
Authors: Cindy B Matsen; Babak Mehrara; Anne Eaton; Deborah Capko; Anastasia Berg; Michelle Stempel; Kimberly J Van Zee; Andrea Pusic; Tari A King; Hiram S Cody; Melissa Pilewskie; Peter Cordeiro; Lisa Sclafani; George Plitas; Mary L Gemignani; Joseph Disa; Mahmoud El-Tamer; Monica Morrow Journal: Ann Surg Oncol Date: 2015-07-21 Impact factor: 5.344
Authors: Akhil K Seth; Scott Persing; Caitlin M Connor; Armando Davila; Elliot Hirsch; Neil A Fine; John Y S Kim Journal: Ann Plast Surg Date: 2013-06 Impact factor: 1.539
Authors: Margaret A Olsen; Kelly E Ball; Katelin B Nickel; Anna E Wallace; Victoria J Fraser Journal: Infect Control Hosp Epidemiol Date: 2016-12-15 Impact factor: 3.254
Authors: Margaret A Olsen; Katelin B Nickel; Victoria J Fraser; Anna E Wallace; David K Warren Journal: Infect Control Hosp Epidemiol Date: 2017-07-03 Impact factor: 3.254
Authors: Oscar J Manrique; Ali Charafeddine; Amjed Abu-Ghname; Joseph Banuelos; Steven R Jacobson; Jorys Martinez-Jorge; Minh-Doan Nguyen; Christin Harless; Nho V Tran; Basel Sharaf; James W Jakub; Tina J Hieken; Amy C Degnim; Judy C Boughey Journal: Medicina (Kaunas) Date: 2019-08-14 Impact factor: 2.430
Authors: Margaret A Olsen; Katelin B Nickel; Ida K Fox; Julie A Margenthaler; Anna E Wallace; Victoria J Fraser Journal: JAMA Surg Date: 2017-09-20 Impact factor: 14.766