Body mass index impacts infection rates in immediate autogenous breast reconstruction
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PURPOSE: Risk of postoperative infection following breast cancer reconstruction warrants consideration of both classic and procedure-specific risk factors. We performed a retrospective chart review of patients with breast cancer over a 10-year period that underwent reconstructive surgery to identify factors that increase risk of postoperative infection. METHODS: Rates of postoperative infection were assessed in primary (immediate or delayed, alloplastic or autogenous) and secondary reconstructive procedures. Patient characteristics, surgical details, and cancer features were analyzed using two-sample t test and Fisher's exact test for continuous and categorical data, respectively. RESULTS: 456 procedures were performed on 264 patients with 29 cases of postoperative infection (6%). Infection was more likely to occur in earlier reconstructive procedures (p < 0.03). Overall, primary reconstructive procedures were associated with a higher infection rate (p = 0.005). Other associated risk factors included: autogenous reconstruction (p < 0.018), length of admission (p < 0.001) and immediate reconstruction (p = 0.01). Subgroup analysis revealed increased risk of infection with immediate autogenous reconstruction (p < 0.03). Furthermore, patients with greater body mass index (BMI) receiving immediate autogenous reconstruction had a greater risk of infection (p < 0.003). Factors unrelated to risk of infection included history of irradiation, smoking, cancer stage, tumor type and tumor size. CONCLUSIONS: Our findings suggest that risk of infection is higher in immediate autogenous reconstructions particularly when patients are overweight (BMI > 30). Our data do not support a relationship between infection and irradiation, features of cancer, or repeated reconstructive procedures. Prospective studies may be required to further validate these findings.
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