Abstract P10: Reducing Infection Rates in Implant Based Breast Reconstruction

PURPOSE: Infection is the most significant complication in implant based breast reconstruction, potentially leading to reconstructive failure. We hypothesized that implementation of an evidence-based protocol marked by preoperative decolonization and sterility optimization would result in a decline in post-operative infection rates. METHODS: Informed by a literature review, we developed an evidence-based, peri-operative infection prevention protocol, implemented in 2015. Surgical outcomes were compared between patients who had undergone implant based breast reconstruction before and after protocol implementation. A Fisher’s exact test was used to compare infection rates before and after protocol implementation. A logistic regression analysis was modeled to evaluate the impact of the protocol on infection rate while controlling for non-modifiable risk factors. RESULTS: 358 breasts underwent reconstruction before protocol implementation and 135 afterwards. Patients were similar in terms of demographics and surgical characteristics. There was a significantly reduced incidence of clinically relevant infection after protocol implementation (10.1% to 2.9%, p= 0.009). Logistic regression analysis confirmed that the protocol was independently associated with a decrease in infection risk (OR 0.244, p=0.017). Post-protocol, no gram positive bacteria were isolated among cultures obtained from infected periprosthetic fluid. Radiation and drain duration greater than 21 days were independently associated with greater risk for infection. CONCLUSIONS: Our evidence-based protocol was associated with a significant decline in infection rates among implant based breast reconstruction patients, and was particularly effective for gram-positive infections. We will continue to employ this protocol in our practice, and will consider future directions for addressing gram negative infections as well.