Determinants of Clean Surgical Wound Infections for Breast Procedures at an Oncology Center

Abstract

Objective: To determine the clean surgical wound infection rate for breast procedures and the risk factors predisposing patients to these infections. Design: A survey study. Setting: Oncology center. Patients: A consecutive sample of adult female patients who underwent surgical breast procedures for suspected carcinoma of the breast. Patients undergoing excisional biopsy, lumpectomy, or mastectomy from January 1985 to January 1987 were included in the study. Intervention: Clean surgical wound infection rates were derived overall and for each procedure type. The medical records of all patients were then reviewed to extract data on patient characteristics and operative information in order to assess the risk factors for infection. Results: Among the breast procedures performed on 448 patients, the overall clean surgical wound infection rate was 8.7% (39/448). The clean surgical wound infection rate for each procedure type was as follows: biopsy 2.3%, lumpectomy 6.6%, and mastectomy 19%. In addition to the type of procedure, factors significantly (p>.05) associated with the development of clean surgical wound infection in the univariate analysis included: presence of surgical drains (p>.01); closed suction drainage (odds ratio [OR]= 16.5, 95% confidence interval [$CI_{95}$] = 5.0-54.7); location of the drain (OR=3.3, $CI_{95} = 1.7-6.6$); prolonged preoperative stay (OR= 1.2, $CI_{95} = 1.01.5$); length of surgery (OR= 2.2, $CI_{95} = 1.7-3.0$); and greater mean age (OR= 1.6, $CI_{95} = 1.2-2.1$). Conclusion: Clean surgical wound infections are not uncommon in patients undergoing breast procedures. Factors relating to both the patient and operative techniques contribute to the clean surgical wound infection rate. Further consideration should be given to perioperative antibiotic prophylaxis for selected breast procedures, and the role of surgical drains should be reassessed.