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서울대학교병원

Int. J. Surg., Mar 15 2024, | https://doi.org/10.1097/JS9.0000000000001235 Dynamic insights into infection risk over time in two-stage implant-based breast reconstruction: a retrospective cohort study

Ha, Jeong Hyun MD, MS^a,b; Ahn, Seoin BS^c; Kim, Hong-Kyu MD, PhD^d; Lee, Han-Byoel MD, PhD^d,e,f; Moon, Hyeong-Gon MD, PhD^d,g; Han, Wonshik MD, PhD^d,e,f; Hong, Ki Yong MD, PhD^b; Chang, Hak MD, PhD^b,h; Lee, Gordon K. MD, FACSⁱ; Choi, Jinwook MD, PhD^a,j; Jin, Ung Sik MD, PhD^b,h

^aInterdisciplinary Program of Medical Informatics, Seoul National University College of Medicine, Seoul, South Korea

^bDepartment of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, South Korea

^cInterdisciplinary Program of Bioengineering, Seoul National University College of Medicine, Seoul, South Korea

^dDepartment of Surgery, Seoul National University Hospital, Seoul, South Korea

^eCancer Research Institute, Seoul National University, Seoul, South Korea

^fBiomedical Research Institute, Seoul National University Hospital, Seoul, South Korea

^gGenomic Medicine Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, South Korea

^hDepartment of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, South Korea

ⁱDivision of Plastic Surgery, Department of Surgery, Stanford University Medical Center, CA, USA

^jDepartment of Biomedical Engineering, Seoul National University College of Medicine, Seoul, South Korea

Jinwook Choi, Ung Sik Jin These two authors contributed equally to this work.

^*Corresponding authors: Jinwook Choi, Ung Sik Jin

Abstract

Background: Infections following postmastectomy implant-based breast reconstruction (IBR) can compromise surgical outcomes and lead to significant morbidity. This study aimed to discern the timing of infections in two-stage IBR and associated risk factors.

Method: A review of electronic health records was conducted on 1,096 breasts in 1,058 patients undergoing two-stage IBR at ** National University Hospital (2015-2020). Infections following the first-stage tissue expander (TE) insertion and second-stage TE exchange were analyzed separately, considering associated risk factors.

Results: Over a median follow-up of 53.5 months, infections occurred in 2.9% (32/1096) after the first stage and 4.1% (44/1070) after the second stage. Infections following the first-stage procedure exhibited a bimodal distribution across time, while those after the second-stage procedure showed a unimodal pattern. When analyzing risk factors for infection after the first-stage procedure, axillary lymph node dissection (ALND) was associated with early (≤7 weeks) infection, while both ALND and obesity were independent predictors of late (>7 weeks) infection. For infections following the second-stage procedure, obesity, postmastectomy radiotherapy, a history of expander infection, ALND, and the use of textured implants were identified as independent risk factors. Postmastectomy radiotherapy was related to non-salvaged outcomes after infection following both stages.

Conclusion: Infections following first and second-stage IBR exhibit distinct timelines reflecting different pathophysiology. Understanding these timelines and associated risk factors will inform patient selection for IBR and aid in tailored postoperative surveillance planning. These findings contribute to refining patient suitability for IBR and optimizing personalized postoperative care strategies.

논문정보

형식Research article
게재일2024년 03월 (BRIC 등록일 2024-03-26)
연구진국내(교신)+국외 연구진
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