How can we improve surgical outcomes for women with breast cancer? 

Surgical site infections (SSI) following breast cancer surgery are not only costly, but impact the length and quality of recovery time for women. If we understand the risk factors, we can develop new interventions to prevent these infections.

Our study looks at these risk factors and outcomes of surgical site infection following breast cancer surgeries, including health-related quality of life and economic costs.

Methods
We used a prospective longitudinal cohort design to determine accurate incidence and risk factors for SSI within one year after breast-conserving surgery, mastectomy, and mastectomy with immediate reconstruction. Using inpatient and outpatient follow-up data, we measured the clinical outcomes of SSI, including consequent further surgical interventions, antibiotic administration, and development of antibiotic resistance. We also looked at the impact of SSI on overall health-related quality of life, depressive symptoms, and sexual functioning. We also assessed specific issues related to the healing breast incision.  We then quantified the costs of these infections using financial data obtained from inpatient hospitalizations and outpatient clinic visits. 

Findings
Women were more likely to experience a surgical site infection following breast surgery if the following occurred:

• insertion of a breast implant or tissue expander
• suboptimal prophylactic use of antibiotics
• mastectomy
• previous radiation to the chest
• current or recent smoking

In terms of cost, the attributable cost of these infections is just over $4,000 per patient. Because this only includes hospital-associated costs, we believe the true societal cost is underestimated.