Stopping Traffic: An Analysis of Number of Scrubbed Personnel and Infection in Implant-Based Breast Reconstruction.

BACKGROUND: Postoperative surgical site infection (SSI) is a devastating complication of implant-based breast reconstruction. Its occurrence may require additional hospitalization and ultimately necessitate prosthesis removal. The effect of foot traffic in the operating room has not yet been investigated within plastic surgery. OBJECTIVES: This study analyzed the influence of scrubbed and unscrubbed personnel on postoperative SSI in immediate implant-based breast reconstruction. METHODS: This was a retrospective review of 223 consecutive patients who underwent immediate implant-based reconstruction from 2015 to 2021 at the authors' institution. Patient demographics, comorbidities, smoking status, laterality, number of personnel, use of drains, and length of surgery were collected. The primary outcome assessed was surgical site infection with secondary outcomes of delayed wound healing, skin necrosis, hematoma, seroma, and reoperation within 90 days. RESULTS: Patients who had a postoperative SSI had a mean number of 8.7 scrubbed individuals, whereas those who did not have a postoperative SSI had a mean number of 7.9 individuals scrubbed (P < .05). Univariate analysis demonstrated that increasing number of scrubbed individuals was predictive of SSI (odds ratio [OR]: 1.239, CI: 1.064-1.444, P < .05). A multivariate logistic regression demonstrated increased likelihood of SSI with increasing number of individuals scrubbed (OR: 1.232, CI: 1.027-1.478, P < .05). CONCLUSIONS: This study demonstrates an increased risk of SSI in immediate, implant-based breast reconstruction with an increased number of personnel in the operative field. The findings highlight the importance of reducing foot traffic in the operating room when feasible to reduce risk of postoperative SSI and its associated morbidity.

Impact of Intraoperative Hypothermia on Autologous Breast Reconstruction.

OBJECTIVE: Studies have identified perioperative hypothermia as a risk factor for impaired wound healing, increased hospital length of stay, and surgical site infection. This study examines the effect of intraoperative hypothermia on postoperative outcomes in autologous microvascular free flap breast reconstruction. METHODS: This was a retrospective review of 55 patients who experienced intraoperative hypothermia, defined as less than 35.0°C core body temperature and 99 normothermic patients who underwent autologous-based microvascular free flap breast reconstruction from 2013 to 2021. Demographics, comorbidities, smoking status, intraoperative warming devices, type of autologous reconstruction, hypothermia (and its duration), and length of surgery were collected. The outcomes assessed were infection rate, reoperation within 90 days, skin necrosis, wound healing complications, hematoma, seroma, and readmission within 90 days. RESULTS: In the study population of 154 consecutive patients, 8.4% had type 1 or type 2 diabetes and 3.2% were current smokers. A total of 90.3% of patients (139) underwent deep inferior epigastric perforator flap reconstruction, 7.1% (11) superficial inferior epigastric artery flap reconstruction, and 4 (2.6%) another free flap type. A total of 35.7% of the patients (55) experienced intraoperative hypothermia defined as less than 35.0°C. In the hypothermic group, a higher proportion of patients had wound healing complications (52.7% vs 29.3%, P < 0.05), hematoma (16.4% vs 5.1%, P < 0.05), and readmission for postoperative complications (34.5% vs 14.1%, P < 0.05). There was also a trend toward higher incidence of seroma (7.3% vs 5.1%), surgical site infection (12.7% vs 9.1%), skin necrosis (12.7% vs 9.1%), and unplanned reoperation within 90 days (10.9% vs 7.1%). Further analysis via Firth logistic regression demonstrated intraoperative hypothermia predicted postoperative hematoma (odds ratio [OR], 3.68; 95% confidence interval [CI], 1.17-11.60; P < 0.05), readmission within 90 days (OR, 3.20; 95% CI, 1.45-7.08; P < 0.05), and wound healing complications (OR, 2.69; 95% CI, 1.36-5.33; P < 0.05). CONCLUSIONS: This study demonstrates that intraoperative hypothermia is a significant risk factor for postoperative wound healing complications, hematoma, and readmission within 90 days in autologous breast reconstruction. Because of a finite amount of donor sites, it is important to find ways to minimize the risk of postoperative complications. Our results support that maintaining strict normothermia during autologous breast reconstruction can significantly improve patient outcomes and reduce morbidity.